ReviewScandinavian journal of child and adolescent psychiatry and psychology2025
A systematic review of selective serotonin reuptake inhibitor (SSRI)-induced activation and manic/hypomanic switch in children and adolescents.
Review in Scandinavian journal of child and adolescent psychiatry and psychology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Serotonin selective reuptake inhibitor (SSRI) - induced activation and manic/hypomanic switch in children should be defined and delimited from each other. If not, this could contribute to inappropriate treatment decisions. This systematic review aimed, therefore, to explore how SSRI - induced activation and manic/hypomanic switch in children are defined, delimited from each other, assessed, and diagnosed. Methods: The PRISMA guidelines were followed. A systematic literature search was conducted in Pubmed, Cochrane, Scopus, and PsychINFO (from 8th to 15th March 2023). Eligible studies were in English, covering a population aged six to 18 years, where the outcome was activation or manic/hypomanic switch in relation to SSRI treatment. Two blinded assessors independently screened all abstracts, and thirty articles were included. Definitions, described symptoms, assessments, and inter-rater reliability were recorded. Results: Twelve articles were categorized as activation and 18 as mania/hypomania. Eight articles presented a clear definition of activation and four of mania/hypomania. Two articles presented inter-rater/test-retest reliability. One specific instrument was used for assessment of activation. No instrument was used for assessment of mania/hypomania. Symptom overlap was found, but more symptoms of 'aggression and hostility', 'anxiety and panic', and 'suicide and self-harm' were reported in activation while more 'cognitive and thought process alterations' and 'changes in mood and emotions' were reported in mania/hypomania. Discussion/conclusion: Vague definitions, and inadequate assessments and diagnostic procedures were found. There were some differences in symptoms between activation and manic/hypomanic switch. Other: The study protocol was published on Prospero 2023, CRD42023422133.
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