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In a recent study, investigators reported that treatment with nortriptyline helped only a small percentage of children (average age, 10 years) with prepubertal-onset major depression. Because many of these children had bipolar family members, poor response might have signified that these patients actually had occult bipolar disorder but had not yet passed through the age of risk. After 2 to 5 years of follow-up, the researchers reported that 32 percent of the children had switched to bipolar disorder. Now the same authors describe a 10-year follow-up of 91 percent of the original sample (72 probands with prepubertal depression; 28 controls).
By age 21, almost half of those with prepubertal depression had lifetime diagnoses of bipolar I disor…