What is the treatment of Bipolar Disorder in Children and Teens?

To date, there is no cure for bipolar disorder. However, treatment with medications, psychotherapy (talk therapy), or both may help people get better.

It's important for you to know that children sometimes respond differently to psychiatric medications than adults do.

To treat children and teens with bipolar disorder, doctors often rely on information about treating adults. This is because there haven't been many studies on treating young people with the illness, although several have been started recently.

One large study with adults funded by NIMH is the Systematic Treatment Enhancement Program for Bipolar Disorder (visit STEP-BD for more information). This study found that treating adults with medications and intensive psychotherapy for about nine months helped them get better. These adults got better faster and stayed well longer than adults treated with less intensive psychotherapy for six weeks.Combining medication treatment and psychotherapies may help young people with early-onset bipolar disorder as well. However, it's important for you to know that children sometimes respond differently to psychiatric medications than adults do.

Medications

Before starting medication, the doctor will want to determine your child's physical and mental health. This is called a "baseline" assessment. Your child will need regular follow-up visits to monitor treatment progress and side effects. Most children with bipolar disorder will also need long-term or even lifelong medication treatment. This is often the best way to manage symptoms and prevent relapse, or a return of symptoms.

It's better to limit the number and dose of medications. A good way to remember this is "start low, go slow." Talk to the psychiatrist about using the smallest amount of medication that helps relieve your child's symptoms. To judge a medication's effectiveness, your child may need to take a medication for several weeks or months. The doctor needs this time to decide whether to switch to a different medication. Because children's symptoms are complex, it's not unusual for them to need more than one type of medication.

Keep a daily log of your child's most troublesome symptoms. Doing so can make it easier for you, your child, and the doctor to decide whether a medication is helpful. Also, be sure to tell the psychiatrist about all other prescription drugs, over-the-counter medications, or natural supplements your child is taking. Taking certain medications and supplements together may cause unwanted or dangerous effects.

To date, lithium (sometimes known as Eskalith), risperidone (Risperdal), and aripiprazole (Abilify) are the only medications approved by the U.S. Food and Drug Administration (FDA) to treat bipolar disorder in young people.

Lithium Poisoning

Children may be showing early signs of lithium poisoning if they develop the following:

• Diarrhea
• Drowsiness
• Muscle weakness
• Lack of coordination
• Vomiting.

Take your child to the emergency room if he or she is taking lithium and has these symptoms. You should know that the risk of lithium poisoning goes up when a child becomes dehydrated. Make sure your child has enough to drink when he or she has a fever or sweats, such as when playing sports in the hot summer.

Lithium is a type of medication called a mood stabilizer. It can help treat and prevent manic symptoms in children ages 12 and older. In addition, there is some evidence that lithium might act as an antidepressant and help prevent suicidal behavior. However, FDA's approval of lithium was based on treatment studies in adults. In fact, some experts say the FDA might not approve giving lithium to bi...