Bipolar Medications for Children
Bipolar medications for children are a subject of controversy due to the unknown long term side effects , the lack of knowledge about pediatric bipolar disorder in general, and the paucity of good research on the effectiveness of the medications themselves. The Journal of the American Academy of Child and Adolescent Psychiatry published guidelines in March of 2005 on treatment of bipolar disorder in pediatric patients. A flow chart on bipolar medications was included in that paper.
The guidelines were arrived at by analyzing the research available and ranking that research in the order of its quality. This is the best information on what bipolar medications should be chosen when treating this disorder in children . I am not a doctor, and this is merely an attempt to explain a protocol already outlined by doctors who are experts in pediatric bipolar disorder.
This web page and its linking pages are meant to serve as a more simplified and accessible summary for parents or professionals who are attempting to understand or ask questions about the choices in bipolar medications. Children who have early onset bipolar have been harmed by antidepressants and stimulants. Therefore it is important for us to be more educated about the bipolar medications used to treat children.
Don’t Depend on the Doctors to Give you the Necessary Information
Parents and professionals may fail to ask important questions about bipolar medications because they are intimidated by psychiatrists. Unfortunately some psychiatrists can be cold and dismissive; they may fail to tell you about side effects or other important information you need to know about the medications your child are on. You can’t depend on them to monitor your child’s medications, or to make choices without input from you.
Play and Active Role in Assessing your Child’s Response to Medication
When it comes to your child you cannot be too cautious or too informed. Sometimes the only way to help your child, is to take the lead in forging a relationship with your doctor. Ask questions, stay educated, and be a good observer and reporter. Hopefully this information will give you some confidence to discuss questions or concerns you may about bipolar medications.
The guidelines are divided into two sections with six progressive stages in each section. If one stage does not work, the doctor can move to the next stage.
Key Points About Guidelines
The guidelines are not applicable for Bipolar II , only for Bipolar I, manic or mixed, with or without psychosis.
I asked experts in the field why this is the case and was told, that basically due to lack of research and lack of funding this is the only information that is available. Information about Bipolar I, depressed is included but less conclusive.
This will be change as more studies are done on early onset bipolar. In fact, since the guidelines were published in 1995, both Risperidone (Risperdol) and Aripiprazole (Abilfy) were approved by the FDA to treat Pediatric Bipolar Disorder.
Even though guidelines for treating Bipolar II are less conclusive, recent research suggests many of the children presenting with Bipolar NOS will convert to Bipolar I, and even some of those with BPII will convert to BP I. (Birmaher, 2006).
Before reading the guidelines it is important to understand the two groups of bipolar medications used to treat early onset: mood stabilizers and atypical antipsychotics.
Below is a summary of the research supporting the effectiveness of the drugs commonly prescribed for early onset bipolar. Keep in mind unless specified otherwise, the effectiveness refers to Bipolar I, manic or mixed in adults and children.
Lithium Carbonate or Lithium
The best research evidence for child bipolar- including some suggestion that it helps with child depressive episodes and evidence that it does help with adult depressive episodes.
Divalproex or Depakote
The second best research evidence for child bipolar including some suggestion that it helps with child depressive episodes.
Carbamazapine or Tegretol
Pretty good evidence that it helps with adults.
Oxcarbazepine or Trileptal
Some case reports or suggestion that it is helpful for children. No evidence that it is helpful for adults, no hard evidence that it is helpful for children.
Topiramate or Topamax
Some evidence it’s helpful for kids.
No evidence that its helpful.
Respiridone or Risperdol
Good evidence for adults, some evidence for children.
Olanzapine or Zyprexa
Good evidence for adults some evidence for children. Also evidence for adults with both manic/ mixed and depressive episode of BP.
Quetiapine or Seroquel
Good evidence for adults some evidence for children. Also evidence for adults with depressed episode of BP. Click here for more information about seroquel, specifically it's relationship to anger.
Aripiprazole or Abilfy
Good evidence for adults some evidence for children.
Ziprasidone or Geodon
Good evidence for adults some evidence for children.
Clozaril or Clozapine
Some evidence for children.
Axelson D, Birmaher B, Strober M, et al. Phenomenology of children and adolescents with bipolar spectrum disorders. Arch Gen Psychiatry. 2006;63:1139-1148.
Kowatch RA, Fristad MA, Birmaher B, Wagner KD, Findling RL, Hellander M, Child Psychiatric Workgroup Members. Treatment guidelines for children and adolescents with bipolar disorder: Child Psychiatric Workgroup on Bipolar Disorder. J Am Acad Child Adolesc Psychiatry. 2005;44:213-235.
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