Art and Craft of Pharmacotherapy in PBD: Problem Solving in Pediatric Bipolar Disorder

Abstract

Pharmacotherapy research has a critical role in enriching clinical practice. However, the pediatric pharmacotherapy studies often suffer from small numbers, open trials, intangible methods that do not lend themselves to enroll seriously ill patients, and worst of all, too slow behind the actual clinical experience accrued through trial and error. Therefore, researchers and clinicians come to learn from each other the craft of how to interpret research data and what the pertinent clinical questions or struggles would entail. In this article, I attempt to bring to the forefront, clinical dilemmas and real life clinical challenges, and I attempt to tie in the research findings to address these problems to the extent possible, highlighting the short falls of current emiprical evidence. For example, integrating evidence from various clinical trials, we demonstrated the effectiveness of a pharmacotherapy algorithm in PBD (Pavuluri et al., 2004). One of the major findings on the review of pharmacotherapy research is that the use of a single mood stabilizer in the treatment of PBD has been shown to be ineffective in more than 50% of cases (Kafantaris et al., 2001; Kowatch et al., 2003). Adjunctive medications are often necessary to successfully treat this disorder. Thus, the use of rescue medications even in the in acute or longer– term trials. Furthermore, a systematic approach to medication management will prove useful in updating a patient’s treatment when faced with the development of medication tolerance or worsening of this cyclical and multifaceted disorder.