Evidence-Based Treatment of Pediatric Bipolar Disorder

Considering the complexity of pediatric bipolar disorder (BPD), there is a great need to identify safe, effective treatments. Treatment approaches can differ depending on the phase of BPD (acute manic/mixed, acute depressive, or maintenance). Monotherapy treatments include second-generation anti-psychotics (SGAs) or mood stabilizers. SGAs appear to be more effective, with five medications approved by the Food and Drug Administration (FDA), but the metabolic side effects are concerning. Lithium is the only mood stabilizer approved by the FDA. There is less focus on pharmacological treatment of depressive episodes, with two FDA-approved treatments: olanzapine/fluoxetine and lurasidone. There is also less focus on maintenance treatment, as only aripiprazole and lithium are FDA approved. Other research has focused on adjunctive treatments with additional medications and psychotherapy. Overall, there has been progress in diagnosis and treatment for pediatric BPD. Further research should explore double-blind, placebo-controlled studies of promising medications, along with long-term effects of medications and efficacy of adjunctive treatments.