What Are the Treatments for Children With Bipolar Disorder?

Children who are diagnosed with bipolar disorder (BPD) will need to diligently follow a treatment plan for many years to come. Medication is necessary to stabilize moods and treat any other underlying issues, but the plan should also include education and therapy to help the child and her family learn to manage this disease.

Medication

• The types of medications used include mood stabilizers, anticonvulsants, antipsychotics, benzodiazepines, calcium channel blockers and sometimes antidepressants. Lithium is the first-choice mood stabilizer because it has a long history of success controlling manic episodes. It may sound odd to include anticonvulsants (Depakote, Lamictal, Tegretol, and Trileptal) in a list of bipolar medications, but they help prevent mania. The antipsychotic medications (Abilify, Geodon, Risperdal, Seroquel, Clorazil and Zyprexa) are often used when quick control is necessary. They also help prevent future episodes of mania and depression and control irritability and aggression. Benzodiazepines are only used only for short-term treatment because they are addictive. Antidepressants are not a first choice and are used only with caution because they can trigger a manic episode.

Education

• Successful management of bipolar disorder in children depends on a team approach that includes parents, caretakers and teachers along with physicians and therapists. The first step is education. Everyone, but especially the child and his parents/caretakers, should be taught about the disorder, how it manifests, the triggers that indicate impending mood swings, the purpose and proper use of medications, coping techniques, and how to manage behaviors. The physician who makes the diagnosis and prescribes medication should participate by teaching about the course of BPD and medications, but ongoing support and education is better obtained through therapy.

Therapy

• Family therapy is encouraged, as the parents' role is critical to ensure compliance with medication and to support their child's behavioral and emotional issues. This disease demands incredible energy and strength to manage. The child with BPD needs extreme attention so the family must learn how to take care of each member while maintaining a positive family dynamic. All of this requires professional intervention. Individual psychotherapy may be appropriate for the child. Another approach that has proven to be successful is cognitive behavioral therapy. The mood swings of BPD, especially depression, result in anxiety, pessimism, and overall negative thoughts and expectations. The CBT approach teaches children to become aware of their thoughts, how they influence behavior, and to learn new ways to respond. Another therapeutic method is interpersonal and social rhythm psychotherapy (IPSRT), which focuses on stabilizing natural rhythms so that a dependable routine is developed.

Community Based Mental Health

• Community-based mental health may also be called wraparound or direct care services. The purpose of this type of program is to provide consistent support across environments. To accomplish this, trained therapists work one-on-one with the child in her home, at school and during community activities. This is an individualized approach that emphasizes building on strengths. Parents---and whenever age appropriate, the child---are an integral part of the team to ensure the treatment plan is appropriate for their needs.

Alternative Treatment

• Alternative treatments are available but frequently aren't covered by health insurance. Supplementation of essential fatty acids may improve nerve function and help lift depression. Light therapy benefits those who suffer from seasonal depression. Additional studies are needed, but transcranial magnetic stimulation may treat depression by using magnets to stimulate a specific portion of the brain. The effect is similar to electroconvulsive shock treatment, but without seizures, electricity or anesthesia.