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How is Bipolar Disorder Treated?

Bipolar Disorder in Children & Teens

What Can I Do To Help My Child?

Once the diagnosis of bipolar disorder is made, the treatment of children and adolescents is based mainly with medication.

The two most important types of medication used to control the symptoms of bipolar disorder are mood stabilizers and antidepressants.  Physicians may also prescribe other medications to help with insomnia, anxiety, restlessness, or psychotic symptoms.

Mood stabilizers are used to improve symptoms during manic, episodes; they may sometimes also reduce symptoms of depression. Three mood stabilizers are widely used in the United States:

• Lithium (Eskalith, Lithobid, Lithonate, and other brands)

• Valproate (most commonly used as divalproex [Depakote])

• Carbamazepine (Tegretol)

For all mood stabilizers, blood tests are used to determine the correct dose and to monitor safety.

WARNING:  According to studies conducted in Finland in patients with epilepsy, Valproate [Depakote] may increase testosterone levels in teenage girls and produce polycystic ovary syndrome in women who began taking the medication before age 20.  Increased testosterone can lead to polycystic ovary syndrome with irregular or absent menses, obesity, and abnormal growth of hair. Therefore, young female patients taking Valproate [Depakote] should be monitored carefully by a physician.  Information from National Institute of Mental Health.

Additional medications may be used for insomnia and agitation following a manic episode:

• Anti-anxiety medicines such as lorazepam (Ativan) and clonazepam (Klonopin)

• Anti-psychotic medicines such as haloperidol (Haldol) and perphenazine (Trilafon)

Both anti-anxiety and anti-psychotic medicine can cause drowsiness as a side effect.  Anti-psychotic medicines may also cause muscle stiffness, restlessness, and other side effects.

Most professionals consider the following two types of antidepressants to be first choices in bipolar disorder:

• Bupropion (Wellbutrin)

• Selective serotonin reuptake inhibitors: fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft)

If these do not work, or if they cause unpleasant side effects, the other choices are:

• Mirtazapine (Remeron)

• Monoamine oxidase inhibitors: phenelzine (Nardil), tranylcypromine (Parnate). These may be very effective if other drugs do not help, but also require a special diet to avoid dangerous side effects.

• Nefazodone (Serzone)

• Tricyclic antidepressants: amitriptyline (Elavil), desipramine (Norpramin, Pertofrane), imipramine (Tofranil), nortriptyline (Pamelor). Tricyclics may be more likely to cause side effects, or to set off manic episodes or rapid cycling.

• Venlafaxine (Effexor)

CAUTION:  Using antidepressant medication to treat depression in a person who has bipolar disorder may induce manic symptoms if it is taken without a mood stabilizer.  In addition, using stimulant medications to treat ADHD or ADHD-like symptoms in a child with bipolar disorder may worsen manic symptoms.  While it can be hard to determine which young patients will become manic, there is a greater likelihood among children and adolescents who have a family history of bipolar disorder.  If manic symptoms develop or markedly worsen during antidepressant or stimulant use, a physician should be consulted immediately, and diagnosis and treatment for bipolar disorder should be considered.  Information from National Institute of Mental Health.

Research on the effectiveness of these and other medications in children and adolescents with bipolar disorder is ongoing.

Adverse drug reactions should be reported to the FDA's MedWatch program.  This can be done by phone (1-800-332-1088), by fax (1-800-332-0178), or on the Internet via the MedWatch web site.

NEXT:  What Can I Do To Help My Child? 

Bipolar Disorder in Children & Teens

What Can I Do To Help My Child?

More Information

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