Review of Pediatric Bipolar Meds Finds Atypicals Better than Mood Stabilizers
Controversies about the diagnosis and treatment of bipolar disorder in children continue to be a stock feature of journals and blogs. Recently, the most comprehensive review and meta-analysis of pediatric bipolar medication options was published—and the results will likely encourage you to prescribe atypical antipsychotics over mood stabilizers. Researchers surveyed both published and unpublished studies over the past 20 years on the treatment of mania in children. They found a total of 46 relevant studies: 29 open-label trials and 17 randomized trials, reporting on 2,666 pediatric patients. To be included, studies must have focused on treatment of bipolar mania (bipolar depression studies were excluded), they had to use DSMIV criteria for bipolar disorder, and they had to use a validated mania rating scale, which was typically the Young Mania Rating Scale (YMRS). This was a large study which used the narrow criteria for bipolar disorder rather than the broad criteria. The studies focused specifically on the treatment of mania. (Of note, the use of the YMRS in children has been criticized.) Here are some of the more clinically relevant findings from the study:
Mood stabilizers do not appear effective for mania and are associated with a lot of side effects. SGAs should be the treatment of first choice for mania in pediatric bipolar disorder, but you need to monitor these children very closely for weight gain and be aware of the length of time a child stays on the medication. None of these studies looked at prevention of manic episodes, so don’t conclude that long term SGA is recommended here. See the December 2010 issue of CCPR for the data on on safety, or lack thereof, of antipsychotics in children. Also, the fact that mood stabilizers are not effective and that SGAs can have sedating effects beyond mania is relevant when considering the ongoing debate over the validity of even “narrow” phenotype PBD.
PO Box 626, Newburyport MA 01950
© 2023 Carlat Publishing, LLC and Affiliates, All Rights Reserved.