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Bipolar Depression in Pediatric Populations

Epidemiology and Management

  • Therapy in Practice
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Abstract

Depression in children and adolescents with bipolar disorder is more commonly observed than mania or hypomania, and is associated with significant functional disability in multiple environmental realms. Optimal management of pediatric bipolar depression is often defined by its multimodal nature with emphasis on both psychopharmacological and psychosocial treatment. This article provides a brief overview of the epidemiology and clinical course of pediatric bipolar depression, a clinically-oriented guide to the evidence-based psychopharmacological and psychosocial management of bipolar depression in youth, and suggestions on how best to integrate medication and therapy. Recommended treatment for bipolar depression in pediatric populations usually includes both medication and psychosocial interventions given a paucity of double-blind, placebo-controlled psychopharmacological studies. Lithium and lamotrigine are feasible and tentatively efficacious options; however, treatment with quetiapine monotherapy may be no better than placebo. Furthermore, some youth may be at heightened risk for developing manic symptoms after treatment with selective serotonin reuptake inhibitors (SSRIs). Psychotherapy, either alone or adjunctively with medications, provides practitioners with a safe and feasible alternative. Interpersonal and Social Rhythm Therapy for Adolescents (IPSRT-A), Child- and Family-Focused Cognitive Behavioral Therapy (CFF-CBT), Dialectical Behavior Therapy for Adolescents (DBT-A), family psychoeducation, and Family Focused Therapy for Adolescents (FFT-A) are evidence-based treatments available to clinicians treating youth with bipolar depression.

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Acknowledgments

Drs. Cosgrove and Roybal report no conflicts of interest.

Dr. Chang is a consultant for GlaxoSmithKline, Eli Lilly and Company, Merck, and Bristol-Myers Squibb; receives research support from GlaxoSmithKline, the National Institute of Mental Health, and the National Alliance for Research in Schizophrenia and Depression.

Preparation of this review was supported by Dr. Cosgrove’s Fellowship from the Veteran’s Administration War-Related Illness and Injury Study Center (WRIISC) as well as a Pilot Early Career Grant from the Lucile Packard Foundation for Children’s Health, on which Dr. Cosgrove is the principal investigator.

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  1. Pediatric Bipolar Disorders Program, Division of Child and Adolescent Psychiatry, Stanford University School of Medicine, 401 Quarry Road, Palo Alto, CA, 94305, USA

    Victoria E. Cosgrove, Donna Roybal & Kiki D. Chang

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  1. Victoria E. Cosgrove
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  2. Donna Roybal
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Correspondence to Victoria E. Cosgrove.

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Cosgrove, V.E., Roybal, D. & Chang, K.D. Bipolar Depression in Pediatric Populations. Pediatr Drugs 15, 83–91 (2013). https://doi.org/10.1007/s40272-013-0022-8

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