Adolescent hypomania does not predict bipolar disorder

By Mark Cowen, Senior MedWire Reporter

Results from a Swedish study show that only a small proportion of depressed adolescents with hypomania spectrum episodes will develop bipolar disorder in adulthood.

In study of 64 individuals aged 16-17 years who screened positive for depression symptoms and lifetime hypomania spectrum symptoms, only six had experienced another hypomanic episode, or an episode or mania, by the age of 30-33 years.

"Thus, maintenance or prophylactic treatment does not seem warranted for this group," comment Päären Aivar (Uppsala University) and team in the Journal of Affective Disorders.

The findings come from a community-based study of 2300 adolescents who were screened for depression and hypomania between 1991 and 1993.

Of those 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%]).

Of these, 64 participated in follow-up interviews after an average of 14 years.

The researchers found that just four (6%) of the participants interviewed at follow-up reported at least one episode of hypomania in adulthood, and just two (3%) reported at least one episode of mania.

In contrast, however, 38 (59%) met criteria for major depression at follow-up.

Aivar et al conclude: "The main message of this study is that 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."

They add: "Our ability to recognize subjects with future bipolar disorder on the community level remains limited. Thus, long-term preventive or prophylactic pharmacological treatment in children with hypomania spectrum disorder might be risky.

"Reliable early identifiers of this heterogeneous disorder still remain to be detected."

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