In terms of treating bipolar disorder in children, the bulk of the evidence that we have is for medications called atypical antipsychotics, including risperidone, seroquel, aripiprazole, olanzapine, and others. And there are a number of such medications where there have been good studies, so-called double-blind, placebo-controlled studies, which show that these medications work, particularly for mania. Almost all of the trials focus on the manic side, and indeed some of these medications do have FDA indications for use in children, for mania.

Other medications that are used are the so-called mood stabilizers, such as lithium and valproate. There is some evidence that children with bipolar disorder may be somewhat less likely to respond to those medications than do the adults with bipolar disorder, although this is an area that certainly needs a lot more work.

One problem of course is that all of these medications have side effects, and the atypical antipsychotic medications in particular are often associated with weight gain and with children beginning to have difficulty with their so-called lipid profiles, this is called the metabolic syndrome, and we are concerned about long-term consequences. So you’re always balancing what’s effective versus the side-effect profile, trying to get as much effectiveness as you can and as few side effects as you can, and it’s really a very individualized kind of decision.

It’s a decision that really needs to be made with the family, the parents of the child, the child, and the physician all working together to balance out these different considerations.

Ellen Leibenluft, MD, is Chief of the Section on Bipolar Spectrum Disorders, Emotion and Development Branch, Intramural Research Program, National Institute of Mental Health.

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