What goes up must come down: The burden of bipolar depression in youth

Background: In the pediatric bipolar disorder literature, mania has eclipsed depression as the mood state of most interest. Though depressive episodes tend to be more prevalent and persisting than manic episodes, research about the associated consequences is limited. The goal of the present study was to compare the influences of depressive and manic symptoms on domains of functioning in which youth with bipolar disorder often demonstrate deficits. Method: Youth meeting DSM-IV-TR criteria for bipolar spectrum disorders (l, II, and NOS) between the ages of seven and 13 were recruited from a clinic in a large Midwestern city (N=54). Both parent and clinician report of manic and depressive symptoms were used in regression analyses to determine how each set of symptoms was related to child functioning. Results: Parent-rated child depression symptoms were associated with problem behaviors (p < 0.05), and lower quality of life (p < 0.001). Clinician-rated child depression was associated with greater psychiatric illness (p < 0.05), lower child self-concept (p < 0.001), lower quality of life (p < 0.05) hopelessness (p < 0.05), and suicidal ideation (p < 0.05) Parent-rated mania was associated with better self-esteem (p < 0.05) and physical wellbeing (p < 0.05). Clinician-rated mania was associated with greater psychiatric illness (p < 0.05) and physical wellbeing (p < 0.05). Limitations: The specific outcomes predicted by parent and clinician rated symptoms vary. Though the overall story told - that bipolar depression is associated with significant impairment in youth - is consistent, further research is necessary to more fully understand the impact of each mood state. Conclusion: Mania is undoubtedly destructive, but this study provides evidence to suggest that depression may be more deleterious to youths psychosocial functioning and quality of life; more attention to understanding and ameliorating the effects of bipolar depression on youth is warranted.