RATE AND PREDICTORS OF PREPUBERTAL BIPOLARITY DURING FOLLOW-UP OF 6-YEAR-OLD TO 12-YEAR-OLD DEPRESSED CHILDREN

Objective: To investigate the rate and predictors of onset of DSM-III bipolar I and bipolar II disorders among 6- to 12-year-old prepubertal subjects with DSM-111 major depressive disorder (MDD) who were follow ed for a 2- to 5-year period. Methods: This was a prospective, blindly rated study of 79 children with MDD and 31 normal control children ma tched for age, gender, and socioeconomic status. Subjects and a second informant were assessed at 4-month intervals using the Kiddie Schedul e for Affective Disorders and Schizophrenia-Present Episode Version-19 86 modified to include 4-month interval ratings and to include DSM-III diagnoses. Family history (FH) was assessed using the FH-Research Dia gnostic Criteria obtained from the mother about the subject's first- a nd second-degree relatives. Results: Bipolarity developed in 31.7% (N = 25) of the children with MDD at a mean age of 11.2 +/- 2.0 years and 80% were prepubertal. Loaded FH and multigenerational FH were signifi cantly associated with bipolar I. Neither prior nor current use of tri cyclic antidepressants nor atypical depressive features were predictiv e. Conclusions: These findings strongly support the need to educate fa milies of children with prepubertal-onset MDD about the possibility of the emergence of manic and hypomanic symptoms to encourage early reco gnition and appropriate treatment.