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Abstract
BackgroundIn child and adolescent psychiatry, mood stabilizers are mainly prescribed for bipolar disorders (BD). Recognition of BD in adolescent is now clearly established. However, whether bipolarity exists in children is more controversial. To distinguish different clinical presentation in youth, it is recommended to use severe mood dysregulation (SMD) or temper dysregulation disorder (TDD) regarding previously called BD not otherwise specified. This point is currently in discussion for DSM 5. This distinction is very important as recent studies showed that treatment efficacy depends on diagnosis. MethodsWe reviewed pharmacological treatment approaches for BD in children and adolescents focusing both on short-term efficacy, prevention of relapse and adverse effects. ResultsWe found 16 double blind randomized controlled trials (DBRCT) with rigorous methodological criteria assessing short-term efficacy of medications in BD in children and/or adolescents. Four used mood stabilizers (lithium, n=2; valproate, n=1; divalproate, n=1; oxcarbamazepine, n=1); eight second-generation antipsychotics (SGA); two compared divalproate with an SGA; one compared lithium, valproate and risperidone; and one combined divalproate plus quetiapine. We found at least one DBRCT showing superiority to placebo for lithium, valproate, as compared to SGA (aripiprazole, risperidone, quetiapine, olanzapine and ziprasidone). Finally, we found only one relapse prevention DBRCT comparing lithium and divalproate. In sum, most studies refer to SGA short-term efficacy and trials remain too rare regarding mood stabilizers. However, anti-epileptics’ secondary effects are more evaluated compared with SGA or lithium because of their use in treating epilepsy. ConclusionCurrent state of data and recent studies bring us to stay very careful regarding use of mood stabilizers in pre-pubertal child with BD. In contrast, these treatments are indicated for adolescent BD in addition to psychotherapeutic treatment and educational care although the number of studies is still limited.
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