Bipolar Disorder in Children
Early-Onset Bipolar Disorder

Medication for Bipolar Disorder

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 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 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

Other Medications

Doctors may prescribe antipsychotic medications (Risperdal, Zyprexa, Seroquel) for use during manic states, particularly when children experience delusions or hallucinations and when rapid control of mania is needed. Some of the newer antipsychotic medications are very effective in controlling rages and aggression. Weight gain is often a side effect of anti-psychotic medications.

Calcium channel blockers (verapamil, nimodipine, isradipine) have recently received attention as potential mood stabilizers for treating acute mania, ultra-ultra-rapid cycling, and recurrent depression.

Anti-anxiety medications (Klonopin, Xanax, Buspar, and Ativan) decrease anxiety by diminishing activity in brain arousal systems. They reduce agitation and over-activity, and help promote standard sleep. Doctors commonly use these medications as add-ons to mood stabilizers and antipsychotic drugs in acute mania.

Side-Effects of Bipolar Medications

Side effects that are particularly troublesome and that are worse in children include the following. Atypical neuroleptics (except aripiprazloe) are associated with marked weight gain in many children. One day we hope to have specific genetic tests that will tell us beforehand which people will gain weight on these medications. But right now, it is trial and error. The dangers of this weight gain include glucose problems that may include the onset of diabetes and increased blood lipids that may worsen heart and stroke problems later in life. In addition, these drugs can cause an illness called tardive dyskinesia, which is irreversible, unsightly, repeated movements of the tongue in and out of the mouth or cheek and some other movement abnormalities. Depakote may also be associated with increased weight and possibly with a disease called polycystic ovarian syndrome (POS). In some cases POS is associated with infertility later in life. Lithium has been the market the longest and is the only medication that has been shown to be effective against future episodes of mania and of depression and of completed suicides. Some people who take lithium over a long time will need a thyroid supplement and in rare cases may develop serious kidney disease.

It is very important that children on these medications be monitored for the development of serious side effects. These side effects need to be weighed against the dangers of the manic-depressive illness itself, which can rob children of their childhood.

Psychotherapy

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In addition to seeing a child psychiatrist, the treatment plan for a child with bipolar disorder usually includes regular therapy sessions with a licensed clinical social worker, a licensed psychologist, or a psychiatrist who provides psychotherapy. Cognitive behavioral therapy, interpersonal therapy, and multi-family support groups are an essential part of treatment for children and adolescents with bipolar disorder. A support group for the child or adolescent with the disorder can also be beneficial, although few exist.

Therapeutic Parenting^TM

Parents of children with bipolar disorder have discovered numerous techniques that the Child and Adolescent Bipolar Foundation refers to as therapeutic parenting. These techniques help calm their children when they are symptomatic and can help prevent and contain relapses. Such techniques include:

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