Should we be prescribing antipsychotics to young people with bipolar disorder?


This systematic literature review and meta-analysis conducted by researchers from the University of Nebraska Medical Center, will be of interest to all clinicians who treat paediatric bipolar disorder.

Treatment decisions for young people have previously been based on extrapolation from adult trials, case reports, open label trials or expert opinion. This new study provides a summary of clinical trials of young people from the last two decades.

The reviewers found 17 randomised controlled trials and 29 open label studies of antimanic agents in paediatric bipolar disorder (including 2,666 patients).  The review evaluated a range of drugs, including traditional mood stabilisers, other anticonvulsants, second-generation antipsychotics and naturopathic compounds.

The results of the meta-analysis show that:

  • Second-generation antipsychotics improve response compared with placebo in paediatric bipolar disorder
  • The results of randomised controlled trials of traditional mood stabilisers and other anticonvulsants are less promising
  • All psychotropic drugs are associated with serious adverse events, and additional research is needed to identify drugs with better safety profiles
  • Research on the efficacy of naturopathic compounds and on the safety and efficacy of psychotropic drugs for children younger than 10 years is limited

The reviewers conclude:

A substantial body of scientific literature has evaluated the safety and efficacy of various medicines and drug classes in the treatment of mania in pediatric bipolar disorder. More work is needed to assess the safety and efficacy of psychotropic drugs in children younger than 10 years, to further evaluate the efficacy of naturopathic compounds, and to further evaluate the effects of antimanic treatments for the management of depression and attention-deficit/hyperactivity disorder.

Liu HY, Potter MP, Woodworth KY, Yorks DM, Petty CR, Wozniak JR, Faraone SV, Biederman J. Pharmacologic treatments for pediatric bipolar disorder: a review and meta-analysis. J Am Acad Child Adolesc Psychiatry. 2011 Aug;50(8):749-62.e39. Epub 2011 Jul 13. [PubMed abstract]

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