Magazine article Clinical Psychiatry News

Polypharmacy Often Used in Bipolar Children. (Some Data Support Practice)

Magazine article Clinical Psychiatry News

Polypharmacy Often Used in Bipolar Children. (Some Data Support Practice)

Article excerpt

CHICAGO -- When it comes to bipolar disorder, the general reluctance to treat young patients with polypharmacy disappears. In fact, combined drug treatment is apparently common and the few data that are available seem to justify the practice, Dr. Robert Findling said at an industry supported symposium at the American Psychiatric Association's Institute on Psychiatric Services.

It's best to start patients on monotherapy, "but you should recognize that it may not get them all better, and combined treatment is likely to be necessary," said Dr. Findling, director of the division of child and adolescent psychiatry at University Hospitals of Cleveland.

Efforts to apply evidence-based practice to pediatric bipolar disorder are hampered by a lack of data that are specific for this population. Furthermore, it is dear that results of adult trials cannot always be extrapolated to the young.

No Food and Drug Administration--labeled treatment exists for the condition. "Everything you do is off label," Dr. Findling noted. Within these constraints, he advised starting monotherapy with one of the two most established drugs, lithium or divalproex.

Lithium is the best-documented treatment, although only one placebo-controlled study exists in younger patients (dual diagnosed teenagers), and most data come from acute open trials. Dosing is well defined and is reasonably easy to do, he said.

The drug is generally well tolerated, but neurologic side effects, such as dysarthria and unsteady gait, have been seen in prepubertal patients at therapeutic doses. "Nuisance side effects" may be particularly distressing. For example, polyuria can lead to bedwetting and may cause intense shame. Hypothyroidism, apparently as common in children as adults, can have a negative effect on stature. …

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