Can we improve comorbid anxiety in youth with bipolar disorder?
Bipolar Disorder Among Youth. The typical period of BPD onset as a syndrome is between 16 and 24 years of age. By the conventional fully-syndromal criteria discussed earlier, the condition becomes less prevalent with decreasing age. Bipolar spectrum disorders affect 0.1% of children and 1% of adolescents.
What are the treatment options for bipolar disorder?
Bipolar disorder (BPD) is being diagnosed with increasing frequency in the pediatric population as the phenomenology of this disorder is becoming more clearly delineated. ... Pharmacologic treatment of pediatric bipolar disorder Child Adolesc Psychiatr Clin N Am. 2009 Apr;18(2):455-69, x. doi: 10.1016/j.chc.2008.11.004. ... Traditional mood ...
Should lithium be used to treat bipolar disorder in youth?
Open-label studies suggest that zonisamide may be useful for the treatment of adults with bipolar disorder (McElroy et al., 2005); however, there have been no studies examining zonisamide for the treatment of children and adolescent with bipolar disorder. Common side effects of zonisamide in patients with epilepsy include nephrolithiasis, drowsiness, ataxia, and loss of appetite.
What is the best medication for bipolar depression in teens?
· In DSM-5, bipolar and related disorders are given a chapter on their own (between depressive disorders and schizophrenia spectrum disorders), where bipolar-like phenomena that do not fulfill the diagnostic criteria for BD type I, II or cyclothymic disorder (i.e., short-duration hypomanic episodes and major depressive episodes, hypomanic ...
What treatment is recommended for youth with bipolar disorder?
A majority of pharmacologic trials with children and adolescents have focused on the treatment of bipolar mania. The pharmacologic agents that are typically used to treat mania in youths include lithium, antiepileptic drugs with mood stabilizing effects, and second generation antipsychotic (SGA) medications.
Which pharmacologic treatment option is best for patients diagnosed with bipolar disorder?
The most widely used drugs for the treatment of bipolar disorder include lithium carbonate and valproic acid (also known as Depakote or generically as divalproex). Lithium carbonate can be remarkably effective in reducing mania, although doctors still do not know precisely how it works.
What are the pharmacological treatment for bipolar disorder?
Medications may include: Mood stabilizers. You'll typically need mood-stabilizing medication to control manic or hypomanic episodes. Examples of mood stabilizers include lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, others) and lamotrigine (Lamictal).
Which medication would best be used for a child diagnosed with bipolar disorder?
Lithium. Lithium is FDA-approved to treat bipolar disorder in children and teens ages 7 to 17 years old. Lithium is among the most common medications for bipolar disorder. You may hear it called “the gold standard” or “first-line” choice.
What is the most effective treatment for bipolar disorder?
The most effective treatment for bipolar disorder is a combination of medication and psychotherapy. Most people take more than one drug, like a mood-stabilizing drug and an antipsychotic or antidepressant.
What are non pharmacological treatment interventions for bipolar disorder?
Cognitive-behavioural therapy, family-focused therapy, and psychoeducation offer the most robust efficacy in regard to relapse prevention. The most complex situations including comorbidities can be helped by behavioral and cognitive therapy for bipolar disorder. Evaluations emphasize positive impact.
What is pharmacological management?
Pharmacologic management tells when a patient takes a prescribed medicine, several side effects may be expected but can involve the potential for drug dependency or addiction.
Do SSRIs work for bipolar disorder?
Antidepressants Used for Bipolar Disorder The ISBD Task Force recommends that doctors prescribe these antidepressant types first to treat bipolar disorder: selective serotonin reuptake inhibitors (SSRIs),such asCelexa, Lexapro, Paxil, Prozac, and Zoloft. Bupropion,such as Wellbutrin.
Why do patients with bipolar disorder take anticonvulsants?
Today, they are often prescribed alone, with lithium, or with an antipsychotic drug to control mania. Anticonvulsants work by calming hyperactivity in the brain in various ways. For this reason, some of these drugs are used to treat epilepsy, prevent migraines, and treat other brain disorders.
Which of the following categories of medications is the most likely to be used to treat a manic episode in a teenager with bipolar disorder?
The most common medications for treating bipolar disorder in children and teens are antipsychotics, lithium and anticonvulsants.
What is the most common drug used to treat bipolar disorder?
Lithium. In the UK, lithium is the main medicine used to treat bipolar disorder. Lithium is a long-term treatment for episodes of mania and depression. It's usually prescribed for at least 6 months.
What mood stabilizers are FDA approved for children?
Lithium remains the only FDA-approved mood stabilizer for use in children > 12 years of age and along with valproic acid and carbamazepine, forms the triad of traditional mood stabilizers used for initiation of treatment for PBD.
Is risperidone safe for bipolar youth?
A recent 3-week, multicenter, randomized, double-blind, placebo-controlled study assessing the efficacy of risperidone for acute mania in children and adolescents with bipolar I disorder reported that risperidone was more effective than placebo for reducing manic symptoms in bipolar youth. 41 Specifically, in this study, participants were randomized to treatment with placebo, risperidone 0.5 to 2.5 mg/d, or risperidone 3 to 6 mg/d. Both risperidone groups had significantly more responders than placebo, and there was no difference in efficacy between the 2 dosage groups. However, the lower-dose group had fewer adverse events (AEs) and treatment discontinuations, suggesting that lower doses of risperidone may be more beneficial than higher doses.
What is the best medication for mania in youth?
Pharmacologic agents that are typically used to treat mania in youth include lithium, the antiepileptic drugs divalproex and carbamazepine, and the atypical antipsychotic agents risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole, with other adjunctive medications used as indicated. The only medications that are approved by the US FDA to treat acute mania in youth are lithium for children aged 12 years or older and risperidone and aripiprazole for children aged 10 years or older. In the past, there was limited information available regarding the use of these medications in youth, and therapy was largely based on adult literature, but knowledge has now begun to emerge on the treatment of pediatric bipolar disorder. Nevertheless, a majority of the pharmacologic trials done in children and adolescents with bipolar disorder are for the treatment of mania.
Is bipolar disorder a pediatric disorder?
Bipolar disorder is being diagnosed and treated with increasing frequency in the pediatric population. In one office-based practice sample, there was a 40-fold rise in the number of children and adolescents treated for bipolar disorder between 1994 and 2003.1 However, the diagnosis and treatment of bipolar disorder are often challenging in youth. Bipolar disorder presents differently in children and adolescents compared with adults, perhaps due to developmental differences in symptom expression. Nonetheless, traditional mood stabilizers and atypical antipsychotic agents are being used to treat all phases of pediatric bipolar disorder. Evidence supporting the use of these medications in acute manic or mixed episodes in youth is accumulating rapidly. However, prospective studies for the treatment of acute bipolar depression and maintenance therapy in children and adolescents are few, possibly due to its atypical presentation, high rates of comorbidity, and the dearth of long-term outcome data in this population. No medication has been approved by the United States Food and Drug Administration (FDA) for treating all phases of bipolar disorder in children and adolescents, but the literature is swiftly evolving, and new data on the treatment of pediatric bipolar disorder are constantly emerging. This article summarizes the extant literature of published pharmacologic studies of children and adolescents with bipolar disorder. A literature search using Medline/PubMed was conducted to identify published peer-reviewed papers.
Is lithium good for bipolar?
Lithium, one of the oldest mood stabilizers available, has been safely used to treat bipolar disorder in both adults and youth. In a double-blind, placebo-controlled study, Geller and colleagues assessed adolescents with bipolar disorder I or II, mania, or major depressive disorder with at least one predictor of future bipolar disorder and co-occurring substance dependence during a 6-week outpatient trial that included random weekly urine drug assays and random and weekly serum lithium levels.15 The authors found that lithium was effective for improving overall outcome measures as measured by a global functioning score. The mean age at onset of bipolar disorder was 9.6± 3.9 years, and the mean serum lithium level of active responders was 0.9 mEq/L.
Is bipolar disorder a major depression?
Depression is a major component of the clinical presentation of children and adolescents with bipolar disorder. Bipolar adolescents whose index episode is major depression have a more protracted recovery than those with an index manic or mixed episode.64 This illness phase has also been associated with a high-risk of suicide in youth and adults. However, limited knowledge is available to guide therapeutic approaches to bipolar depression in adolescents. Treating bipolar depression is a complicated task, as treatment with combinations of medications with the potential for aggravating manic symptomatology is often necessary. SSRIs have been reported to cause or exacerbate mania in youth with bipolar disorder. A retrospective study of children and adolescents with bipolar disorder reported that SSRIs were efficacious in the treatment of bipolar depression and that concomitant use of SSRIs during the treatment of active manic symptoms with mood stabilizers did not inhibit the antimanic effects of these medications.65 However, SSRIs were also associated with relapse of manic symptomatology in patients with depressive symptoms in the absence of active mania.
Is bipolar disorder a comorbidity?
ADHD is, by far, the most common comorbidity with pediatric bipolar disorder. The presence of comorbidities often worsens the prognosis of these patients and complicates their treatment. For bipolar youth with co-occurring ADHD, mood stabilization with a traditional mood stabilizer or an atypical antipsychotic medication is necessary before initiating stimulant therapy.73
Abstract
Treatment options for bipolar disorder have been primarily studied in adults. However, there is a growing body of research of these treatments in youths with bipolar disorder.
Empirical Evidence of the Pharmacological Treatment of Bipolar Disorder in Children and Adolescents with Manic Episodes
For the purpose of this article, response and remission rates are reported as indicated in the original publications. Definitions for response and remission vary across different studies, however, and differ based on the scale used and/or the cutoff used (e.g., percentage change and absolute score).
Empirical Evidence of the Pharmacological Treatment of Bipolar Depression in Children and Adolescents
Youth with bipolar disorder may experience full depressive episodes or subsyndromal depressive symptomatology. Youth with bipolar disorder spend nearly 40% of the time with impairing depressive symptoms ( 3 ).
Treatment-Resistant Bipolar Disorder
Despite documented efficacy of several pharmacological agents in the treatment of bipolar disorder in children and adolescents, empirical evidence shows that a substantial proportion of patients fail to achieve an adequate response or remission of symptoms.
Psychosocial Interventions in the Treatment of Bipolar Disorder
The development of bipolar disorder during childhood or adolescence disrupts ongoing developmental processes. Therefore, a comprehensive, multimodal treatment approach that combines psychopharmacology with adjunctive psychosocial therapies is usually indicated for children and adolescents with bipolar disorder ( 85 ).
Complementary Medicine
Omega-3 fatty acids are long-chain polyunsaturated fatty acids (LC-PUFAs) and are so named because of the position of the last double bond in their chemical structures.
Psychopharmacological Treatment of Bipolar Disorder with Comorbid Conditions
Despite evidence that patients with comorbid anxiety disorders are at increased risk for poor treatment response and treatment-emergent episodes ( 4 ), no clinical trials have explicitly studied the treatment of comorbid anxiety in pediatric bipolar disorder.
What is the purpose of bipolar disorder?
Opinion statement Purpose of review Bipolar disorder is a chronic and disabling condition that often presents in adolescence and leads to significant functional impairment , especially in the areas of emotional, cognitive, and social development. Pharmacotherapy is a vital component of the complex treatment of this disorder.The purpose of this review is to provide an overview of the available data on the management of bipolar disorder and the most common comorbid conditions in youth. Recent findings Several medications such as lithium and second-generation antipsychotics (risperidone, aripiprazole, olanzapine, quetiapine, and asenapine) are currently approved by the FDA for the management of acute mixed or manic phases of pediatric bipolar disorder. Very limited data are available on continuation treatment and management of depressive phases of bipolar disorder. There is some evidence that supports the use of a combination of an antipsychotic with lithium or an anticonvulsant for treatment of resistant cases. Summary Monotherapy with an atypical antipsychotic or lithium is the preferable initial treatment of acute manic or mixed episodes. The available evidence supports the use of an olanzapine/fluoxetine combination for the treatment of bipolar depression, which has also been approved by the FDA for this purpose. Additional studies are needed to evaluate safety and efficacy of psychopharmacological interventions, especially focusing on treatment of the depressive and maintenance phases of bipolar disorder.
Is bipolar disorder a comorbid condition?
Bipolar disorders (BD) are now recognized to occur in children and adolescents, often with other comorbid conditions, most notably attention deficit hyperactivity disorder (ADHD). Early recognition and treatment of BD in children and adolescents is vitally important to reduce ongoing syndromal or subsyndromal symptomatology, psychosocial morbidity and risk for suicide. BD is a familial illness and early onset depression, mood lability, or subsyndromal manic symptoms may increase the risk for the eventual emergence of manic episodes. While some longitudinal studies of clinical samples have suggested a higher risk of BD in individuals with ADHD, naturalistic longitudinal studies of community samples have not. Many youth with BD do meet symptom criteria but not the 4- or 7-day duration criteria. Symptoms of irritability, inattentiveness, and hyperactivity should be carefully assessed with longitudinal follow-up to ascertain whether these symptoms are indeed manifestations of BD (e.g., clustering of other manic symptoms, change from baseline, and functional impairment). Treatment of ADHD may benefit from stimulants after stabilizing the mood first. More treatment and longitudinal studies in comorbid BD and ADHD are needed to better understand protective and risk factors associated with brain responses and genetic/environmental factors.
What is AP medication?
... Antipsychotic (AP) drugs are recommended for the treatment for schizophrenia [1] and bipolar disorders [2] in children and adolescents . These drugs are effective in managing the core symptoms of these two diseases [1,2]. ...
Is PBD a psychosocial disorder?
Pediatric bipolar disorder (PBD) has emerged as a research field in which psychosocial treatments have provided a plethora of empirical findings over the last decade . We addressed this issue through a systematic review aimed of establishing their effectiveness and feasibility as adjunctive therapies for youth with PBD or at high-risk for PBD. A comprehensive search of databases was performed between 1990 and September 2014. Overall, 33 studies were specifically related to the issue and 20 of them were original articles. Evidence suggests that both «multi-family psychoeducational psychotherapy» and «family-focused therapy» are possible effective treatments for PBD. Likewise, «child and family-focused cognitive-behavioral therapy» may be characterized as a treatment in its experimental phase. The remaining therapies fail to obtain enough empirical support due to inconsistent findings among clinical trials or data solely based on case reports. Studies of psychosocial treatments provide concluding results concerning their feasibility and acceptability. Larger sample sizes and more randomized controlled trials are mandatory for diminishing methodological shortcomings encountered in the treatments displayed. Copyright © 2014 SEP y SEPB. Published by Elsevier España. All rights reserved.
Can a child have a mood disorder?
Mood disorders in children account for a significant amount of disability. However due to varied presentation of symptoms and subsyndromal episodes among children and adolescents, it is often difficult to correctly diagnose mood disorders. We are presenting a case of an adolescent male with atypical mood symptoms and highlighting on the difficulties faced in the diagnosis and the challenges in his management.
Is clozapine used for schizophrenia?
The use of clozapine (CLZ) for treatment-resistant schizophrenia is well established in adults. However, it is seldom used in youth with early onset schizophrenia (EOS) largely because of lack of clarity about its risk benefit ratio. This review synthesises and evaluates available evidence regarding the efficacy and tolerability of CLZ in EOS with the aim to assist clinical decision-making. We conducted a systematic review of the primary literature on the clinical efficacy and adverse drug reactions (ADRs) observed during CLZ treatment in EOS. We also identified relevant practice guidelines and summarised current guidance. CLZ showed superior efficacy than other antipsychotics in treating refractory EOS patients; short-term clinical trials suggest an average improvement of 69% on the Brief Psychiatric Rating Scale that was sustained during long-term follow-up (up to 9 years). No fatalities linked to CLZ treatment were reported. Sedation and hypersalivation were the most common complaints, reported by over 90% of patients. Other common ADRs (reported in 10-60% of patients) were enuresis, constipation, weight gain, and non-specific EEG changes. Less common ADRs (reported in 10-30% of patients) were akathisia, tachycardia and changes in blood pressure. Neutropenia was reported in 6-15% of cases but was usually transient while agranulocytosis was rare (<0.1%). Seizures were also uncommon (<3%). Metabolic changes were relatively common (8-22%) but emergent diabetes was not frequently observed (<6%). Overall the rate of discontinuation was low (3-6%). Current guidelines recommend the use of CLZ in EOS patients who have failed to respond to two adequate trials with different antipsychotics and provide detailed schedules of assessments to evaluate and assess potential ADRs both prior to initiation and throughout CLZ treatment. Available data although limited in terms of number of studies are consistent in demonstrating that CLZ is effective and generally safe in the treatment of refractory EOS provided patients are regularly monitored.
Does MST help with depression?
Magnetic seizure therapy (MST) has shown efficacy in adult patients with treatment-resistant depression with limited impairment in memory. To date, the use of MST in adolescent depression has not been reported. Here we describe the first successful use of MST in the treatment of an adolescent patient with refractory bipolar depression. This patient received MST in an ongoing open-label study for treatment-resistant major depression. Treatments employed a twin-coil MST apparatus, with the center of each coil placed over the frontal cortex (ie, each coil centered over F3 and F4). MST was applied at 100 Hz and 100% machine output at progressively increasing train durations. Depressive symptoms were assessed using the 24-item Hamilton Depression Rating Scale and cognitive function was assessed with a comprehensive neuropsychological battery. This adolescent patient achieved full remission of clinical symptoms after an acute course of 18 MST treatments and had no apparent cognitive decline, other than some autobiographical memory impairment that may or may not be related to the MST treatment. This case report suggests that MST may be a safe and well tolerated intervention for adolescents with treatment-resistant bipolar depression. Pilot studies to further evaluate the effectiveness and safety of MST in adolescents warrant consideration.