New treatment for bipolar disorder in children and adolescents: learning from adult studies

BACKGROUND
Up to 45% of bipolar patients fail to respond adequately to or do not tolerate treatment with standard antimanics (lithium, valproate, carbamazepine, or olanzapine). Several new potential normothymic and antimanic treatments are under study. However, there is less literature available on new treatments for bipolar disorder in children and adolescents, but many youths with manic symptoms are treated with mood stabilizers. Our goal was to review the current literature on alternatives to lithium, valproate and carbamazepine in the treatment of bipolar disorder in children, adolescents and adults, focusing on the potential uses of these drugs in youth.

METHODS
In a comprehensive computerized and manual literature search in Medline, we identified articles, abstracts and book chapters describing new treatments for bipolar disorder in children, adolescent, and adults. We also manually searched the abstracts in recent APA, AACAP and ECNP Annual Meetings.

RESULTS
There are very few studies on the treatment of youths with bipolar disorder. The strongest evidence of antimanic action in this age group is on lithium, valproate, and recently on olanzapine, and adjunctive risperidone. Evidence on new antiepileptics and other novel treatments is very limited or none.

CONCLUSION
More controlled studies on the treatment of children and adolescents with bipolarity are needed. Lithium, valproate, olanzapine and risperidone are probably the drugs with more evidence as antimanic efficacy in children and adolescents, but potential risks and benefits of treatment versus no treatment must be discussed with parents.

CITATION  Actas Esp Psiquiatr. 2003 Jan-Feb;31(1):40-7