What treatments are available for children and teens with bipolar disorder?

To date, there is no cure for bipolar disorder. However, treatment with medications, psychotherapy (talk therapy), or both may help people get better.

To treat children and teens with bipolar disorder, doctors often rely on information about treating adults. This is because there haven't been many studies on treating young people with the illness, although several have been started recently.

One large study with adults funded by NIMH is the Systematic Treatment Enhancement Program for Bipolar Disorder (visit STEP-BD for more information). This study found that treating adults with medications and intensive psychotherapy for about nine months helped them get better. These adults got better faster and stayed well longer than adults treated with less intensive psychotherapy for six weeks.¹⁹ Combining medication treatment and psychotherapies may help young people with early-onset bipolar disorder as well.¹¹ However, it's important for you to know that children sometimes respond differently to psychiatric medications than adults do.

Medications

Before starting medication, the doctor will want to determine your child's physical and mental health. This is called a "baseline" assessment. Your child will need regular follow-up visits to monitor treatment progress and side effects. Most children with bipolar disorder will also need long-term or even lifelong medication treatment. This is often the best way to manage symptoms and prevent relapse, or a return of symptoms.¹¹

It's better to limit the number and dose of medications. A good way to remember this is "start low, go slow." Talk to the psychiatrist about using the smallest amount of medication that helps relieve your child's symptoms. To judge a medication's effectiveness, your child may need to take a medication for several weeks or months. The doctor needs this time to decide whether to switch to a different medication. Because children's symptoms are complex, it's not unusual for them to need more than one type of medication.²⁰

Keep a daily log of your child's most troublesome symptoms. Doing so can make it easier for you, your child, and the doctor to decide whether a medication is helpful. Also, be sure to tell the psychiatrist about all other prescription drugs, over-the-counter medications, or natural supplements your child is taking. Taking certain medications and supplements together may cause unwanted or dangerous effects.

Some of the types of medications generally used to treat bipolar disorder are listed below. Information on medications can change. For the most up to date information on use and side effects contact the U.S. Food and Drug Administration (FDA)External Link: Please review our disclaimer. website. You can also find more information in the NIMH Medications booklet.

To date, lithium (sometimes known as Eskalith), risperidone (Risperdal), and aripiprazole (Abilify) are the only medications approved by the U.S. Food and Drug Administration (FDA) to treat bipolar disorder in young people.

Lithium is a type of medication called a mood stabilizer. It can help treat and prevent manic symptoms¹¹ in children ages 12 and older.²¹ In addition, there is some evidence that lithium might act as an antidepressant and help prevent suicidal behavior.²² However, FDA's approval of lithium was based on treatment studies in adults. In fact, some experts say the FDA might not approve giving lithium to bipolar youth if the agency were to review this treatment today.

Risperidone and aripiprazole are a type of medication called an atypical, or second-generation, antipsychotic. These medications are called "atypical" to set them apart from earlier types of medications, called conventional or first generation antipsychotics. Short-term treatment with risperidone can help reduce symptoms of mania or mixed mania in children ages 10 and up. Aripiprazole is approved to treat these symptoms in children 10-17 years old who have bipolar I.²¹

Your child's psychiatrist may recommend other types of medication, which are listed below. Studies in adults with bipolar disorder show these medications may be helpful. However, these medications have not been approved by the FDA to treat bipolar disorder in children.

Anticonvulsant medications are commonly prescribed to treat seizures, but these medications can help stabilize moods too. They may be very helpful for difficult-to-treat bipolar episodes. For some children, anticonvulsants may work better than lithium. Not every child can take lithium. Examples of anticonvulsant medications include:

• Valproic acid or divalproex sodium (Depakote)
• Lamotrigine (Lamictal).

Valproic acid, lamotrigine, and other anticonvulsant medications have an FDA warning. The warning states that their use may increase the risk of suicidal thoughts and behaviors. People taking anticonvulsant medications for bipolar or other illnesses should be closely monitored for new or worsening symptoms of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior. People taking these medications should not make any changes without talking to their health care professional.

Atypical antipsychotic medications are sometimes used to treat symptoms of bipolar disorder in children. These medications are called "atypical" to set them apart from earlier types of medications, called conventional or first-generation antipsychotics. In addition to risperidone and aripiprazole, atypical antipsychotic medications include:

• Olanzapine (Zyprexa)
• Quetiapine (Seroquel)
• Ziprasidone (Geodon).

Antidepressant medications are sometimes used to treat symptoms of depression in bipolar disorder. Doctors who prescribe antidepressants for bipolar disorder usually prescribe a mood stabilizer or anticonvulsant medication at the same time. If your child takes only an antidepressant, he or she may be at risk of switching to mania or hypomania. He or she may also be at risk of developing rapid cycling symptoms.²⁶ Rapid cycling is when someone has four or more episodes of major depression, mania, hypomania, or mixed symptoms within a year.²⁷ Some antidepressants that may be prescribed to treat symptoms of bipolar depression are:

• Fluoxetine (Prozac)
• Paroxetine (Paxil)
• Sertraline (Zoloft).

However, results on effectiveness of antidepressants for treating bipolar depression are mixed. The STEP-BD study showed that, in adults, adding an antidepressant to a mood stabilizer is no more effective in treating depression than using a mood stabilizer alone.²⁸

Some medications are better at treating one type of bipolar symptom than another. For example, lamotrigine (Lamictal) seems to be helpful in controlling depressive symptoms of bipolar disorder.¹¹

What are the side effects of these medications?

Before your child starts taking a new medication, talk with the doctor or pharmacist about possible risks and benefits of taking that medication.

The doctor or pharmacist can also answer questions about side effects. Over the last decade, treatments have improved, and some medications now have fewer or more tolerable side effects than past treatments. However, everyone responds differently to medications, and in some cases, side effects may not appear until a person has taken a medication for some time.

If your child develops any severe side effects from a medication, talk to the doctor who prescribed it as soon as possible. The doctor may change the dose or prescribe a different medication. Children and teens being treated for bipolar disorder should not stop taking a medication without talking to a doctor first. Suddenly stopping a medication may lead to "rebound," or worsening of bipolar disorder symptoms or other uncomfortable or potentially dangerous withdrawal effects.

The following sections describe some common side effects of the different types of medications used to treat bipolar disorder.

1. Mood Stabilizers

2. In some cases, lithium can cause side effects such as:

   • Restlessness
   • Frequent urination
   • Dry mouth
   • Bloating or indigestion
   • Acne
   • Joint or muscle pain
   • Brittle nails or hair.²⁹
   
   

   Lithium may cause other side effects not listed here. Tell the doctor about bothersome or unusual side effects as soon as possible.

   If your child is being treated with lithium, it is important for him or her to see the treating doctor regularly. The doctor needs to check the levels of lithium in the child's blood, as well as kidney function and thyroid function.

   Each mood stabilizing medication is different and can cause different types of side effects. Some common side effects of lamotrigine and valproic acid include:

   • Drowsiness
   • Dizziness
   • Headache
   • Diarrhea
   • Constipation
   • Heartburn
   • Mood swings
   • Stuffed or runny nose, or other cold-like symptoms.^{30, 31}
   
   

   These medications may also be linked with rare but serious side effects. Talk with the treating doctor or a pharmacist to make sure you understand signs of serious side effects for the specific medications your child is taking.

3. Atypical Antipsychotics

4. Some people have side effects when they start taking atypical antipsychotics. Most side effects go away after a few days and often can be managed successfully. People who are taking antipsychotics should not drive until they adjust to their new medication. Side effects of many antipsychotics include:

   • Drowsiness
   • Dizziness when changing positions
   • Blurred vision
   • Rapid heartbeat
   • Sensitivity to the sun
   • Skin rashes
   • Menstrual problems for girls
   • Weight gain.
   
   

   Atypical antipsychotic medications can cause major weight gain and changes in metabolism. This may increase a person's risk of getting diabetes and high cholesterol.³² While taking an atypical antipsychotic medication, your child's weight, glucose levels, and lipid levels should be monitored regularly by a doctor.

   In rare cases, long-term use of atypical antipsychotic drugs may lead to a condition called tardive dyskinesia (TD). The condition causes muscle movements that commonly occur around the mouth. A person with TD cannot control these movements. TD can range from mild to severe, and it cannot always be cured. Sometimes people with TD recover partially or fully after they stop taking the drug.

5. Antidepressants

6. The antidepressants most commonly prescribed for treating symptoms of bipolar disorder can also cause mild side effects that usually do not last long. These can include:

   • Headache, which usually goes away within a few days.
   • Nausea (feeling sick to your stomach), which usually goes away within a few days.
   • Sleep problems, such as sleeplessness or drowsiness. This may occur during the first few weeks but then goes away. To help lessen these effects, sometimes the medication dose can be reduced, or the time of day it is taken can be changed.
   • Agitation (feeling jittery)
   • Sexual problems, which can affect both men and women. These include reduced sex drive and problems having and enjoying sex.
   
   

   Some antidepressants are more likely to cause certain side effects than other antidepressants. Your doctor or pharmacist can answer questions about these medications. Any unusual reactions or side effects should be reported to a doctor immediately.

   For the most up-to-date information on medications for treating bipolar disorder and their side effects, please see the online NIMH Medications booklet.

Psychotherapy

In addition to medication, psychotherapy ("talk" therapy) can be an effective treatment for bipolar disorder. Studies in adults show that it can provide support, education, and guidance to people with bipolar disorder and their families. Psychotherapy may also help children keep taking their medications to stay healthy and prevent relapse.

Some psychotherapy treatments used for bipolar disorder include:

1. Cognitive behavioral therapy helps young people with bipolar disorder learn to change harmful or negative thought patterns and behaviors.
2. Family-focused therapy includes a child's family members. It helps enhance family coping strategies, such as recognizing new episodes early and helping their child. This therapy also improves communication and problem-solving.
3. Interpersonal and social rhythm therapy helps children and teens with bipolar disorder improve their relationships with others and manage their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes.
4. Psychoeducation teaches young people with bipolar disorder about the illness and its treatment. This treatment helps people recognize signs of relapse so they can seek treatment early, before a full-blown episode occurs. Psychoeducation also may be helpful for family members and caregivers.

Other types of therapies may be tried as well, or used along with those mentioned above. The number, frequency, and type of psychotherapy sessions should be based on your child's treatment needs.

A licensed psychologist, social worker, or counselor typically provides these therapies. This professional often works with your child's psychiatrist to monitor care. Some may also be licensed to prescribe medications; check the laws in your state. For more information, see the Substance Abuse and Mental Health Services AdministrationExternal Link: Please review our disclaimer. web page on choosing a mental health therapist.

In addition to getting therapy to reduce symptoms of bipolar disorder, children and teens may also benefit from therapies that address problems at school, work, or in the community. Such therapies may target communication skills, problem-solving skills, or skills for school or work. Other programs, such as those provided by social welfare programs or support and advocacy groups, can help as well.¹¹

Some children with bipolar disorder may also have learning disorders or language problems.³⁶ Your child's school may need to make accommodations that reduce the stresses of a school day and provide proper support or interventions.

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