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No Evidence of Antidepressant-Induced Mania in Pediatric Patients With Depression
Children and adolescents with unipolar depression treated with antidepressant medication did not have an increased incidence of mania/hypomania in the weeks following antidepressant initiation compared with those who did not initiate an antidepressant, according to study findings published in JAMA Psychiatry.
“We found no evidence to suggest that antidepressants induce mania/hypomania in this patient group,” wrote corresponding authors Suvi Virtanen, PhD, and Zheng Chang, PhD, of Karolinska Institutet in Stockholm, Sweden, and study coauthors. “The risk was similar in treatment and control groups by 12 weeks, which is the time window during which treatment-emergent mania is expected to occur.”
The study included 43,677 pediatric patients with depression with a median age of 15. Among them, 24,573 initiated antidepressant medication within 90 days of diagnosis and 19,104 did not.
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At 12 weeks after treatment initiation, the cumulative incidence of mania was 0.26% in the group of pediatric patients treated with antidepressants and 0.20% in the control group not treated with antidepressants, according to the study.
Predictors of mania at 12 weeks included hospitalizations, parental bipolar disorder, and use of antipsychotics and antiepileptics. Specifically, hospitalization was associated with a 2.1-fold increased risk, inpatient hospitalization as the source of diagnosis with a 2.3-fold increased risk, parental bipolar disorder with a 4.1-fold increased risk, antipsychotic use with a 4.4-fold increased risk, and antiepileptic use with a 7.0-fold increased risk, researchers reported.
At 52 weeks, the cumulative incidence of mania was 0.79% in the antidepressant treatment group and 0.52% in the control group.
“We found a small risk difference only in the longer follow-up analysis,” researchers wrote, “suggesting that the risk increase may be attributable to factors other than the medication.”
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