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Treating Bipolar Disorder in Children and Adolescents

The following treatment guidelines are meant as a reference tool, but are not intended as treatment advice or to replace the clinical decision-making process of psychiatrists or other health professionals who administer these treatments. In clinical practice there are often good reasons why treatment approaches differ from what is described here.

 

Research on treating Bipolar Disorder in children and adolescents has been sparse, making it difficult to offer clear guidelines for treatments tailored specifically for youth [ref, ref]. The recommendations for treatment are thus the same as the general treatment approaches for Bipolar Disorder for adults [ref]. However, the following points should be kept in mind:

One study on Valproate [ref] and another on Oxcarbazepine [ref] found these medications not to be effective for treating Manic or Mixed Episodes in children and adolescents. These reasons why these medications may not work as well for youths as for adults remain unknown. Most authorities still consider Valproate as a first-choice treatment option for treating Manic or Mixed Episodes in children and adolescents [ref], but it is possible that in the future these recommendations will change. Valproate is listed in Step 2 of the treatment guidelines for Manic or Mixed Episodes, and Oxcarbazepine is listed in Step 4.

Lithium, Olanzapine, Quetiapine, Ziprasidone, Risperidone and Aripiprazole are all considered to be effective for treating Manic or Mixed Episodes in children and adolescents [ref]. These medications are included in Step 2 of the treatment guidelines for Manic or Mixed Episodes.

A very large percentage of children and adolescents with Bipolar Disorder will also suffer from concurrent Anxiety Disorders or ADHD.

In the case of Anxiety Disorders, it could be helpful to refer to the Guidelines for Treating Bipolar Disorder with Comorbid Anxiety Disorders.

In the case of ADHD, standard treatments with Stimulants can be used once the youth's Bipolar Disorder is stabilized and the youth continues to take a Mood Stabilizer such as Valproic Acid [ref]. This is important because otherwise taking Stimulants can induce or worsen manic symptoms.

 

Comorbid Anxiety Disorders

Pregnancy-Related Issues