How is Bipolar Disorder Treated?

Bipolar Disorder in Children & Teens

What Can I Do To Help My Bipolar 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), perphenazine (Trilafon), and risperidone (Risperdal)

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.  For example, side effects of Risperdal include tardive dyskinesia, a serious movement disorder, and neuroleptic malignant syndrome, which can cause paralysis and gross motor seizures.

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? 

More Information

Bipolar Disorder Patients on Divalproex [Depakote] More Likely to Commit Suicide Than Those on Lithium ~ Researchers compared the suicide rates of bipolar patients on lithium to those on Depakote.  It was found that the risk of completed suicide death was 2.7-times higher during treatment with Depakote than during treatment with lithium.

Bipolar Disorder Medication ~ Information from Medscape.

FDA Panel Rejects Strong Warnings of Suicide Risk on Epilepsy Drugs ~ Eleven common epilepsy drugs - also used by doctors to treat bipolar disorder and migraines - were found to nearly double the risk of suicidal thoughts or behaviors.  Still, the FDA voted against placing a "black box" warning on the drugs.

How is bipolar disorder treated? ~ Information on medications from RxList .

Intoxication Anosognosia: The Spellbinding Effect of Psychiatric Drugs (pdf) ~ Intoxication anosognosia (medication spellbinding) is an expression of this drug-induced mental disability.  Intoxication anosognosia causes the victim to underestimate the degree of drug-induced mental impairment, to deny the harmful role that the drug plays in the person's altered state, and in many cases compel the individual to mistakenly believe that he or she is functioning better.

Psychiatric Drug Facts ~ Dr. Peter Breggin's site includes information on how psychiatric drugs really work, adverse drug effects on the brain and mind, the role of the FDA, drug company practices, recent medical and legal developments.

Psychotherapy for Bipolar Disorder ~ At least five psychotherapy approaches for bipolar disorder have been been shown to be of benefit when added to medications for the treatment of bipolar disorder, compared to medications alone. 

Reclaiming your power during medication appointments with your psychiatrist ~ Meeting with a psychiatrist during "medication appointments" is usually a very disempowering experience.  The meetings usually last for 15 or 20 minutes.  During the meeting we are expected to answer a few perfunctory questions and to leave with prescriptions for powerful drugs that can dramatically alter the quality of our lives.  In these meetings the psychiatrist assumes a position of power and we usually fulfill the expected role of being a quiet, unquestioning, passive patient.  Subsequently we will be praised for merely being compliant or scolded/punished if we fail to comply with prescribed medications.  Here are some strategies for changing the power imbalance during medication meetings with psychiatrists.

Topiramate (Topamax), Mood Disorders and PTSD ~ Topamax is only approved for the treatment of people with seizures.  There are few systematic studies that establish the safety or efficacy of topiramate as a treatment for people with mood disorders, PTSD, or eating disorders.  While such studies are underway, what is currently known about the use of topiramate for the control of mood disorders, PTSD and eating disorders comes mostly from uncontrolled case reports.

The Use of Cannabis as a Mood Stabilizer in Bipolar Disorder ~ The authors present case histories indicating that a number of patients find cannabis (marijuana) useful in the treatment of their bipolar disorder. Some used it to treat mania, depression, or both.

What Killed Rebecca Riley? ~ It is estimated that there are nearly one million children diagnosed as bipolar, making it more common than autism and diabetes combined.  And to treat it, doctors are administering some medications that have yet to be approved for children.  In the case of Rebecca Riley, that cocktail of medications proved fatal and now her parents have been charged with her murder.