title: Excessive mood elevation and behavioral activation with antidepressant treatment of juvenile depressive and anxiety disorders: a systematic review.
abstract: BACKGROUND
  The prevalence, characteristics and implications of excessive arousal-activation in children and adolescents treated with antidepressants for specific illnesses have not been systematically examined.
  
  
  METHODS
  We compared reports of antidepressant trials (n = 6,767 subjects) in juvenile depressive (n = 17) and anxiety disorders (n = 25) for consensus-based indications of psychopathological mood elevation or behavioral activation.
  
  
  RESULTS
  Rates of excessive arousal-activation during treatment with antidepressants were at least as high in juvenile anxiety (13.8%) as depressive (9.79%) disorders, and much lower with placebos (5.22 vs. 1.10%, respectively; both p < 0.0001). The antidepressant/placebo risk ratio for such reactions in paired comparisons was 3.50 (12.9/3.69%), and the meta-analytically pooled rate ratio was 1.7 (95% confidence interval: 1.2-2.2; both p ≤ 0.001). Overall rates for 'mania or hypomania', specifically, were 8.19% with and 0.17% without antidepressant treatment, with large drug/placebo risk ratios among depressive (10.4/0.45%) and anxiety (1.98/0.00%) disorder patients.
  
  
  CONCLUSIONS
  Risks of excessive mood elevation during antidepressant treatment, including mania-hypomania, were much greater than with placebo, and similar in juvenile anxiety and depressive disorders. Excessive arousal-activation in children or adolescents treated with antidepressants for anxiety as well as depressive disorders calls for particular caution and monitoring for potential risk of future bipolar disorder.
authors.affiliation: Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy. emanuela.offidani2@unibo.it
authors.forename: Emanuela
authors.initials: E
authors.lastname: Offidani
authors.forename: Giovanni A
authors.initials: GA
authors.lastname: Fava
authors.forename: Elena
authors.initials: E
authors.lastname: Tomba
authors.forename: Ross J
authors.initials: RJ
authors.lastname: Baldessarini
mesh_terms: D000293:Adolescent; D000339:Affect / Q000187:drug effects; D000367:Age Factors; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000494:pharmacology; D001008:Anxiety Disorders / Q000188:drug therapy / Q000453:epidemiology*; D001143:Arousal / Q000187:drug effects; D001714:Bipolar Disorder / Q000453:epidemiology* / Q000523:psychology; D002648:Child; D003866:Depressive Disorder / Q000188:drug therapy*; D004644:Emotions / Q000187:drug effects; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010919:Placebos; D012307:Risk Factors
chemical_list: D000928:Antidepressive Agents; D010919:Placebos