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August 30, 2005

Anticonvulsants Safe for Kids With Bipolar Disorder?

Many of the drug trials for anticonvulsants and other mood stabilizers only have adults as their subjects. This creates a problem when deciding what is the safest medication to prescribe a child with bipolar disorder. This article goes over some of the risks and benefits of using anticonvulsants and other mood stabilizers in children diagnosed with bipolar disorder.

Lithium has been studied the most in regards to pediatric bipolar disorder (PBD) and is surprisingly the only FDA approved mood stabilizer for kids. It is currently approved for those 12 and over, although it is used for children younger than 12. "In an open-label study of 100 adolescents with type I bipolar disorder,4 63% met response criteria after 4 weeks of lithium and 26% showed manic symptom remission. Symptoms worsened in both groups, however, when 40 responders were randomly assigned to continue or discontinue lithium for 2 weeks" (Current Psychiatry Online, 2005). Lithium also has had a double-blind placebo controlled trial with adolescents.

Valproate has not had any double-blind placebo controlled studies done on it although open-label trials have been done on it. Its effectiveness in children and adolescents in the trials within this article ranged between 47%-80%. There are several serious side effects that could effect children. Special care must be taken when prescribing to adolescent girls with bipolar disorder due to some of these side effects.

Carbamazepine is often used as an adjunctive treatment for lithium, but is sometimes used as monotherapy. It cannot be used with monoamine oxidase inhibitors and has some sensitivity to tricyclic antidepressants. Its drug interactions should be taken into account when prescribing.

Oxcarbazepine has fewer drug interactions and similar efficacy when treating PBD. It also has less side effect risks, although it can alter ones estrogen and progestrone levels. This means it may make oral contraceptives (birth control pills) ineffective, so this should be considered when prescribing to teenage girls. It has no double-blind placebo controlled studies done on it.

Lamotrigine has been studied for kids with seizure disorders, but there are no controlled trials testing its effectiveness in kids with bipolar disorder. It can result in a severe rash, which seems to be age-related. This should be taken into consideration when prescribing for kids and adolescents.

Topiramate does not have much information available for use in children with bipolar disorder. It may have cognitive effects on users, some have reported having difficulty remembering words. It can result in weight loss, which is uncommon for a mood stablizer. This should be monitored by a physician when it is prescribed.

This article has useful information in regards side effects, benefits, and prescribing information for pediatric bipolar disorder. You can access this full article by clicking here.

Original Source: Are anticonvulsants safe for pediatric bipolar disorder? Current Psychiatry Online. August 2005. By Weller, E.B., Kloos, A.L., Hitchcock, S., Weller, R. A.


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