Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 3: Children and Mental Health
Overview of Mental Disorders in Children
Depression and Suicide in Children and Adolescents
Treatment
Bipolar Disorder
Pharmacological Treatment
The treatment of bipolar disorder entails treating symptoms of both depression
and mania. For decades, lithium has been the well-researched mainstay treatment
for mania in adults. Mania in bipolar disorder of children is also treated with
lithium, although the relevant research on children lags behind that on adults.
Only in recent years have researchers begun to study lithium in children and
adolescents, with good clinical response. Open trials of lithium were conducted
in the late 1980s (Varanka et al., 1988; Strober et al., 1990). More recently,
lithium proved to be more effective than placebo in treating adolescents who
were bipolar and substance dependent (Geller et al., 1998).
Children experience the same safety problems with lithium as do adults: toxicity
and impairment of renal and thyroid functioning (Geller & Luby, 1997). Lithium
is therefore not recommended for families unable to keep regular appointments
that would ensure monitoring of serum lithium levels and of adverse events.
Patients who discontinue taking the drug have a high relapse rate (Strober et
al., 1990).
As yet, there are no controlled studies on a number of other psychotropic agents
also used clinically in children and adolescents with bipolar disorder,
including valproate, carbamazepine, methylphenidate, and low-dose chlorpromazine
(Campbell & Cueva, 1995; Geller & Luby, 1997).
6 Major depression refers to conditions marked by a major depressive episode, such as major depressive disorder, bipolar disorder, and related conditions. The word "major" refers to the number of symptoms. See Chapter 4 for DSM-IV diagnostic criteria.
7 The relationship between sexual orientation,
depression, and suicidal thoughts and behavior is not well understood. Several
studies suggest a link (Faullener & Cranston, 1998; Garofolo et al., 1998;
Garofolo et al., 1999).
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