Bipolar disorder is a medical condition with many different treatment options to help your child or teen. Medications are usually a central part of treatment and are often very effective at stabilizing the mood and managing other symptoms of the disorder.
How does my child's doctor know which medications to prescribe for bipolar disorder?
Before starting any medication, your child's doctor will assess your child's mental and physical health. This is called finding out your child's "baseline" and may involve taking blood tests. Your child or teen will have regular follow-up appointments so their doctor can monitor their progress and check if medications have adverse side effects.
How long will my child need to take medications?
Most children and teens with bipolar disorder need to take medications for a long time. Usually, they start with low doses and then increase them gradually as needed.
Because the symptoms of bipolar disorder are quite complex, it is not unusual to need more than one medication to manage them. Your child may also need to take a medication for several weeks or months to give their doctor a chance to assess if it is suitable.
What types of medications are usually prescribed for bipolar disorder?
Doctors typically prescribe one or more of the following classes of medications to treat bipolar disorder in children and teens:
- mood stabilizers
- anticonvulsant medications
- atypical (second generation) antipsychotics
- antidepressants
These medications can sometimes come in different formulations (for example, in pill, powder or liquid). You can discuss the options with your child's doctor.
Mood stabilizers
Lithium
Lithium is approved by Health Canada to treat and prevent symptoms of mania or hypomania in children aged 12 and older. Lithium can also act as an antidepressant and help prevent suicidal behaviour.
If your child is prescribed lithium, they will need regular tests to monitor its level in their blood. If the level is too low, lithium will not be effective. If it is too high, it can cause toxicity (poisoning), which is a medical emergency. Caffeine intake can affect the blood lithium level, as can other over-the-counter and prescribed medications.
Adverse effects of lithium
Lithium may cause:
- a fine (very slight) tremor
- cognitive dulling (slowed thinking)
- frequent urination
- stomach upset (pain, nausea, vomiting, diarrhea)
- headaches
- acne
- rash
- weight gain
Signs of lithium toxicity
Lithium toxicity is more likely to happen if a child is dehydrated. The signs of toxicity include:
- diarrhea
- drowsiness
- difficulty speaking
- a severe tremor
- muscle weakness
- lack of co-ordination
Assuming the lithium level in the blood is within a safe range, most teenagers do not experience significant adverse effects. However, they do need regular blood tests to check for thyroid and kidney function, as lithium can affect these organs over longer periods of time.
Anticonvulsant medications
Anticonvulsants are sometimes used as mood stabilizers in bipolar disorder, but they were originally developed to treat seizures. These medications are not approved by Health Canada to treat bipolar disorder in children and teens. However, your doctor may prescribe these medications "off label", as they may work for some children.
The most common anticonvulsant medications for bipolar disorder are:
Valproic acid
Valproic acid treats manic and depressive episodes.
Adverse effects of valproic acid
Possible adverse effects include:
- tremor
- stomach upset
- hair thinning
- weight gain
- polycystic ovarian syndrome (PCOS) in females, which can lead to obesity, excess body hair and an irregular menstrual cycle
Your doctor may order blood tests to monitor for adverse effects. In rare cases, valproic acid is also linked with serious side effects involving the liver.
Valproic acid carries a warning around the possibility of increased suicidal ideation (thoughts of suicide). In addition, it can change the levels of other medications that your child might be taking at the same time. As a result, it is important to tell your doctor about all the medications that your child or teen is taking. Girls taking valproic acid should be carefully monitored by a doctor for symptoms or signs of PCOS.
Lamotrigine
Lamotrigine is used mainly to treat the depressive episodes of bipolar disorder.
Adverse effects of lamotigrine
Possible adverse effects include:
- fatigue
- blurred vision
- headaches
- lack of co-ordination
- stomach upset
- painful periods
- rashes
In rare cases, lamotigrine may also be linked with serious side effects involving the skin. If your child develops a new rash after they start on this medication, tell your child's doctor as soon as possible.
Lamotrigine may also change the blood levels of other medications that your child is taking at the same time. It is important to tell your doctor about all the medications that your child or teen is taking.
Atypical (second generation) antipsychotics
Atypical antipsychotics are used more frequently than anticonvulsants to treat bipolar disorder in children and teens. They include:
- aripiprazole (Abilify)
- risperidone (Risperdal)
- quetiapine (Seroquel)
- olanzapine (Zyprexa)
- ziprasidone (Zeldox)
- lurasidone (Latuda)
- clozapine (Clozaril)
Only aripiprazole has been approved by Health Canada for treating bipolar disorder (in teens aged 13 to 17). The rest are not approved and so may be prescribed "off label".
Adverse effects of atypical antipsychotics
Adverse effects may include:
- drowsiness
- light headedness
- menstrual problems for girls (with certain medications)
- weight gain (sometimes significant, especially in children, depending on the medication)
The significant weight gain and changes in metabolism from some antipsychotics can increase a child's risk of developing diabetes and high cholesterol. If your child is taking antipsychotics, their doctor should carefully monitor their weight and the levels of glucose and lipids (fats) in their blood.
In rare cases, long-term use of antipsychotics can lead to a neurological condition called tardive dyskinesia (TD). This involves uncontrolled muscle movements, most often around the mouth. Some children who reduce the dose or stop the antipsychotic may recover partially or fully, but others do not.
Antidepressants
Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), are sometimes prescribed to treat depression in bipolar disorder. They are usually used at lower doses and for shorter periods of time in bipolar disorder than they are for depression.
If a doctor prescribes an antidepressant for bipolar disorder, they will often prescribe a mood stabilizer at the same time. This is to reduce the risk of a child or teen switching to mania or hypomania.
Further information
For more information on bipolar disorder, please see the following pages:
Bipolar disorder: Signs and symptoms
Bipolar disorder: Treatment with psychotherapy and lifestyle changes
