title: Can manic switches be predicted in pediatric major depression? A systematic literature review.
abstract: BACKGROUND
  The rate of switching from major depression to bipolar disorder is high in children. Predicting who is at risk for switching poses unique challenges and is of high clinical relevance. Our aim was to examine the existing scientific literature elucidating if certain clinical correlates predict ultimate bipolar switches in children initially presenting with a depressive episode.
  
  
  METHODS
  We conducted a systematic literature search of studies assessing the risk factors for bipolar switching in youth. In all, seven studies fit our a priori criteria and were thus included in our qualitative review.
  
  
  RESULTS
  Together, these papers found that manic switches in pediatric depression can be predicted by several risk factors, including positive family history of mood disorders, emotional and behavioral dysregulation, subthreshold mania, and psychosis.
  
  
  CONCLUSIONS
  We identified only seven prospective informative studies for our review. The majority of subjects included in these studies were referred and Caucasian. Thus, the results may not generalize to other community samples and other ethnicities.
  
  
  CONCLUSIONS
  These findings can help alert clinicians of the risk of manic switches.
authors.affiliation: Massachusetts General Hospital, Department of Pediatric Psychopharmacology, Boston, MA, USA; Harvard Medical School, Department of Psychiatry, Boston, MA, USA. Electronic address: muchida@partners.org.
authors.forename: Mai
authors.initials: M
authors.lastname: Uchida
authors.affiliation: Sant'Andrea Hospital, Sapienza University, NESMOS Department, Rome, Italy; Harvard Medical School, Department of Psychiatry, Boston, MA, USA.
authors.forename: Giulia
authors.initials: G
authors.lastname: Serra
authors.affiliation: Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA; Harvard Medical School, Department of Psychiatry, Boston, MA, USA.
authors.forename: Lazaro
authors.initials: L
authors.lastname: Zayas
authors.affiliation: Massachusetts General Hospital, Department of Pediatric Psychopharmacology, Boston, MA, USA.
authors.forename: Tara
authors.initials: T
authors.lastname: Kenworthy
authors.affiliation: Massachusetts General Hospital, Department of Pediatric Psychopharmacology, Boston, MA, USA.
authors.forename: Brittany
authors.initials: B
authors.lastname: Hughes
authors.affiliation: Massachusetts General Hospital, Department of Pediatric Psychopharmacology, Boston, MA, USA.
authors.forename: Ariana
authors.initials: A
authors.lastname: Koster
authors.affiliation: SUNY Upstate Medical University, Departments of Psychiatry and of Neuroscience and Physiology, Syracuse, NY, USA.
authors.forename: Stephen V
authors.initials: SV
authors.lastname: Faraone
authors.affiliation: Massachusetts General Hospital, Department of Pediatric Psychopharmacology, Boston, MA, USA; Harvard Medical School, Department of Psychiatry, Boston, MA, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Biederman
mesh_terms: D000293:Adolescent; D001714:Bipolar Disorder / Q000150:complications* / Q000523:psychology; D002648:Child; D002657:Child Development; D003863:Depression / Q000209:etiology; D003865:Major Depressive Disorder / Q000209:etiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors
keywords: Bipolar disorder; Major depressive disorder; Manic switch; Pediatric