According to a soon-to-be-published study in the Journal of Affective Disorders, Swedish researchers concluded that only a small proportion of depressed adolescents with hypomanic episodes will develop bipolar disorder in adulthood.
The study participants came from a community-based sample of 2300 adolescents who were screened for depression and hypomania between 1991 and 1993.
- Of these, 64 individuals aged 16-17 years who screened positive for symptoms of depression and lifetime hypomania spectrum symptoms participated in follow up interviews after an average of 14 years.
- Only six of the 64 individuals experienced another hypomanic episode, or an episode or mania, by the age of 30-33 years.
Author Paaren Aivar, with Uppsala University, and his co authors, thus concluded that
“maintenance or prophylactic treatment does not seem warranted for [youth who have experienced a hypomanic episode].”
Of the group of 2300 adolescents who screened positive for depressive symptoms, 90 also screened positive for full syndromal hypomania lasting more than 4 days (n=40 [1.7%]), brief-episode hypomania lasting less than 4 days (n=18 [0.8%]), or subsyndromal hypomania (n=32 [1.4%]), and 64 of the 90 adolescents participated in follow-up interviews after an average of 14 years.
- Only four (6%) of the participants interviewed at follow-up reported at least one episode of hypomania in adulthood
- Only two (3%) reported at least one episode of mania.
- 38 (59%) met criteria for major depression at follow-up.
Aivar et al further conclude:
“…a significant number of adolescents initially diagnosed with full-syndrome, brief-episode, and subsyndromal hypomania did not develop bipolar disorder as adults. However, a substantial proportion reported major depression later in life.”
This is consistent with previous findings that suggest that youth with mood symptoms in childhood and adolescent continue to be most at risk for developing major depression, and not bipolar disorder, as adults.
The researchers echo what many clinicians have attempted to explain to frustrated and confused parents for many years; that we continue to have very little ability to recognize youths at risk of developing bipolar disorder.
Dr. Aivar et al conclude that long-term prophylactic pharmacological treatment in children with hypomania spectrum disorder is not warranted.
The risks of psychopharmacologic treatment to prevent the development of bipolar disorder outweigh the potential benefits for youth, even if they have been diagnosed with full-syndrome of hypomania.
J Affect Disord 2012; Advance online publication