A Pilot Study of Antidepressant-Induced Mania in Pediatric Bipolar Disorder: Characteristics, Risk Factors, and the Serotonin Transporter Gene

• Published in: Biological psychiatry (1969) 2006-11, Vol.60 (9), p.1005-1012
• Main Authors: Baumer, Fiona M., Howe, Meghan, Gallelli, Kim, Simeonova, Diana Iorgova, Hallmayer, Joachim, Chang, Kiki D.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult and adolescent clinical studies; Age Factors; Alleles; antidepressant-induced mania; Antidepressive Agents - adverse effects; Biological and medical sciences; Bipolar disorder; Bipolar Disorder - chemically induced; Bipolar Disorder - drug therapy; Bipolar Disorder - genetics; Bipolar disorders; Chi-Square Distribution; Child; Female; Gene Frequency; General aspects; Humans; Longitudinal Studies; Male; Mania; Medical sciences; Mood disorders; Neuropharmacology; Parent-Child Relations; Pharmacology. Drug treatments; Pilot Projects; Polymorphism, Genetic; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychopharmacology; Reverse Transcriptase Polymerase Chain Reaction - methods; Risk Factors; Serotonin Plasma Membrane Transport Proteins - genetics; serotonin transporter gene; Serotonin Uptake Inhibitors - adverse effects; suicide
• ISSN: 0006-3223; 1873-2402
• DOI: 10.1016/j.biopsych.2006.06.010

Antidepressant-induced mania (AIM) has been described in bipolar disorder (BD) and has been associated with the short-allele of the serotonin transporter gene (5-HTT). We wished to investigate the frequency of and risk factors for AIM in pediatric patients with or at high risk for BD. Fifty-two children and adolescents (30 with BD and 22 with subthreshold manic symptoms, 15.1 ± 3.4 years old), all with a parent with BD, were interviewed with their parents for manic/depressive symptoms occurring before and after past antidepressant treatment. The 47 subjects with serotonin reuptake inhibitor (SSRI) exposure were genotyped for the 5-HTT polymorphism. Fifty percent of subjects were AIM+ and 25.5% had new onset of suicidal ideation. The AIM+ and AIM− groups did not differ significantly in relation to allele (p = .36) or genotype (p = .53) frequencies of the 5-HTT polymorphism. The AIM+ subjects were more likely to have more comorbidities (3.2 vs. 2.4; p = .02) and be BD type I (p = .04) than AIM− subjects. Youth with or at high risk for BD may be particularly vulnerable to SSRI AIM and thus should be monitored if given SSRIs. In this preliminary study, we did not find that the 5-HTT polymorphism significantly influenced vulnerability to AIM.