Bipolar Disorder in Children and Teens

While medicines to treat bipolar disorder have been well studied for use in adults, there are few long-term studies that confirm the effectiveness and safety of mood stabilizers or antipsychotics in children and adolescents who have bipolar disorder. Be sure to use all medicines exactly as your child's doctor has prescribed them. If your child has intolerable side effects from any medicine, call your doctor immediately.

Medication Choices

Medicines most often used to treat bipolar disorder in children and adolescents include:

• Mood stabilizers, such as lithium (for example, Eskalith or Lithobid), divalproex (Depakote), carbamazepine (for example, Tegretol), lamotrigine (Lamictal), or valproate (Depacon).
• Antipsychotics, such as olanzapine (Zyprexa), risperidone (Risperdal), or aripiprazole (Abilify). Antipsychotics can be used alone, or they may be combined with mood stabilizers for more effective control of manic episodes.
• Antidepressants such as selective serotonin reuptake inhibitors (SSRIs), like fluoxetine (Prozac, for example), to control episodes of depression. While antidepressants can be helpful for some children with bipolar disorder, they can also trigger mania. Doctors usually prescribe antidepressants along with mood stabilizers or antipsychotics to help prevent a manic episode. And the doctor needs to carefully monitor the child for mood changes.

Before prescribing medicine to treat bipolar disorder, your doctor will check your child for possible suicidal behavior by asking a few questions. See a list of questions your doctor may ask your child.

What To Think About

Deciding which medicines to use to treat bipolar disorder in children and adolescents can be a complicated issue. Be sure to discuss all the options and side effects with your child's doctor. Your child may have to try several medicines or combinations of medicines before finding what works best. Some medicines that seem to work at first may not work in the long term. Carefully monitoring the effects of medicines is a process that is essential in identifying what is working and what may need to be changed.

If the doctor prescribes the mood stabilizer lithium carbonate, your child will need regular blood tests to monitor the amount of lithium in the blood. Too much lithium may lead to serious side effects. Your child will also need regular blood tests to monitor the amount of carbamazepine and divalproex in the blood when using these medicines.

When you and your child's doctor are deciding which types of medicines to use in the treatment of bipolar disorder, consider:

• The side effects of each medicine and how well your child can tolerate them.
• How often your child will need to take the medicines.
• Whether your child is being treated for other illnesses or disorders and how those medicines will interact with medicines for bipolar disorder.
• Whether your child has used any of the medicines before and whether they worked.

FDA Advisory. The U.S. Food and Drug Administration (FDA) has issued an advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when the doses are changed.