Pharmacologic Treatment Options for Bipolar Disorder in Children and Adolescents

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.