MC 5719
Stanford, CA 94305
Drexel University College of Medicine Office of the Registrar, Philadelphia, PA, 6/30/2004
Perelman School of Medicine University of Pennsylvania, Philadelphia, PA, 06/30/2008
Stanford University Child and Adolescent Psychiatry Fellowship, Stanford, CA, 6/30/2010
Child & Adolescent Psychiatry, American Board of Psychiatry and Neurology
Psychiatry, American Board of Psychiatry and Neurology
View details for Web of Science ID 000550978200024
View details for DOI 10.1016/j.jaac.2017.07.727
View details for Web of Science ID 000544086202273
View details for DOI 10.1176/appi.focus.20150032
View details for PubMedID 31975797
View details for PubMedCentralID PMC6524442
View details for DOI 10.1007/s40596-015-0406-x
View details for PubMedID 26307363
View details for DOI 10.1007/s40596-015-0289-x
View details for PubMedID 25700671
View details for DOI 10.1007/s40596-014-0120-0
View details for PubMedID 24789480
This article reviews the literature that examines whether exposure to psychostimulants or antidepressants precipitates or exacerbates manic symptoms, or decreases the age at onset of mania in pediatric populations. A PubMed search using relevant key words identified studies targeting five distinct clinical groups: (i) youth without a diagnosis of bipolar disorder (BD) at the time of exposure to psychostimulants; (ii) youth with a diagnosis of BD at the time of exposure to psychostimulants; (iii) youth without a diagnosis of BD at the time of exposure to antidepressants; (iv) youth with a diagnosis of BD at the time of exposure to antidepressants; and (v) youth who develop BD after exposure to these medications. In patients with attention-deficit hyperactivity disorder (ADHD), the risk for mania was found to be relatively low with the use of psychostimulants. For patients with BD and ADHD, effective mood stabilization is important prior to adding a stimulant. For children with depression and/or anxiety, the risk of antidepressant-induced mania (AIM) was generally low (<2%), but the risk of general 'activation' secondary to a selective serotonin reuptake inhibitor (SSRI) may be greater (2-10%). However, rates of AIM in specialty clinics appear to be much higher. SSRIs may be particularly problematic in specific populations, such as those with some symptoms of mania or a family history of BD, but the precise risk is unknown. There is no clear evidence that stimulants or SSRIs accelerate the natural course of BD development in overall samples, but in individual cases prescribers should proceed cautiously when using these agents in youth already at risk for developing BD, such as those with ADHD and mood dysregulation, a history of prior AIM, a history of psychosis, or a family history of BD.
View details for PubMedID 21692547