Thyroid Autoimmune Disease and Mania Brought on by Antidepressant Therapy in Children with Mood Disorders

Horowitz Bruni^*
*Correspondence: Horowitz Bruni, Department of Developmental and Social Psychology, Sapienza University, Rome, Italy, Email:

Keywords

Thyroid autoimmune disease • Mood disorders • Antidepressant therapy

Introduction

In mood disorders, antidepressants are the psychotropics that are prescribed the most, and up to 50% of BD patients receive antidepressant treatment at any point as the disease progresses. Antidepressants are still the most common form of pharmacotherapy for children and adolescents with BD because the depressive episode is the most common type of index episode. In spite of their far and wide use, antidepressants might abbreviate the prodromal span and lead to weakening of the disease visualization. The possibility that antidepressants can cause (hypo) mania in young people is another cause for concern. According to the most recent version of the Diagnostic and Statistical Manual (DSM-5), the phenomenon known as antidepressant treatmentemergent mania (ATEM) is recognized as a BD manifestation [1].

Criteria based on uniform definitions of the time period between the start of antidepressant therapy and the onset of ATEM have been argued for in previous consensus reports on the use of antidepressants in BD. ATEM has had a risk period of three weeks to six months; The minimum duration of the mood transition after taking antidepressants has ranged from four days to several months, and the threshold criteria for the severity of the symptoms have ranged from the absence of any manic symptoms to complete syndromal mania. It is not surprising that there is a lack of agreement regarding the clinical factors associated with an increased risk of ATEM given the variety of definitions [2].

Literature Review

The literature on ATEM is less consistent in the population of children and adolescents, despite the fact that this phenomenon has been widely observed in adults. Peripubertal children were found to be more susceptible to ATEM than older age groups, according to a pivotal epidemiological finding. In terms of demonstrating the risks associated with taking antidepressants in the pubertal age group, this study has been helpful. Despite the fact that there exists an extensive group of writing on clinical indicators for ATEM, a couple of works in writing examined conceivable biomarkers related with ATEM in the kid and juvenile populace [3].

Recent research suggests that age at BD onset, female gender, the polarity of the onset episode, recurrent depressive episodes, the bipolar I subtype, the presence of concurrent manic symptoms, and a previous history of ATEM may be clinical risk factors. There was no significant correlation between genetic markers at the 5HTTLPR polymorphism and ATEM, according to a recent metaanalysis of the serotonin transporter gene (5HTTLPR) and ATEM. This has likewise been investigated in earlier examinations by exploring the relationship between BDNF quality polymorphism and ATEM, however comparably, they didn't exhibit a huge affiliation.

Discussion

For a really long time, quite possibly of the most well-known thought in temperament jumble writing is the possibility that safe provocative pathways could assume a significant part in basic sickness pathology. As a result, the connection between autoimmune thyroid disease and BD has been known for a long time. A recent meta-analysis found that adult patients with BD and healthy controls did not significantly differ in the prevalence of anti-thyroid peroxidase antibodies (TPO-abs), despite inconclusive previous research on the topic. Thyroid disease was found to be one of the most significant risk factors for female ATEM patients in a previous study. Despite the fact that they got information from a huge populace of BD people and utilized severe patient choice, they didn't determine the subtype of thyroid issue and regardless of whether the determination was made in view of coursing thyroid autoantibodies. Moreover, the likely job of TPO-abs in pediatric state of mind problem has seldom been concentrated straightforwardly [4,5].

Studies that combine to provide a more accurate biomarker prediction for which subtypes of patients may experience ATEM phenomena have high clinical utility because they offer useful insights into the most effective treatment of BD at an early age. The purpose of our research is to investigate the connection between ATEM and autoimmune thyroid disease in children and adolescents. We speculated that immune system thyroid confusion could add to the pathogenesis of ATEM and support the possibility that TPO-abs could be utilized as a biomarker for the clinical dynamic cycle. We compared the seroprevalence and titer of TPO-abs in patients with pediatric ATEM cases to those without ATEM to test this hypothesis.

The transition to mania during antidepressant treatment is a new accepted feature of BD in DSM-5. There is a psychopharmacological need that has not been met because the mechanisms that underlie these transitions remain elusive. Significant endeavors have been made to look into potential clinical gamble factors that might assume a part in ATEM. A recent meta-analysis looked at the genetic (serotonin transporter and brain-derived neurotrophic factor gene polymorphisms) and clinical (age of onset, sex, BD subtype, rapid cycling feature, comorbid diagnoses, antidepressant type, and number of depressive/manic episodes) risk factors for ATEM. According to this metaanalysis, the only clinical risk factors that appear to consistently be associated with an increased risk of ATEM are an increased number of depressive episodes and previous ATEM history [6].

The current study confirmed the lack of association between ATEM and age of onset, sex, the type of antidepressant, and a family history of mood disorders. Despite the fact that previous studies have shown that selective serotonin reuptake inhibitors (SSRIs) are more frequently associated with ATEM than tricyclic antidepressants (TCA) and serotonin and norepinephrine reuptake inhibitors (SNRIs), we were unable to identify any group differences in the type of antidepressant used by our participants. In addition, our study demonstrated that ATEM+ individuals had a higher prevalence of ADHD and anxiety comorbidity. In a past imminent upper treatment concentrate on youth at high gamble for BD, Strawn et al. demonstrated a link between ADHD comorbidity and adverse events caused by antidepressants. In addition, alcohol abuse disorder was identified as one of the risk factors in male BD patients with ATEM+ by Scott et al.

Conclusion

Our outcomes go past reports, demonstrating the way that ADHD and uneasiness problems could be related with ATEM in the youngster and juvenile populace. We likewise found proof interestingly that the ATEM+ bunch introduced a more unfortunate clinical working score. A lack of agreement regarding the definition of ATEM could be the cause of inconsistent results regarding comorbid diagnoses. Blended discoveries are incompletely made sense of by phenotypic heterogeneity. As a result, it is still unclear which wellestablished clinical factors are responsible for ATEM. However, rather than comparing healthy controls with antidepressant-exposed ATEM- controls, we used stringent criteria to define ATEM status against the potential cofounders.

Acknowledgement

None

Conflict of Interest

None

References

1. Baldessarini, Ross J, Gianni L. Faedda, Emanuela Offidani and Gustavo H. Vazquez, et al. "Antidepressant-associated mood-switching and transition from unipolar major depression to bipolar disorder: A review." Journal of affective disorders 148 (2013): 129-135.

Google Scholar, Crossref, Indexed at

2. Biernacka, Joanna M, Susan L. McElroy, Scott Crow and Alexis Sharp, et al. "Pharmacogenomics of antidepressant induced mania: A review and meta-analysis of the serotonin transporter gene (5HTTLPR) association." J Affect Disord 136 (2012): e21-e29.

Google Scholar, Crossref, Indexed at

3. Degner, Detlef, Merle Haust, Johannes Meller and Eckart Rüther, et al. "Association between autoimmune thyroiditis and depressive disorder in psychiatric outpatients." Eur Arch Psychiatry Clin Neurosci 265 (2015): 67-72.

Google Scholar, Crossref, Indexed at

4. Duffy, Anne, Martin Alda, Leah Crawford and Robert Milin, et al. "The early manifestations of bipolar disorder: A longitudinal prospective study of the offspring of bipolar parents." Bipolar Disord 9 (2007): 828-838.

Google Scholar, Crossref, Indexed at

5. Howard, Sasha R, Nicolas de Roux, Juliane Leger and Jean‐Claude Carel, et al. "Puberty and its disorders." Clin Pediatr Endocrinol (2019): 235-287.

Google Scholar, Crossref, Indexed at

6. Lidzba, Karen, Hanna Küpper, Gerhard Kluger and Martin Staudt. "The time window for successful right-hemispheric language reorganization in children." Eur J Paediatr Neurol 21 (2017): 715-721.

Google Scholar, Crossref, Indexed at