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My son has bipolar disorder and is mostly depressed. He did not tolerate Lamictal (lamotrigine) or Seroquel (quetiapine). What are some other options for treatment?

When exploring treatment options in children diagnosed with bipolar disorder, it is important to remember each child is different, and may respond to different medications. Some children may need more than one medication to control their symptoms of bipolar disorder. There are many different types of medications used to treat acute manic episodes, acute depressive episodes, as well as maintenance medications for bipolar disorder. Both "mood stabilizers" and "atypical antipsychotics" are medications used in children and adults although some of them are not approved by the FDA for children. The atypical antipsychotics Abilify® (aripiprazole), Risperdal® (risperidone) and  Seroquel® (quetiapine) are FDA approved for bipolar disorder in children 10 to 17 years of age while Olanzapine (Zyprexa) is approved in children with bipolar disorder 13 to 17 years. Lithium, which is considered a mood stabilizer is also approved in children with bipolar 12 to 17 years of age. Other mood stabilizers are agents such as Tegretol® (carbamazepine), Depakote® (divalproex), and Lamictal® (lamotrigine); however, these are not FDA approved for the treatment of youths with bipolar disorder.

Currently, there are not any treatment guidelines for children diagnosed with bipolar depression. Based on studies in adults, lithium is recommended as one treatment option for children with bipolar depression. Other mood stabilizers, such as Depakote (divalproex) and Lamictal (lamotrigine) have also shown benefits but are not FDA approved. In some cases, an antidepressant may be added after a child has been taking a mood stabilizer. Please check out the medication fact sheets on www.nami.org to learn more about each of these medications. It is important to discuss treatment options with your child's doctor, and to understand the risks and benefits of each medication. Some children may also benefit from cognitive behavioral therapy (CBT) or other types of psychotherapy in addition to medications.

Author: Meghan Morgan, PharmD, BCPP

References:

  1. Kowatch RA, Fristad M, Birmaher B, et. al. Treatment guidelines for children and adolescents with bipolar disorder: child psychiatric workgroup on bipolar disorder. J Am Acad Chil Adolesc Psychiatry. 2005; 44:213-235.
  1. Bipolar Disorder in Children and Teens. www.nimh.nih.gov

 


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