Medicating Pediatric Bipolar Disorder: Challenges and Concerns

There’s little doubt that the diagnosis of childhood-onset bipolar disorder is on the rise. Office visits by children diagnosed with bipolar disorder multiplied 40-fold from 1994-2003. Disagreements abound as to what this means. Some researchers view the trend as a sign of progress: A disorder that has long gone undiagnosed in children is now being better screened and treated. Others, however, are more skeptical; they perceive the trend to be an example of gross over-diagnosis.

In truth, bipolar disorder is quite difficult to diagnose in children, and the presentation of childhood mania differs dramatically from adults. Children in the manic phase of the disorder tend toward extreme agitation and destructive outbursts, as opposed to the euphoria more common among adults.

The most widely used medications in the treatment of pediatric bipolar disorder are lithium and Depakote. Although studies confirm the effectiveness of these medications, their safety is questionable due to the life-long nature of bipolar disorder. Long term lithium use is linked to weight gain, acne, tremors and kidney dysfunction. Prolonged Depakote use is associated with pancreatitis and liver failure. Both medications require stringent blood-level monitoring. The bottom line: The benefit-vs.-risk of medicating childhood-onset bipolar disorder is a considerable concern.

Joseph Wegmann, R.Ph., LCSW is a licensed clinical pharmacist and a clinical social worker with more than thirty years of experience in the field of psychopharmacology. His diverse professional background in psychopharmacology and counseling affords him a unique perspective on medication management issues. In addition to consulting with numerous psychiatric facilities, he has presented psychopharmacology seminars to thousands of clinicians in 46 states.

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