Teens may experience delays in bipolar progression after major depressive disorder, according to study

Adolescents may experience delayed bipolar disorder (BD) progression after major depressive disorder (MDD) diagnosis, according to a study published online May 29 in JAMA Psychiatry.

Adrian E. Desai Boström, M.D., Ph.D., from the Karolinska Institute in Stockholm, and colleagues examined the association of age at MDD onset with early transition to BD and the subsequent use of psychiatric inpatient services as a severity indicator. The analysis included 114 adults and 114 youths participating in the Stockholm MDD Cohort (1997 to 2018), which encompassed both outpatient and inpatient care.

The researchers found that youth were substantially less likely to transition early (odds ratio, 0.42), despite having more outpatient visits (mean visits per month, 1.21 versus 0.97 for adults). Following a BD diagnosis, both groups experienced substantially reduced inpatient care, concurring with a marked decline in antidepressant use without increased lithium use.

"These results underscore the vital importance of early and accurate BD diagnosis in youths, especially in inpatient settings, and offer crucial insights for tailoring pharmacologic strategies in patients experiencing a first episode of MDD at risk for transitioning to BD," the authors write.

Two authors disclosed ties to Janssen Sweden.

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