Strawn Jeffrey R, Adler Caleb M, McNamara Robert K, Welge Jeffrey A, Bitter Samantha M, Mills Neil P, Barzman Drew H, Cerullo Michael A, Chang Kiki D, Strakowski Stephen M, DelBello Melissa P
Division of Bipolar Disorders Research, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine.
Bipolar Disord. 2014 Aug;16(5):523-30. doi: 10.1111/bdi.12113. Epub 2013 Aug 13.
Depressive and anxiety disorders are common in youth who are at risk for bipolar disorder (i.e., youth who have at least one parent with bipolar disorder) and antidepressants are commonly prescribed as treatment. However, there are few data regarding the safety and tolerability of antidepressants in this population. Therefore, we sought to prospectively examine the effects of these medications in children and adolescents who are diagnosed with depressive or anxiety disorders and have a parent with bipolar I disorder.
Youth aged 9-20 years, with at least one parent with bipolar I disorder [high risk (HR)], were recruited (n = 118) and assessed using semi-structured diagnostic interviews. Participants were prospectively evaluated using a modified version of the Longitudinal Interval Follow-up Evaluation to assess changes in affective and anxiety symptoms and were treated naturalistically.
Over the course of 43-227 weeks (mean duration of follow-up: 106 ± 55 weeks), 21% (n = 25) of youth had antidepressant exposure and, of these, 57% (n = 12) had an adverse reaction (e.g., irritability, aggression, impulsivity, or hyperactivity) that led to antidepressant discontinuation. Those patients who experienced an adverse reaction were significantly younger than those who did not (p = 0.02) and discontinuation of antidepressant therapy secondary to an adverse event occurred at an average of 16.7 ± 17.4 weeks (median: 11 weeks, range: 2-57 weeks). Cox proportional hazard analyses yielded a hazard ratio of 0.725 (p = 0.03), suggesting that there is a 27% decrease in the likelihood of an antidepressant-related adverse event leading to discontinuation with each one-year increase in age.
Antidepressant medications may be poorly tolerated in youth with a familial risk for developing mania. Controlled studies further assessing treatments for depression and anxiety in HR youth are urgently needed.
抑郁和焦虑障碍在有双相情感障碍风险的青少年中很常见（即父母至少一方患有双相情感障碍的青少年），抗抑郁药通常被用作治疗药物。然而，关于抗抑郁药在该人群中的安全性和耐受性的数据很少。因此，我们试图前瞻性地研究这些药物对被诊断患有抑郁或焦虑障碍且父母一方患有双相I型障碍的儿童和青少年的影响。
招募了年龄在9至20岁、父母至少一方患有双相I型障碍[高风险（HR）]的青少年（n = 118），并使用半结构化诊断访谈进行评估。使用改良版的纵向间隔随访评估对参与者进行前瞻性评估，以评估情感和焦虑症状的变化，并进行自然主义治疗。
在43至227周的过程中（平均随访时间：106±55周），21%（n = 25）的青少年接触过抗抑郁药，其中57%（n = 12）出现了不良反应（如易怒、攻击性、冲动或多动），导致停用抗抑郁药。经历不良反应的患者明显比未经历不良反应的患者年轻（p = 0.02），因不良事件而停用抗抑郁治疗的平均时间为16.7±17.4周（中位数：11周，范围：2至57周）。Cox比例风险分析得出风险比为0.725（p = 0.03），表明随着年龄每增加一岁，抗抑郁药相关不良事件导致停药的可能性降低27%。
有家族性躁狂风险的青少年对抗抑郁药的耐受性可能较差。迫切需要进行对照研究，进一步评估HR青少年抑郁和焦虑的治疗方法。
