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Differentiating Unipolar from Bipolar Depression. (Study of 171 Young Children).

HONOLULU -- Clues that were identified in a study of 171 children with depression should help clinicians differentiate unipolar depression from bipolar depression, Dr. Janet R. Wozniak reported at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

A secondary analysis of data from a longitudinal study of children diagnosed with attention-deficit hyperactivity disorder found that depression first appeared at a younger age--usually in the preschool years--in 45 children who had bipolar depression, compared with an onset around age 7 or 8 in 116 children who had unipolar depression, said Dr. Wozniak of Harvard Medical School, Boston.

Children diagnosed with unipolar depression were more likely to present with sadness and anhedonia than those who had depression and mania in which their depressive symptoms were more commonly described as cranky, whiny, and irritable, Dr. Wozniak reported in a poster presentation at the meeting.

Comorbidities were more common in children who had depression and mania, and included conduct disorder in approximately 50%, multiple anxiety disorder in close to 60%, and severe oppositional defiance disorder in 70%.

Rates for these comorbidities in children with unipolar depression were approximately 18%, 45%, and 30%, respectively.

If you're evaluating a moody irritable child, a lot of sadness and anhedonia might suggest unipolar depression. Onset of depression between ages 2 and 4 or the presence of comorbidities might suggest bipolar depression, she said.

The children with bipolar disorder were stratified into three groups: children whose depression preceded mania, children whose mania preceded depression, and children in whom depression and mania presented simultaneously.

Those whose mania or depression presented first had a slightly higher rate of conduct disorder than children in whom mania and depression appeared simultaneously and a significantly higher rate than that of conduct disorder (less than 20%) in children who had unipolar depression.

Children whose depression preceded mania had a rate of multiple anxiety disorder similar to that of those included in the depression plus mania group (around 60%). For those children whose mania preceded depression, the rate of multiple anxiety disorder was similar to that of children who had unipolar depression (around 45%).

Severe oppositional defiant disorder was most common (around 80%) in those children whose mania preceded depression. It was also significantly more common than the approximately 50% rate observed in children whose depression preceded mania or the 30% rate in children with a diagnosis of unipolar depression.

The higher rate of conduct disorder observed in children diagnosed with bipolar depression "dovetails with previous literature looking at dysphoric conduct," Dr. Wozniak said.
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Author:Boschert, Sherry
Publication:Clinical Psychiatry News
Geographic Code:1USA
Date:Jan 1, 2002
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