Drugs for bipolar disorder in children i psych central

Considering medication for your young child or teenager can be scary, but educating yourself can help allay those feelings.

Medication continues to be an effective treatment option for many people with bipolar disorder. There are a variety of drug options to choose from to help manage the symptoms and mood changes that are common with this condition.

Treatment for bipolar disorder often involves a combination of medication, psychotherapy, and lifestyle changes. A strong emotional support network and other options, such as support groups, can also be key tools in successfully managing bipolar disorder.

If medication has been recommended for your child or adolescent, it is natural to be concerned.

But knowing more about the medications prescribed, how these different “classes” or types work, and what questions to ask can help you on your journey to finding the best treatment for your child.

Bipolar disorder is a mental health problem characterized by extreme mood swings. There are three main types of bipolar disorder, each with its own unique symptoms and diagnostic criteria.

Two main features of bipolar disorder are manic and depressive episodes. The symptoms of bipolar disorder may look different in your child than in an adult.

In a manic episode, for example, your child may be hyperactive, talkative, and unable to sleep. In a depressive episode, they may cut themselves off from the world and appear hopeless and uninterested in their friends or hobbies.

Before the 90s, bipolar disorder was underdiagnosed in young people.

While the average age of onset is in your mid-twenties, bipolar disorder can affect people of any age. In fact, children as young as 5 have been diagnosed with bipolar disorder.

A study survey several countries have found a bipolar disorder rate of nearly 4% among young adults under the age of 21, up from a previous estimate of 1.8%.

It can be difficult to diagnose bipolar disorder in children and teens, who can already seem more emotional, unpredictable, or energetic than adults. Symptoms of bipolar disorder may overlap with those of anxiety, depression, and attention deficit hyperactivity disorder (ADHD). This overlap can make it difficult to diagnose bipolar disorder in your child.

While the reality or possibility of a diagnosis of bipolar disorder for your child may seem frightening and overwhelming, the condition is treatable and medication can be an essential part of your child’s treatment plan.

Lithium is approved by the FDA to treat bipolar disorder in children and adolescents between the ages of 7 and 17.

Lithium is among the most common medications for bipolar disorder. You may hear him call it “the gold standard” or the “front line” choice. It is derived from a natural element and has been first proven to help with bipolar disorder in the 1950s and 1960s.

Lithium, originally used as a salt, has been shown to have a noticeable “calming” effect on mania in particular. It has then been linked to significant reductions in suicidal behavior.

Experts believe lithium works by balance the brain’s neurotransmitters, which are the chemical messengers that your central nervous system uses to communicate.

Simply put, lithium can help stabilize your child’s mood and also prevent future episodes.

Research has proven that the drug – now taken as an oral tablet – is a safe and reliable treatment option for children or adolescents with bipolar disorder.

Lithium requires consistent blood tests to determine which dose is best for your child. Also, because lithium can affect the thyroid and kidneys, it is essential to monitor your child’s diet, blood tests and side effects.

Other side effects can include:

  • drowsiness
  • headache
  • nausea or dizziness
  • diarrhea
  • excessive thirst
  • increased urination
  • weight gain
  • weakness or fatigue
  • problems with memory or concentration

Aside from Depakote, anticonvulsants do not have FDA approval for use in children, so they are considered “off label” use for bipolar disorder.

Anticonvulsants refer to drugs originally used to help prevent seizures, especially in patients with epilepsy. Their effectiveness in treating bipolar disorder was first discovered in the 1960s, although usually an anticonvulsant was only tried if a patient did not respond to lithium.

So why do anti-epileptic drugs work for a mood disorder?

Well, anticonvulsants help your brain calm down, which is good for both epilepsy and bipolar disorder!

Researchers point out that epilepsy and bipolar disorder share an “episodic nature” and, despite their obvious differences, are both influenced by the overexcitability of nerve cells in the brain (neurons).

They are thought to work by decreasing this nerve activity, or neural discharge, in the brain.

Commonly used anticonvulsants include:

  • carbamazepine (Tegretol)
  • lamotrigine (Lamictal)
  • topiramate (Depakote)

Common side effects are:

  • dizziness
  • drowsiness
  • tremor
  • weight gain
  • nausea
  • diarrhea

Prozac is the only FDA Approved Antidepressant for use in children. Both Prozac and Lexapro are approved for use in adolescents.

As the name suggests, antidepressants specifically target the depressive phase of bipolar disorder. Common symptoms of depression include hopelessness, sadness, and worthlessness.

Antidepressants alone are often not the first choice for bipolar disorder because it has been shown to cause symptoms of mania in some people.

There are two main types of antidepressants used for bipolar disorder: serotonin and norepinephrine reuptake inhibitors (SNRIs) and selective serotonin reuptake inhibitors (SSRIs).

SNRIs work by increasing the levels of serotonin and norepinephrine – neurotransmitters in the brain responsible for mood – which help stabilize their mood. Commonly used SNRIs include duloxetine (Cymbalta) and venlafaxine (Effexor).

SSRIs work by preventing serotonin from leaving the brain quickly. This increases the level of serotonin, so there is more to help regulate your child’s mood.

Examples of prescribed SSRIs are:

  • citalopram (Celexa)
  • escitalopram (Lexapro)
  • fluoxetine (Prozac)
  • sertraline (Zoloft)

The side effects of SNRIs and SSRIs differ, but they both share:

  • upset stomach or nausea
  • dry mouth
  • headache
  • insomnia or other sleep problems
  • dizziness
  • sexual dysfunction
  • changes in appetite or weight

Certain atypical antipsychotics are FDA approved to treat bipolar disorder in children under 17 years old. These include Risperidone, Abilify, and Zyprexa.

Atypical antipsychotics, or “second generation antipsychotics,” are a class of drugs used with increased frequency to treat bipolar disorder.

In particular, these drugs treat the manic phase of bipolar disorder or psychosis – the inability to differentiate between reality and unreality.

Atypical antipsychotics have a strong sedating or calming effect, but often fewer side effects.

Like many other types of drugs used to treat bipolar disorder, atypical antipsychotics adjust chemicals in your brain, including dopamine and serotonin.

Research suggests that the two mood stabilizers like lithium and atypical antipsychotics are particularly effective in reducing the likelihood of the episode recurring. This combination can help maintain stability while preventing manic and depressive episodes.

Commonly used atypical antipsychotics include:

Side effects can include:

  • Feeling tired
  • dizziness
  • nausea
  • dry mouth
  • weight gain

Asking your child to start medication for bipolar disorder can seem overwhelming, but educating yourself about the different options can help ease some of your anxiety.

Many people living with bipolar disorder respond well to medications and find them helpful in managing their symptoms.

Remember: When it comes to starting or continuing a drug regimen, communication is key!

It is important that young patients and their caregivers know that they have the right to ask questions of their healthcare professionals at any time. Doctors and pharmacists want you to have all the information you need to make decisions about your child’s care.

Questions to consider before the appointment:

  • Does my child have any other known health problems?
  • Is my child currently taking other drugs that may interact with a new drug?
  • Does my child have any known drug allergies?
  • Have other family members ever taken this medicine? How did they respond?

Questions to ask your doctor or pharmacist:

  • Why is this your medicine of choice for my child?
  • What is the average starting dose?
  • What are the common and rare side effects of starting this medication?
  • If my child starts this medication, when will we know if it “works”?
  • If the drug does not have the desired effect, will we increase the dose or switch to another drug?
  • If my child needs to stop taking this medicine, what should we do? What side effects might occur?
  • Is this drug covered by my insurance? If not, how much does it cost out of pocket?

Questions to discuss with your child:

  • Do you trust this doctor?
  • What do you think about the possibility of starting a medication?
  • Are you ready to be totally honest with me about the side effects?
  • Are you ready to do your best to take your medication as directed?
  • Do you understand that there are foods and substances that can interact dangerously with these drugs?
  • If this treatment option does not work, can you agree to let me know so that we can research alternatives?

It can be easy to think of discussing medication as an “adult” conversation, mostly between parents and doctors.

But remember, it is your child or teen who will experience the changes brought about by a new medication and who will take responsibility for sticking to a new regimen.

Consider speaking with your child and try to make room for their feelings and opinions. Let them know that you are a supporting partner on their journey to stability and recovery, of which medication is only a part.

Below are some helpful resources for providing additional training and support:

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