Bipolar disorder (BD) is a difficult-to-treat chronic disorder that burdens healthcare systems worldwide, including patients’ lives (Novick & Swartz 2019). Patients suffering from BD have mood dysregulation, such as extreme irritability, intense temper, and anger outbursts. Also, they have unusual shifts in mood, concentration, energy, and ability to execute routine work. The mood changes are classified as hypomanic (i.e., irritable or abnormally happy) and depressive. About 1.8% of adolescents and children globally have bipolar disorder. In the US, approximately 2.4% of children and adolescents have BD. Also, about 2.8% of the adult population has BD, constituting about 5.7 million people (Srinivas et al., 2020). In this regard, there are off-label and FDA-approved drugs for treating children and adolescents with BD.

Off-label drug

The FDA first approved quetiapine in 2006 and 2008 to treat adult patients with BD (Srinivas et al., 2020). However, this medication is commonly used to treat BD in the pediatric population (persons aged 10-17 years). Quetiapine is prescribed to children and adolescents with aggressive and manic symptoms. Most essentially, an eight-week prescription of quetiapine has high efficacy in treating depression or sad moods in adolescents and children (Srinivas et al., 2020). However, quetiapine is classified under atypical antipsychotics that cause metabolic alterations resulting in increased body weight. The side effects of quetiapine range from mild to severe; they include but are not limited to sore throat, stuffy nose, dizziness, fatigue, joint pain, high triglycerides, constipation, and headache. Quetiapine has extrapyramidal effects commonly known as drug-induced movement disorders such as dystonia, dyskinesia, and akathisia (Srinivas et al., 2020).

FDA-approved drug

Lithium is an FDA-approved drug for treating pediatric bipolar disorder, especially among youths aged between 12-17 years (Grant & Salpekar, 2018). It is preferably used to alleviate hypomanic experiences among children, adolescents, and adults. Also, it is used to prevent relapses and treat other acute episodes such as depression, anger, and aggression. According to practice guidelines, patients with bipolar disorder are first administered a mood stabilizer. Lithium is a first-line mood stabilizer for children and adolescents (Grant & Salpekar, 2018). However, lithium has side effects such as diarrhea and nausea, which tend to occur in the early stages of treatment. Acute experiences of diarrhea and nausea can result in drug discontinuation. However, these experiences tend to cease over time. Polydipsia and polyuria are other side effects of lithium that cause increased thirst and urination (Grant & Salpekar 2018). These effects cannot lead to drug discontinuation since they are mild. Another distressing and prevalent side effect of lithium is weight gain. Most patients are advised to observe their diets when given lithium as their medication.

Non-pharmacological intervention

Cognitive-behavioral therapy (CBT) is the most prevalent therapeutical approach suggested by all clinical guidelines for treating patients with BD. Typically, CBT is used to help individuals with BD change their pattern of thoughts (Novick and Swartz 2019). Some CBT strategies include practicing avoidance, learning relaxation techniques to calm the body, and facing fears. CBT plays four key roles in treating children and adolescents with BD. Firstly, it can lessen symptoms such as increased mood disorders, irritability, and depression. Secondly, it is used to foster drug adherence during the treatment process. Thirdly, educating patients about early signs of BD and how to overcome them. Lastly, CBT treats comorbid conditions (Srinivas et al., 2020). Mostly, medicine prescription is combined with CBT to attain the ideal goal of well-being.

References

Grant, B., and J. A. Salpekar. 2018. “Using Lithium in Children and Adolescents with Bipolar Disorder: Efficacy, Tolerability, and Practical Considerations.” Pediatric Drugs 20(4):303–14. doi: 10.1007/s40272-018-0289-x.

Novick, Danielle M., and Holly A. Swartz. 2019. “Evidence-Based Psychotherapies for Bipolar Disorder.” Focus 17(3):238–48. doi: 10.1176/app.focus.20190004.

Srinivas, Sushma, Tarun Parvataneni, Ramkrishna Makani, and Rikinkumar S. Patel. 2020. “Efficacy and Safety of Quetiapine for Pediatric Bipolar Depression: A Systematic Review of Randomized Clinical Trials.” Cureus 12(6):4–10. doi: 10.7759/cureus.8407.