Abstract
To Our Readers:
Mood disorders in youth present substantial challenges for clinical practice and research.
Children and adolescents with mood disorders have heterogeneous, unstable, and incompletely understood phenotypes. Differentiating unipolar from bipolar depression in early life is one such key challenge for our field. Early identification of bipolar disorder in youth is critical to avoid treatments that may worsen the course of the illness later in life (Honeycutt et al., 2024). Conversely, ruling out bipolar disorder early in life mitigates the use of inappropriate treatments with a high side effect burden in youth with unipolar depression (DelBello MP et al., 2023). This topic has been addressed in our journal and elsewhere for more than 20 years (Geller et al., 2000; Singh et al, 2014; Yan et al, 2023).
In this issue, Dr. Silverman and colleagues from the Center for Youth Bipolar Disorder, Center for Addiction and Mental Health in Toronto, Canada share new important work focused on the characterization of depressive phenotypes in youth (Silverman et al, 2024). This study examined a sample of youth (n = 373) with bipolar I disorder, other specified bipolar and related disorders, and youth at high risk for bipolar disorder. The research team collected structured diagnostic interviews and assessments of depressive symptom severity. Data analyses compared participants with bipolar disorder (n = 208) and major depressive disorder (n = 165). These two subsamples had similar demographics, family history, and co-occurring conditions. However, patients with bipolar disorder had a higher rate of psychiatric hospitalizations, eating disorders, and psychotic symptoms. Patients with bipolar disorder had greater symptom severity with respect to depressed mood, irritability, negative self-image, hopelessness, anhedonia, fatigue, hypersomnia, suicidal ideation, and chronic thoughts of death. However, a regression analysis demonstrated that only depressed mood predicted a diagnosis of bipolar disorder (Silverman et al., 2024).
This exploratory study with a relatively large sample size provides important directions for future research and insights for consideration in clinical practice. The present findings suggest that elevated depressive symptom severity in youth should increase suspicion for a diagnosis of bipolar disorder. This interesting work does have limitations and future replication studies are critical. This study also underscores the importance of future work that refines objective measures of depressive symptoms and scalable physiological measures for clinical practice.
Minimizing side effect burden is a key priority for precision medicine approaches in our field. Mixed serotonin–dopamine antagonist medications (atypical antipsychotics and second-generation antipsychotics) are increasingly used for the treatment of mood and psychotic disorders in youth (Moon et al., 2023; Zhu et al., 2024). Unfortunately, at least 50% of children and adolescents experience substantial weight gain during treatment with mixed serotonin–dopamine antagonist medications and ensuing medical complications (Bobo et al., 2013). Early identification of young patients at risk for weight gain and medical morbidity during treatment with mixed serotonin–dopamine antagonist medications would advance patient-centered care.
In this issue, Lyu and colleagues (Lyu et al, 2024) advance the understanding of weight gain in youth treated with mixed serotonin–dopamine antagonist medications. The study focused on electronic medical record data from a large sample (n = 16,262) of patients aged 5–19 years treated with mixed serotonin–dopamine antagonist medications (aripiprazole, risperidone, quetiapine, olanzapine, lurasidone, ziprasidone, paliperidone, and clozapine). The research team identified rapid, gradual, transient, and no weight gain trajectories in this sample. Notably, the study suggests that patients with younger age, male sex, non-Hispanic white race, lower baseline BMI, and index treatment with olanzapine may have an elevated risk for weight gain during treatment with mixed serotonin-dopamine antagonist medications (Lyu et al, 2024). This study contributes to existing knowledge regarding risk factors for weight gain during treatment with mixed serotonin-dopamine antagonist medications. The work by Lyu and colleagues underscores the need for more research focused on related early identification, interventions, and complex modeling with larger datasets.
Finally, a special thanks to Dr. Raman Baweja and colleagues. Dr. Baweja is a leading expert in the diagnosis and treatment of attention-deficit/hyperactivity disorder (ADHD). He organized a collaborative review of recent cutting-edge innovations in the management of ADHD.
We hope you enjoy this issue of Journal of Child and Adolescent Psychopharmacology.