Excessive mood elevation and behavioral activation with antidepressant treatment of juvenile depressive and anxiety disorders: A systematic review

Emanuela Offidani, Giovanni A. Fava, Elena Tomba, Ross J. Baldessarini

Research output: Contribution to journalReview article

47 Scopus citations

Abstract

Background: The prevalence, characteristics and implications of excessive arousal-activation in children and adolescents treated with antidepressants for specific illnesses have not been systematically examined. Methods: We compared reports of antidepressant trials (n = 6,767 subjects) in juvenile depressive (n = 17) and anxiety disorders (n = 25) for consensus-based indications of psychopathological mood elevation or behavioral activation. Results: Rates of excessive arousal-activation during treatment with antidepressants were at least as high in juvenile anxiety (13.8%) as depressive (9.79%) disorders, and much lower with placebos (5.22 vs. 1.10%, respectively; both p < 0.0001). The antidepressant/placebo risk ratio for such reactions in paired comparisons was 3.50 (12.9/3.69%), and the meta-analytically pooled rate ratio was 1.7 (95% confidence interval: 1.2-2.2; both p ≤ 0.001). Overall rates for 'mania or hypomania', specifically, were 8.19% with and 0.17% without antidepressant treatment, with large drug/placebo risk ratios among depressive (10.4/0.45%) and anxiety (1.98/0.00%) disorder patients. Conclusions: Risks of excessive mood elevation during antidepressant treatment, including mania-hypomania, were much greater than with placebo, and similar in juvenile anxiety and depressive disorders. Excessive arousal-activation in children or adolescents treated with antidepressants for anxiety as well as depressive disorders calls for particular caution and monitoring for potential risk of future bipolar disorder.

Original languageEnglish (US)
Pages (from-to)132-141
Number of pages10
JournalPsychotherapy and Psychosomatics
Volume82
Issue number3
DOIs
StatePublished - Apr 1 2013

All Science Journal Classification (ASJC) codes

  • Clinical Psychology
  • Applied Psychology
  • Psychiatry and Mental health

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