Treatment for Bipolar Disorder in Children

Early detection a Symptoms of bipolar mood disorder in children is needed. And treatment for bipolar disorder in children would be optimal if done immediately. Mood stabilizing agents, particularly lithium has been demonstrated to be an effective treatment for adults with bipolar disorder 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 lithium is efficacious in the management of aggression behavior disorders. Open trials and retrospective chart reviews of children with early-onset bipolar disorder suggest that 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 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 treatment 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 treatment of childhood bipolar disorder 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 mood disorder stabilization is accomplished.
More investigation is needed to determine the most efficacious treatments for early-onset bipolar disorder and its frequent comorbidities.