Depression Fact Sheet for Physicians
rule out bipolar disorder, particularly if there is a family history of bipolar disorder. This evaluation is necessary especially since psychostimulants, often prescribed for ADHD, may worsen manic symptoms. There is also limited evidence suggesting that some of the symptoms of ADHD may be a forerunner of full-blown mania.
Bipolar Disorder: Manic Symptoms
-Severe changes in mood; unusual happiness or silliness, or extreme irritability
-Overly-inflated self-esteem -Great energy increase; ability to go with very little or no sleep for days without tiring
-Increased talking-talks too much, too fast; changes topics too quickly; cannot be interrupted
-Distractibility-attention moves constantly from one thing to the next
-Disregard of risk
Bipolar Disorder: A Warning about Antidepressants
There is some evidence that using antidepressants to treat a child with depression who has bipolar disorder may induce manic symptoms.(27) While it can be hard to determine which young patients will become manic, there is a greater likelihood among children who have a family history of bipolar disorder. Family physicians seeing a child who may be depressed and who has a family history of bipolar disorder may want to consult with a child psychiatrist. Family practitioners should also be aware of the signs and symptoms of mania so that they can educate families on how to recognize these immediately.
Dysthymic disorder (or dysthymia)
This less severe yet typically more chronic form of depression is diagnosed when depressed mood persists for at least one year in children or adolescents, and is accompanied by at least two of the symptoms of major depression.(8) Dysthymia often precedes major depressive disorder. Treatment of the child or adolescent with dysthmia may prevent the deterioration to more severe illness.(12)
Dr. Frank V. deGruy, III, MD, MSFM, Chairman, Department of Family Medicine, University of Colorado Health Sciences Center, advised NIMH on the development of this fact sheet.
Information Resources
National Institute of Mental Health
Office of Communications and Public Liaison
Information Resources and Inquiries Branch
6001 Executive Boulevard, Rm. 8184, MSC 9663
Bethesda, MD 20892-9663
(301) 443-4513
Mental Health FAX 4U: (301) 443-5158
E-mail: nimhinfo@nih.gov
http://www.nimh.nih.gov
American Academy of Child and Adolescent Psychiatry
3615 Wisconsin Avenue, N.W.
Washington, DC 20016
(202) 966-7300
http://www.aacap.org
American Psychiatric Association
1400 K Street, N.W.
Washington, DC 2005
(202) 682-6000
http://www.psych.org
American Psychological Association
750 First Street, N.E.
Washington, DC 20002
(202) 336-5500
http://www.apa.org
NAMI
Colonial Place Three
2107 Wilson Blvd., Suite 300
Arlington, VA 22201-3042
http://www.nami.org
National Depressive and Manic-Depressive Association
730 N. Franklin Street, Suite 501
Chicago, Illinois 60610-3526
(800) 826-3632
http://www.ndmda.org
National Mental Health Association
1021 Prince Street
Alexandria, VA 22314
(800) 969-NMHA
http://www.nmha.org
References
1.Shaffer, D., et al. "The NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3): Description, Acceptability, Prevalence Rates and
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