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Medication and Therapy for Treating Bipolar Disorder in Children

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Detailed overview of medications used to treat childhood bipolar disorder plus their side-effects plus the important role of therapy.

Detailed overview of medications used to treat childhood bipolar disorder plus their side-effects plus the important role of therapy.Few controlled studies have been done on the use of psychiatric medications in children. The U.S. Food and Drug Administration (FDA) has approved only a handful for pediatric use. Psychiatrists must adapt what they know about treating adults to children and adolescents.

Medications used to treat adults are often helpful in stabilizing mood in children. Most doctors start medication immediately upon diagnosis if both parents agree. If one parent disagrees, a short period of watchful waiting and charting of symptoms can be helpful. Treatment should not be postponed for long, however, because of the risk of suicide and school failure.

A symptomatic child should never be left unsupervised. If parental disagreement makes treatment impossible, as may happen in families undergoing divorce, a court order regarding treatment may be necessary.

Other treatments, such as psychotherapy, may not be effective until mood stabilization occurs. In fact, stimulants and antidepressants given without a mood stabilizer (often the result of misdiagnosis) can cause havoc in bipolar children, potentially inducing mania, more frequent cycling, and increases in aggressive outbursts.

No one bipolar medication works in all children. The family should expect a trial-and-error process lasting weeks, months, or longer as doctors try several medications alone and in combination before they find the best treatment for your child. It is important not to become discouraged during the initial treatment phase. Two or more mood stabilizers, plus additional medications for symptoms that remain, are often necessary to achieve and maintain stability.

Parents often find it hard to accept that their child has a chronic condition that may require treatment with several medications. It is important to remember that untreated bipolar disorder has a fatality rate of 18 percent or more (from suicide), equal to or greater than that for many serious physical illnesses. The untreated disorder carries the risk of drug and alcohol addiction, damaged relationships, school failure, and difficulty finding and holding jobs. The risks of not treating are substantial and must be measured against the unknown risks of using medications whose safety and efficacy have been established in adults, but not yet in children.

The following is a brief overview of medications used to treat childhood bipolar disorder. More information about specific medications is available in the Drug Database.

This brief overview is not intended to replace the evaluation and treatment of any child by a physician. Be sure to consult with a doctor who knows your child before starting, stopping, or changing any medication.

Mood Stablizers

  • Lithium (Eskalith, Lithobid, lithium carbonate) - A salt that occurs naturally in the earth, lithium has been used successfully for decades to calm mania and prevent mood cycling. Lithium has a proven anti-suicidal effect. An estimated 70 to 80 percent of adult bipolar patients respond positively to lithium treatment. Some children do well on lithium, but others do better on other mood stabilizers. Lithium is often used in combination with another mood stabilizer.
  • Divalproex sodium or valproic acid (Depakote) - Doctors frequently prescribe this anti-convulsant for children who have rapid cycling between mania and depression.
  • Carbamazepine (Tegretol) - Doctors prescribe this anti-convulsant because of its anti-manic and anti-aggressive properties. It is useful in treating frequent rage attacks.
  • Gabapentin (Neurontin) - This is a newer anti-convulsant drug that seems to have fewer side effects than other mood stabilizers. However, doctors do not know how effective this drug is, and some parents report activation of manic symptoms in young children.
  • Lamotrigine (Lamictal) - This newer anti-convulsant medicine can be effective in controlling rapid cycling. It seems to work well in the depressive, as well as the manic, phase of bipolar disorder. Any appearance of rash must be immediately reported to the doctor, as a rare but severe side-effect may occur (for this reason Lamictal is not used in children under l6).
  • Topiramate (Topamax) -This newer anti-convulsant drug may control rapid-cycling and mixed bipolar states in patients who have not responded well to divalproex sodium or carbamazepine. Unlike other mood stabilizers, it does not have weight gain as a side effect, but its efficacy in children has not been established.
  • Tiagabine (Gabitril) - This newer anti-convulsant drug has FDA approval for use in adolescents and is now being used in children as well.

Valproate (Depakote) Use Warning - National Institute of Mental Health

According to studies conducted in Finland in patients with epilepsy, valproate may increase testosterone levels in teenage girls and produce polycystic ovary syndrome in women who began taking the medication before age 20. Increased testosterone can lead to polycystic ovary syndrome with irregular or absent menses, obesity, and abnormal growth of hair. Therefore, young female patients taking valproate should be monitored carefully by a physician.