Earlier onset of bipolar disorder in children by antidepressants or stimulants? An hypothesis

Among adults and adolescents, bipolar disorder (BD) has a similar prevalence in the US and in the Netherlands. However, among pre-pubertal children, BD is frequently diagnosed in the US and seldomly in the Netherlands. This suggests that, among children, the prevalence of BD is lower in the Netherlands than in the US, indicating an earlier onset of BD in the US than in the Netherlands. It is hypothesized that this may be related to the greater use of antidepressants and stimulants for depression or attention deficit disorder with hyperactivity by US children. In those children who are genetically at risk to develop BD, these drugs may lead to a switch into mania.