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19-06-2013 | Mental health | Article

Depression impact overlooked in pediatric bipolar disorder


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medwireNews: Depression has a larger effect than mania on the functioning of children with bipolar disorder, report researchers.

"Though mania - its phenomenology, impact, and treatment - has dominated the pediatric bipolar disorder literature, this study provides evidence that the low moods of bipolar disorder may be more insidious and impairing than the high," say Amy West (University of Illinois at Chicago, USA) and colleagues.

They found that parent- and clinician-rated depressive symptoms were strongly linked to a range of outcomes in the children, including problem behaviors, self-concept, and quality of life, whereas mania was not. They comment that the "lopsided nature of the results was more striking than expected."

"This is not to say that mania is not impairing," say West et al. But they add: "At the very least, these findings suggest that the collective focus on mania, often it seems at the exclusion of depression, may be misguided."

There were 54 children in the study, aged an average of 9.1 years. Greater clinician-rated depression in these children adversely affected a range of other measures on the Piers-Harris Self-Concept Scale, including intellectual and school status, anxiety, popularity, behavioral adjustment, and happiness and satisfaction, as well as overall self-concept.

"This paints a grim picture of how youth with bipolar depression see themselves; such a negative perspective could limit the initiation and maintenance of positive relationships, opportunities for academic success, and involvement in positive activities," says the team.

However, although parent-rated depression was also associated with many self-concept measures, there were significant interactions such that more severe manic symptoms were associated with a smaller impact of depression on self-concept.

"Given the generally bleak picture of pediatric mania, it is intriguing to think about ways in which this mood state may protect against the darkness of its opposite, depression," West et al write in the Journal of Affective Disorders.

Quality of life was also affected, with both parent- and clinician-related depression associated with poorer scores on several domains of the Questionnaire for Measuring Health-Related Quality of Life in Children (KINDL). By contrast, higher scores for manic symptoms were actually associated with better quality of life for physical wellbeing and self-esteem.

"Most treatment studies for pediatric mania have focused on controlling manic symptoms, and there is concern about prescribing anti-depressants; but it may be that some of the detrimental effects of bipolar depression could be eliminated with adequate treatment," say the researchers.

They also stress the importance of psychotherapy targeting depressive symptoms.

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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