Bipolar disorder at prospective follow-up of adults who had prepubertal major depressive disorder

Objective: The authors' goal was to conduct an adult followup of subjects w ho had participated in a study of nortriptyline for childhood depression. Method: The study group represented 100 (90.9%) of the original 110 subject s and included 72 subjects who had a prepubertal diagnosis of major depress ive disorder and 28 normal comparison subjects. Subjects were assessed with semistructured research interviews given by research nurses who were blind to the subjects' original diagnoses. Results: In the original study, the mean age of The children with prepubert al major depressive disorder was 10.3 years (SD = 1.5); at adult follow-up the mean age of these subjects was 20.7 years (SD=2.0). At follow-up, signi ficantly more of the subjects who had prepubertal diagnoses of major depres sive disorder (N=24 [33.3%]) than normal comparison subjects (none) had bip olar I disorder. Subjects who had prepubertal diagnoses of major depressive disorder also had significantly higher rates of any bipolar disorder than normal subjects (48.6% [N=35] versus 7.1% [N=2]), major depressive disorder (36.1% [N=26] versus 14.3% [N=4]), substance use disorders (30.6% [N=22] v ersus 10.7% [N=3]), and suicidality (22.2% [N=16] versus 3.6% [N=1]). Paren tal acid grandparental mania predicted bipolar I disorder outcomes. Conclusions: High rates of switching to mania have implications for the tre atment of depressed children. The authors discuss the reasons for their fin ding a higher rate of bipolar disorder in this outcome study than was found in the one other adult outcome study of prepubertal major depressive disor der.