Pediatric bipolar major depression: Choosing treatment
- David Axelson, MD
David Axelson, MD
- Professor of Psychiatry
- The Ohio State University College of Medicine
Pediatric bipolar disorder often includes episodes of major depression. As an example, a four-year, prospective observational study of children and adolescents with bipolar disorder (n = 413) found that they were ill with major depression for 6 percent of the follow-up time, and ill with subsyndromal depressive symptoms for another 12 percent of the time .
This topic reviews choosing treatment for pediatric bipolar major depression. Other aspects pediatric bipolar disorder are discussed separately, including an overview of choosing treatment; general principles of using pharmacotherapy; the efficacy and core elements of adjunctive psychotherapy; assessment and diagnosis; and the epidemiology, clinical features, and course of illness:
- Birmaher B, Axelson D, Goldstein B, et al. Four-year longitudinal course of children and adolescents with bipolar spectrum disorders: the Course and Outcome of Bipolar Youth (COBY) study. Am J Psychiatry 2009; 166:795.
- Cosgrove VE, Roybal D, Chang KD. Bipolar depression in pediatric populations : epidemiology and management. Paediatr Drugs 2013; 15:83.
- Detke HC, DelBello MP, Landry J, et al. Olanzapine/fluoxetine combination in children and adolescents with bipolar I depression: A randomized, double-blind, placebo-controlled trial. J Am Acad Child Adolesc Psychiatry 2015.
- Findling RL, Pathak S, Earley WR, et al. Efficacy and safety of extended-release quetiapine fumarate in youth with bipolar depression: an 8 week, double-blind, placebo-controlled trial. J Child Adolesc Psychopharmacol 2014; 24:325.
- DelBello MP, Chang K, Welge JA, et al. A double-blind, placebo-controlled pilot study of quetiapine for depressed adolescents with bipolar disorder. Bipolar Disord 2009; 11:483.
- Chang K, Saxena K, Howe M. An open-label study of lamotrigine adjunct or monotherapy for the treatment of adolescents with bipolar depression. J Am Acad Child Adolesc Psychiatry 2006; 45:298.
- Carandang CG, Maxwell DJ, Robbins DR, Oesterheld JR. Lamotrigine in adolescent mood disorders. J Am Acad Child Adolesc Psychiatry 2003; 42:750.
- Soutullo CA, Díez-Suárez A, Figueroa-Quintana A. Adjunctive lamotrigine treatment for adolescents with bipolar disorder: retrospective report of five cases. J Child Adolesc Psychopharmacol 2006; 16:357.
- Patel NC, DelBello MP, Bryan HS, et al. Open-label lithium for the treatment of adolescents with bipolar depression. J Am Acad Child Adolesc Psychiatry 2006; 45:289.
- Wozniak J, Faraone SV, Chan J, et al. A randomized clinical trial of high eicosapentaenoic acid omega-3 fatty acids and inositol as monotherapy and in combination in the treatment of pediatric bipolar spectrum disorders: a pilot study. J Clin Psychiatry 2015; 76:1548.
- Findling RL, McNamara NK, Gracious BL, et al. Combination lithium and divalproex sodium in pediatric bipolarity. J Am Acad Child Adolesc Psychiatry 2003; 42:895.
- Kowatch RA, Sethuraman G, Hume JH, et al. Combination pharmacotherapy in children and adolescents with bipolar disorder. Biol Psychiatry 2003; 53:978.
- Biederman J, Mick E, Spencer TJ, et al. Therapeutic dilemmas in the pharmacotherapy of bipolar depression in the young. J Child Adolesc Psychopharmacol 2000; 10:185.
- Sit D, Wisner KL, Hanusa BH, et al. Light therapy for bipolar disorder: a case series in women. Bipolar Disord 2007; 9:918.
- Swedo SE, Allen AJ, Glod CA, et al. A controlled trial of light therapy for the treatment of pediatric seasonal affective disorder. J Am Acad Child Adolesc Psychiatry 1997; 36:816.
- Dauphinais DR, Rosenthal JZ, Terman M, et al. Controlled trial of safety and efficacy of bright light therapy vs. negative air ions in patients with bipolar depression. Psychiatry Res 2012; 196:57.
- McClellan J, Kowatch R, Findling RL, Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry 2007; 46:107.
- Ghaziuddin N, Kutcher SP, Knapp P, et al. Practice parameter for use of electroconvulsive therapy with adolescents. J Am Acad Child Adolesc Psychiatry 2004; 43:1521.
- Connor DF. Electroconvulsive therapy, transcranial magnetic stimulation, and deep brain stimulation. In: Dulcan's Textbook of Child and Adolescent Psychiatry, Dulcan MK. (Ed), American Psychiatric Publishing, Inc, Washington, DC 2010. p.795.
- Walter G, Rey JM. Has the practice and outcome of ECT in adolescents changed? findings from a whole-population study. J ECT 2003; 19:84.
- Rey JM, Walter G. Half a century of ECT use in young people. Am J Psychiatry 1997; 154:595.
- Stein D, Weizman A, Bloch Y. Electroconvulsive therapy and transcranial magnetic stimulation: can they be considered valid modalities in the treatment of pediatric mood disorders? Child Adolesc Psychiatr Clin N Am 2006; 15:1035.
- Geller B, Craney JL, Bolhofner K, et al. Two-year prospective follow-up of children with a prepubertal and early adolescent bipolar disorder phenotype. Am J Psychiatry 2002; 159:927.
- Scheffer RE, Tripathi A, Kirkpatrick FG, Schultz T. Guidelines for treatment-resistant mania in children with bipolar disorder. J Psychiatr Pract 2011; 17:186.
- Faedda GL, Baldessarini RJ, Glovinsky IP, Austin NB. Treatment-emergent mania in pediatric bipolar disorder: a retrospective case review. J Affect Disord 2004; 82:149.
- Baumer FM, Howe M, Gallelli K, et al. A pilot study of antidepressant-induced mania in pediatric bipolar disorder: Characteristics, risk factors, and the serotonin transporter gene. Biol Psychiatry 2006; 60:1005.