Pharmacological treatment of Juvenile Bipolar Disorder

Abstract

Juvenile Bipolar Disorder (JBD) has been recognized more frequently in the last years. The disorder might have an atypical presentation in this age range. Thus, irritability with "affective storms" are more frequent than euphoria, the evolution of the disorder is more chronic than episodic and mixed symptoms are more frequent. High prevalence of comorbid conditions, specially Attention-Deficit/Hyperactivity Disorder, seems to be the rule. Despite the devastating effect of JBD in the child development, few pharmacological investigations were conducted in these patients. This review aims to present a critical discussion of the findings from this emerging new area of research, the psychopharmacology of the JBD. To accomplish this task, a systematic computerized search of the literature was conducted through the PUBMED. Findings are presented in three sections: 1) the strength of the scientific evidence in the field; 2) critical description of the main investigations; 3) proposition of an algorithm to guide treatment options. Only one randomized, double-blind, controlled trial was found in the literature. Almost all studies are open prospective trials, case series, or retrospective analyses of medical records. The most investigated drugs are lithium and valproate sodium. This review suggest that a scarce availability of high quality evidence to guide clinicians in the decision on which pharmacological treatment should be used to address bipolar disorder in children and adolescents.