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21-08-2013 | Mental health | Article

Bipolar onset age forecasts depressive problems


Free abstract

medwireNews: Patients’ age at onset of bipolar disorder has a strong influence on their risk for developing severe depression later in their disease course, research suggests.

Patients whose bipolar symptoms appeared before the age of 13 years were at increased risk for requiring treatment for depression as adults, report lead researcher Regina Sala (College of Physicians and Surgeons of Columbia University, New York, USA) and colleagues.

“From a clinical perspective, it is of utmost importance to identify and treat children with bipolar disorder,” they write in the Journal of Pediatrics.

They say that delayed identification of bipolar disorder “could lead to longer duration of untreated bipolar disorder, and, in turn, to greater chronicity of the illness and more social impairment.”

The significance of the issue is underlined by the frequency of childhood bipolar onset, says the team. In the current study, based on data from the National Epidemiologic Survey on Alcohol and Related Conditions, 28.14% of the 1600 patients included had first developed symptoms between the ages of 13 and 18 years (adolescent onset), while 8.92% did so at younger ages (childhood onset).

Between the two survey points, in 2001–2002 and 2004–2005, 75.1% of patients with childhood-onset symptoms sought treatment for depression, compared with 64.3% of those with adult-onset bipolar disorder. This equated to a 2.58-fold increase after accounting for age, gender, race, and income.

In all, 65.6% of patients with bipolar onset in childhood saw a counselor for depression, 33.6% were hospitalized for depression, and 30.3% received emergency room treatment for depression. These rates were, respectively, 2.32-, 3.27-, and 2.46-fold greater than those for patients with adult onset of symptoms.

Rates of treatment for mania, on the other hand, did not significantly differ according to age at bipolar onset, and patients whose symptoms began in adolescence were no more likely to require treatment for depression or mania than were those whose symptoms began in adulthood.

“Childhood-onset bipolar disorder may be more likely to ‘burn out’ of mania and progress into more severe depression during the follow-up compared with the adolescent- or adult-onset bipolar disorder,” suggest the researchers.

Against their expectations, the researchers found that rates of new-onset psychiatric comorbidities did not differ according to age at bipolar onset, and neither did health-related quality of life.

“This may be explained by the fact that there were high rates of new onset of comorbidity and low level of functioning among all 3 groups,” they suggest.

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Eleanor McDermid, Senior medwireNews Reporter

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