Child Bipolar Medication Guidelines

Child Bipolar medication is summarized in the Treatment Guidelines for Children and Adolescents with Bipolar disorder: Child Psychiatric Workgroup on Bipolar Disorder. This web page is a summary of this professional article, written in more simplified terms so parents and others can understand. It is important to realize that in order to evaluate whether or not many of these Child Bipolar Medications are effective, a child must be at a therapeutic blood level. This may take as many as eight weeks to assess.

The first part of these guidelines are written to address Bipolar I Disorder, manic or mixed without psychosis. The second part guidelines addresses Bipolar I Disorder, manic or mixed with psychosis.

Bipolar I Disorder, Manic or Mixed without Psychosis

Bipolar I Disorder, Manic or Mixed without Psychosis.

Definitions

Monotherapy is the use of one drug.

Augmentation is the addition of another drug.

Partial response means that you see improvement, but not enough.

Mood stabilizers

Lithium

Depakote( Valproate)

Tegratol ( Carbamazepine)

Antipsychotics

Zyprexa (Olanzapine)

Seroquel (quetiapine)

Risperdol( Risperidone)

Abilify (Aripiprazole)

Stage 1 Monotherapy One Drug

The first choice if your child has this diagnosis is either a mood stabilizer or an antipsychotic from the list above. The choice of which will depend on the Doctor’s assessment of the symptoms. The Child Bipolar Medications listed here are the ones recommended by the panel, based on their experience and the evidence.

Stage 1A Augmentation

If your child has a partial response then the medication guidelines suggest adding another one of the agents above. This is called augmentation.

For example:

Lithium plus Depakote

Lithium plus Zyprexa

Lithium + Seroquel

Lithium plus Risperdol

Depakote + Zyprexa

Depakote + Seroquel

Depakote + Risperdol

Tegratol+Zyprexa

Tegratol + Seroquel

Tegratol+ Risperdal

Stage 2 Switch the Monotherapy Agent

If your child has no response to the augmenting agent then the medication guidelines suggest switching the primary monotherapy agent.

Example: Your child was on lithium, had a partial response, was tired with lithium and Depakote, with no improvement, then the monotherapy agent would be switched to Tegratol.

If your child has no response in Stage 1 then the Child Bipolar medication guidelines suggest switching to another monotherapy agent.

Example your child tried Lithium and it didn’t work then Depakote might be tried

If your child has a partial response to Stage 2 then the Child Bipolar medication guidelines suggest going back to Stage 1a. Augmenting the agent that is having a partial response.

Example your child tried lithium and it didn’t work, they tried Depakote and it worked partially. The Dr may try your child on Depakote and Seroquel.

Stage 3A or 3 B

If your child has no response to Stage 2 then the Child Bipolar medication guidelines suggest either trying a third monotherapy agent (3A).

or

Combining two agents (3B).

Stage 4A

If the the choie was made to try a third montherapy agent and the child does not respond or there is a partial response,the next choice would be to use combination treatment.

Stage 4B

If 4A produces no or partial response then it is recommended that 2 mood stabilizers be tried with an atypical antipsychotic.

Stage 4B

If the choice was made to skip the third trial of a monotherapy agent and to try combination treatment and that does not work, then it is also recommended that two mood stabilizers and an atypical antipsychotic be tried.

Stage 5

If two mood stabilizers and an atypical antipsychotic are tried and there is no response then alternative monotherapy is recommended (i.e. Geodon or Tripleptal)

Stage 6

If that does not work than ECT is recommended for adolescents or Clozapine.

Bipolar I Disorder, Manic or Mixed with Psychosis.

Stage 1

Mood Stabilizer + Antipsychotic

The first choice if your child has this diagnosis is a mood stabilizer plus an antipsychotic from the list above.

Stage 1A Augmentation or 3 Medications

If your child has a partial response then the Child Bipolar medication guidelines suggest adding another medication from above.

Stage 2 New Combination

If your child had no response or did not tolerate the first Stage 1 combination then the guidelines suggest trying a different combination of mood stabilizer and antipsychotic.

Stage 2A Augmentation

If your child responded partially to Stage 2, then the combination should be augmented with an additional mood stabilizer or antipsychotic.

Stage 3

If your child did not respond to Stage 2 then it is recommended that an alternate antipsychotic be tried.

Stage 3A

If your child had no response to the augmentation in Stage 1A or Stage 2A then the Child Bipolar medication guidelines suggest trying an alternate antipsychotic.

Stage 4

If your child has no response in Stage 3, or a partial response, then the bipolar medication guidelines suggest trying two mood stabilizers and an atypical antipsychotic).

Stage5

If your child has not response in Stage 4 or in Stage 3A then the guidelines recommend monotherapy with Trileptal or Geodon plus another antipsychotic.

Stage 6

If that does not work than ECT is recommended for adolescents or Clozapine. Leave Child Bipolar Medication for Homepage