Childhood treatment with psychotropic medication and development of comorbid medical conditions in adolescent-onset bipolar disorder Jeanette M. Jerrell 1 *, Roger S. McIntyre 2 and Avnish Tripathi 3 1 Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, South Carolina, USA 2 Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, Canada 3 Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA Objective This study aims to investigate the association between early treatment with psychotropic medications and the development of medical comorbidities in pediatric patients who develop bipolar disorder (BD). Methods Data from the South Carolina Medicaid program covering all medical services and medication prescriptions between January 1996 and December 2005 were used to determine the association between childhood exposure to psychotropic medications (i.e., psycho- stimulants, antidepressants, and antipsychotics) and the diagnosis of select comorbid medical conditions in 1841 children and adolescents diagnosed with Diagnostic and Statistical Manual IV defined BD. Results In separate regressions controlling for all psychotropic medications prescribed and all comorbid medical conditions diagnosed prior to the BD, hypertension and cardiovascular disorders were more likely in those prescribed second generation antipsychotics or psycho- stimulants, whereas obesity/overweight was more likely in those taking serotonin norepinephrine reuptake inhibitor/heterocyclic antidepres- sants, and asthma was more likely in those taking selective serotonin reuptake inhibitors. Conclusion Childhood cardiometabolic events appear to be systematically associated with specific classes of psychotropic medications, but no innate, developmental sequencing of cardiometabolic abnormalities was apparent before early adolescence in patients subsequently diag- nosed and treated for BD. Copyright © 2011 John Wiley & Sons, Ltd. key words—pediatric bipolar disorder; comorbid medical conditions; antipsychotics; antidepressants; psychostimulants INTRODUCTION Several comorbid metabolic, cardiovascular, and psy- chiatric disorders (Fleischhacker et al., 2008) affect the presentation, course, and outcome of adult bipolar disorder (BD) (McIntyre, 2008; McIntyre et al., 2008). Over 60% of adults with BD have an age-at-onset dur- ing childhood or adolescence (Leverich et al., 2007; Perlis et al., 2004; Post and Kowatch, 2006). The metabolic/endocrine disorders most likely to co-occur in those with BD are obesity/overweight, type 2 diabe- tes mellitus, dyslipidemia, and thyroid disorders (Cassidy et al., 1999; Fenn et al., 2005; Johannessen et al., 2006; Kilbourne et al., 2004; Krishnan, 2005; McElroy et al., 2006; McIntyre et al., 2004; McIntyre et al., 2005; McIntyre et al., 2006; McElroy et al., 2006; Pine et al., 2001; Regenold et al., 2002; Ruzickova et al., 2003; Simon et al., 2006; Thompson et al., 2006; Wang et al., 2006). Furthermore, the age- adjusted rate of cardiovascular disorders, including hy- pertension, in the adult BD population is significantly higher than rates reported in the general population, with a younger mean age-at-onset (Fenn et al., 2005; Johannessen et al., 2006; Kilbourne et al., 2004; Thompson et al., 2006). Disparate other comorbidities are also associated with BD, for example, asthma (Fenn et al., 2005; Thompson et al., 2006), neurologi- cal disorders (i.e., migraine headaches, seizures, multiple sclerosis, traumatic brain injury, and cerebro- vascular accidents) (Fagiolini et al., 2002; Fagiolini et al., 2005; Simon et al., 2006; Thompson et al., 2006; Wang et al., 2006), and substance-related disor- ders (Kessler et al., 1997; Stinson et al., 2005). The age-at-onset or first diagnosis of these comorbid condi- tions is most likely to occur in early adolescence, often prior to a diagnosis of BD, and gender differences are evident (Jerrell et al., 2011). An adolescent-onset diag- nosis of BD (≥13 years) was significantly associated *Correspondence to: J. Jerrell, Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, 3555 Harden Street Ext., 15 Medical Park Suite 301, Columbia, SC 29203, USA. Tel: 803-434- 4507; Fax: 803-434-4277. E-mail: Jeanette.Jerrell@uscmed.sc.edu Received 25 February 2011 Accepted 12 July 2011 Copyright © 2011 John Wiley & Sons, Ltd. human psychopharmacology Hum. Psychopharmacol Clin Exp 2011; 26: 451– 459. Published online 7 September 2011 in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/hup.1227