We thank Drs Baldessarini, Hennen, and Faedda for their comments and careful reading of our article.1 We agree that as yet unrecognized or latent bipolar disorder is a particular concern and diagnostic challenge among young patients. Given this, and the age-dependent induction potential that we describe (suggesting that treatment with a selective serotonin reuptake inhibitor in as few as 11 to 15 children younger than 15 years is needed for 1 of them to experience a manic conversion, a level of risk that holds even after limiting our sample to patients with minor depression or an anxiety disorder), careful assessment and clinical monitoring during antidepressant treatment cannot be overemphasized—especially among children and adolescents.
Martin A, Young C, Leckman JF, Mukonoweshuro C, Rosenheck R, Leslie D. Risk of Mania With Antidepressants—Reply. Arch Pediatr Adolesc Med. 2005;159(3):298-300. doi:10.1001/archpedi.159.3.298-b