Bipolar Disorder in Children and Teens Treatment Overview

Although mood changes and other symptoms associated with bipolar disorder are challenging, they can be managed effectively. Treatment usually includes medications (such as mood stabilizers) and professional counseling, and often a combination of both is needed. Bipolar illness is a serious disorder that has a big impact on both the child and his or her family. Successful treatment requires that the child and family members understand what happens in bipolar disorder and that the family members help make sure that the child follows the treatment. It can take time for you and your child to accept that the child has a serious, long-term condition that requires ongoing treatment and constant monitoring. However, keep in mind that by working with your child's doctor, you and your child can find effective treatment for the condition. You and your child's doctor can discuss which treatment is right for your child. Older children and teenagers may want to participate in their own treatment decisions.

Initial treatment The first step in determining appropriate treatment for your child with bipolar disorder is evaluating the severity of his or her symptoms. If your child's behavior is suicidal, aggressive, reckless, or dangerous, or if he or she is out of touch with reality (psychotic) or unable to function, the child may need a period of hospitalization. Also, many medications can make the symptoms of bipolar disorder worse, and if your child is taking one of these, he or she may need to taper off and stop the medication. This should only be done under the supervision of a doctor. Initial treatment usually includes medications and counseling.

Medications. Medications most often used include:

• Mood stabilizers, such as lithium (for example, Eskalith or Lithobid), divalproex (Depakote), carbamazepine (for example, Tegretol), lamotrigine (Lamictal), oxcarbazepine (Trileptal), or valproate (Depacon).
• Antipsychotics, such as olanzapine (Zyprexa) or risperidone (Risperdal), which your doctor may combine with a mood stabilizer for more effective control of manic episodes.
• Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (for example, Prozac), or other types of antidepressants to control episodes of depression. While antidepressants can be helpful for some children, they might also trigger mania. A doctor will usually prescribe antidepressants with other medications that help regulate mood, and he or she must carefully monitor the child.

Before prescribing medicine to treat bipolar disorder, your doctor will check your child for possible suicidal behavior by asking a few questions. See a list of questions your doctor may ask your child.

Professional counseling. Counseling works best when symptoms of bipolar disorder are controlled with medications. Several types of therapy may be helpful, depending on the age of the child. These include:

• Cognitive-behavioral therapy, which focuses on modifying certain thinking and behavior patterns.
• Interpersonal therapy, which focuses on social and personal relationships and related problems.
• Problem-solving therapy, a brief type of cognitive therapy that helps you find immediate solutions to problems.
• Family therapy, which can help educate and comfort the entire family.
• Play therapy for very young children.
• Psychological education and support groups.