Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Harvard Longwood Psychiatry Residency Training Program, Boston, MA, USA.
Braz J Psychiatry. 2020 Sep-Oct;42(5):481-488. doi: 10.1590/1516-4446-2019-0802.
To prospectively investigate whether baseline clinical characteristics and medication exposure predict development of major depressive disorder or bipolar disorder in offspring of parents with bipolar disorder.
Youth aged 9-20 years with at least one biological parent with bipolar disorder and no prior history of mood or psychotic episodes (n=93) were prospectively evaluated and treated naturalistically during the study. Participants were divided into two groups: converters, defined as those who met DSM-IV criteria for a mood episode during follow-up (n=19); or non-converters (n=74). Logistic regression models were used to investigate associations between baseline clinical variables and medication exposure during follow-up and risk of developing a first mood episode (conversion).
Multivariate regression analyses showed that baseline anxiety disorders and subsyndromal mood disorders were associated with increased risk of conversion during follow-up. Adding medication exposure to the multivariate model showed that exposure to antidepressants during follow-up was associated with increased risk of conversion.
Caution should be used when treating bipolar offspring with anxiety and/or emerging depressive symptoms using antidepressant agents, given the increased risk of developing a major mood disorder.
前瞻性研究父母患有双相障碍的子女的基线临床特征和药物暴露是否预测其发生重性抑郁障碍或双相障碍。
研究纳入了 9 至 20 岁、至少有一位生物学父母患有双相障碍且无心境或精神病发作既往史的青少年（n=93），对其进行前瞻性评估，并在研究期间进行自然治疗。参与者被分为两组：转换组，定义为在随访期间符合 DSM-IV 心境发作标准的患者（n=19）；或非转换组（n=74）。使用逻辑回归模型调查了基线临床变量和随访期间药物暴露与首次心境发作（转换）风险之间的关系。
多变量回归分析显示，基线时的焦虑障碍和亚综合征心境障碍与随访期间的转换风险增加相关。在多变量模型中加入药物暴露情况后显示，随访期间使用抗抑郁药与转换风险增加相关。
在使用抗抑郁药治疗患有双相障碍的子女的焦虑和/或出现的抑郁症状时应谨慎，因为这会增加发生重性心境障碍的风险。
