Prophylaxis of bipolar disorder in children

For multifaceted management of bipolar disorder that is not restricted to prophylaxis of bipolar disorder, see Principles of managing bipolar disorder in children].

Bipolar disorder is extremely rare in children and prophylaxis should always be managed by a service with practitioners experienced in treating bipolar disorder in children.

Principles of prophylaxis of bipolar disorder in children are similar to those for adults and young people but there is little evidence to support the efficacy of these interventions in children, and treatment recommendations are extrapolated from evidence in adult populations.

• Relapse and mood instability can have potentially disruptive effects on cognitive and emotional development, so the benefits of long-term prophylaxis should be considered alongside the risks of adverse effects with long-term pharmacotherapy.
• Prophylaxis with lithium or sodium valproate may be effective based on limited evidence from observational and naturalistic studies of 6 to 18 months’ duration.
• Children appear to be at higher risk of antipsychotic adverse effects including extrapyramidal adverse effects, effects due to elevated blood prolactin concentration, and weight gain.