Bipolar disorder medications in children usual using a mood disorders stabilizing agent and also equipped with psychosocial treatment. Few randomized, placebo controlled treatment trials have been conducted with youth diagnosed with early-onset bipolar disorder. Therefore, current clinical strategies for youth diagnosed with bipolar disorders continue to include downward extensions of the literature from older adolescent and adult treatment studies of bipolar disorders.
Mood stabilizing agents, particularly lithium has been demonstrated to be an effective bipolar disorder medications for adults with bipolar disorders for acute mania, and bipolar depressive states, and has been shown to offer prophylactive properties in bipolar disorders. In childhood, controlled trials have provided evidence suggesting that bipolar disorder in children medication by lithium is efficacious in the management of aggression behavior disorders.
Open trials and retrospective chart reviews of children with early-onset bipolar disorder symptoms suggest that bipolar disorder in children medication using valproate (Depacon) is efficacious in the treatment of mania in childhood.
A recent randomized clinical trial comparing divalproex (Depakote) and quetiapine, (Seroquel) an atypical antipsychotic in the treatment of 50 adolescent patients with mania suggested that bipolar disorder in children medication using quetiapine is at least as effective as divalproex in the treatment of acute manic symptoms and quetiapine may work more quickly. Placebo-controlled trials will be necessary to determine if quetiapine is an effective monotherapy for child and adolescent mania.
An open-label trial of lamotrigine (Lamictal) in the medication of bipolar depression among youth provides preliminary support for its use in children and adolescents. Given the 8-week trial with 20 adolescents, whose mean final dose of lamotrigine was approximately 130 mg a day, no significant weight changes, rash, or other adverse events were seen during the trial.
Open trials using atypical antipsychotics including risperidone (Risperdal) and others using risperidone in combination with either lithium or valproate suggest that these combinations may be efficacious in controlling symptoms of mania.
An open trial of olanzapine monotherapy in the bipolar disorder medications in children found improvements in measures of both mania and depression after 8 weeks of treatment at doses ranging from 2.5 mg to 20 mg per day.
Psychosocial treatment intervention studies for bipolar disorder among youth include a pilot study by D. J. Miklowitz using an adjunctive family-focused psychoeducational treatment (FFT-A) modified for children and adolescents which had been shown to reduce relapse rate when used in adult bipolar patients. Results of this pilot investigation in children and adolescents treated with mood-stabilizing agents in addition to the psychosocial intervention included improvement in depressive symptoms, manic symptoms, and behavioral disturbance over 1 year.
In addition to managing manic and depressive symptoms in early-onset bipolar disorder, most children with bipolar disorder are likely to need treatment for comorbid ADHD. Chart reviews indicate that treatment of ADHD is significantly more successfully achieved after bipolar disorders medications is accomplished. More investigation is needed to determine the most efficacious treatments for early-onset bipolar disorder and its frequent comorbidities
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