Therapeutic dilemmas in the pharmacotherapy of bipolar depression in the young

Pediatric bipolar disorder is commonly mixed with co-occurring symptoms of major depression and mania, Knowledge has begun to accumulate on the treatm ent of the mania component, but limited information is available to guide t he therapeutic approach to bipolar depression. To this end, we reviewed the medical charts of 59 patients with diagnosis of DSM-III-R bipolar disorder from an outpatient pediatric psychopharmacology clinic. Multivariate metho ds were used to model the probability of improvement and relapse at each vi sit of clinical follow-up, Serotonin-specific antidepressants were signific antly associated with both an increased rate of improvement of bipolar depr ession-relative risk = 6.7 (1.9-23.6); p = 0.003-and a significantly greate r probability of relapse of manic symptomatology-relative risk = 3.0 (1.2-7 .8); p = 0.02, Although mood stabilizers improved manic symptomatology, the y had no demonstrable effect on the symptoms of bipolar depression. Despite the increased risk of mood destabilization, serotonin-specific antidepress ants did not interfere with the antimanic effects of mood stabilizers. Beca use bipolar youth commonly come to clinical practice with depression, these results underscore the importance of assessing a lifetime history of bipol ar disorder in making treatment decisions in depressed youth.