Latest treatments for child and adolescent bipolar disorder from Child and Adolescent Psychiatry convention presentations on early onset bipolar disorder. Report courtesy of Child & Adolescent Bipolar Foundation.

This year's American Academy of Child & Adolescent Psychiatry (AACAP) meeting witnessed a substantial increase from previous years in presentations on early onset bipolar disorder by a variety of research centers. Selected highlights included:

1. Combination Pharmacotherapy in Pediatric Bipolar Disorders-Mood Stabilization

   Dr. Robert Findling presented data on a study of the use of lithium combined with divalproex (Depakote) in adolescents with BD. In this recently completed open-label, prospective, outpatient trial, children and adolescents with bipolar I disorder were treated for up to 20 weeks with combination therapy of lithium and depakote. Substantial symptom reductions were observed. More importantly, approximately half of the subjects who entered the trial achieved syndromal remission. The results of this study lend support to the idea that combination therapy may be a rational form of pharmacotherapy in pediatric bipolarity. It is suggested that treatment start with Lithium or Depakote as monotherapy for a trial of 6 weeks. If at that point the child is considered treatment nonresponsive, a second mood stabilizer may be added.

2. Combination Pharmacotherapy in Pediatric Bipolar Disorders-Treating Comorbid ADHD

   It is widely accepted that ADHD is highly comorbid with BD. In this presentation, Dr. Russell Sheffer and Dr. Robert Kowatch discussed a double-blind trial designed to determine the safety and efficacy of adjunctive Adderall vs. placebo. Subjects were youth ages 7-15 with BD taking Depakote. Results indicate that while significant reductions in mania symptoms are often achieved with Depakote, combination treatments are often needed to additionally address ADHD symptoms Adderall appears both safe and efficacious for co-morbid ADHD, but the mood disorder must be treated first. Of the participants with comorbid ADHD, 92% showed a positive response to adderall. The initial data was not stratified for types of ADHD, but it is suggested that the positive effects are seen on concentration and focus vs. hyperactive behavior. An additional point was made in this presentation that, like ADHD, there may be persistent symptoms of depression, which may respond to a low dose anti-depressant medication.. Again, this treatment should be secondary to treating the BD.

3. Olanzapine (Zyprexa) Treatment for Adolescent Bipolar Disorder

   Dr. Melissa DelBello presented a study designed to assess the effectiveness, tolerability, and safety of Olanzapine (Zyprexa) monotherapy for the treatment of hospitalized adolescents with mania associated with bipolar disorder, type I. In this study, nine manic or mixed-state BD adolescents were treated with 5-20mg of olanzapine during a 4-week open prospective trial. Preliminary results indicate that olanzapine is safe, effective and well tolerated for reducing mania, depressive and psychotic symptoms associated with adolescent BD. 70% of the subjects showed a response and 50% achieved remission, as measured by a score of <12 on the YMRS. It was also noted that comorbid ADHD improved in 89% of the subjects. Side effects noted as follows: sedation (78%), increased appetite (44%), and dizziness (22%). Sedation was associated with nonresponse to treatment, while weight gain (averaging 12 lbs) was associated with a positive response.

4. Omega-3 Fatty Acids in the Treatment of Mood Disorders

   Dr. Janet Wozniak presented a review of the literature, which suggests that this dietary supplement may play an important role in the prevention and treatment of mood disorders, addressing safety, efficacy and dosing. Unfortunately, the current literature is limited to one positive adult bipolar study and one case report addressing adult depression. Dr. Wozniak described her current study in progress, which is focused on the use of Omega-3 fatty acids in the treatment of BD in children and adolescents. Dosing in this study is at 2.6 grams and uses the brand OmegaBrite, the contents of which have been confirmed by MGH labs. The comparison group is being treated with olanzapine and topiramate.

5. Recognition and Treatment of Putative Prodromal Pediatric Bipolar Disorder

   Dr. Kiki Chang discussed the need for prevention of BD in young children. With research advances, several common risk factors have emerged for pediatric bipolar disorder. These include a family history of mood disorders and ADHD in a parent. Dr. Chang presented findings from a recent study designed to evaluate the efficacy of divalproex (Depakote) in children with mood and/or behavior disorders, who have a parent with BD. 25 children with a bipolar parent and who had major depression, dysthymia, ADHD, or cyclothymia were treated with divalproex for 12 weeks. Of the 23 subjects who completed more than 2 weeks of treatment, 18 (78%) were considered responders based on their Clinical Global Impression-Change. Side effects were minimal, except for mild weight gain. The researchers conclude that divalproex may be effective in treating bipolar offspring with mood and behavior disorders. Longitudinal study would be necessary to assess any role of divalproex in the prophylaxis treatment of full-blown BD in these children. This study has important implications for the early recognition and treatment of pediatric BD and raises an interesting area for future research into the efficacy of divalproex as an anti-kindling agent, with possible neuroprotective and neurogenerative effects.