Pediatric Drugs

, Volume 13, Issue 4, pp 225–243

Antidepressants and Psychostimulants in Pediatric Populations

Is there an Association with Mania?
Review Article

DOI: 10.2165/11591660-000000000-00000

Cite this article as:
Goldsmith, M., Singh, M. & Chang, K. Pediatr-Drugs (2011) 13: 225. doi:10.2165/11591660-000000000-00000


This article reviews the literature that examines whether exposure to psychostimulants or antidepressants precipitates or exacerbates manic symptoms, or decreases the age at onset of mania in pediatric populations. A PubMed search using relevant key words identified studies targeting five distinct clinical groups: (i) youth without a diagnosis of bipolar disorder (BD) at the time of exposure to psychostimulants; (ii) youth with a diagnosis of BD at the time of exposure to psychostimulants; (iii) youth without a diagnosis of BD at the time of exposure to antidepressants; (iv) youth with a diagnosis of BD at the time of exposure to antidepressants; and (v) youth who develop BD after exposure to these medications.

In patients with attention-deficit hyperactivity disorder (ADHD), the risk for mania was found to be relatively low with the use of psychostimulants. For patients with BD and ADHD, effective mood stabilization is important prior to adding a stimulant. For children with depression and/or anxiety, the risk of antidepressant-induced mania (AIM) was generally low (<2%), but the risk of general ‘activation’ secondary to a selective serotonin reuptake inhibitor (SSRI) may be greater (2–10%). However, rates of AIM in specialty clinics appear to be much higher. SSRIs may be particularly problematic in specific populations, such as those with some symptoms of mania or a family history of BD, but the precise risk is unknown. There is no clear evidence that stimulants or SSRIs accelerate the natural course of BD development in overall samples, but in individual cases prescribers should proceed cautiously when using these agents in youth already at risk for developing BD, such as those with ADHD and mood dysregulation, a history of prior AIM, a history of psychosis, or a family history of BD.

Copyright information

© Adis Data Information BV 2011

Authors and Affiliations

  • Michelle Goldsmith
    • 1
  • Manpreet Singh
    • 1
  • Kiki Chang
    • 1
  1. 1.Stanford Pediatric Bipolar Disorders ProgramStanford University School of Medicine, Department of PsychiatryStanfordUSA

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