Principles of managing bipolar depression in children

For multifaceted management of bipolar disorder that is not restricted to an episode of bipolar depression, see Principles of managing bipolar disorder in children.

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

Principles of managing bipolar depression in children are similar to those for adults and young people but there is less evidence to support the efficacy of the interventions in children.

• Children treated with an antidepressant can switch to mania and need to be monitored carefully.
• Children are more susceptible to developing agitation, activation and suicidal thoughts when starting treatment with an antidepressant; this effect has been most often observed with SSRIs. Paroxetine should be avoided in children because it has been associated with an increased risk of suicidal thoughts and behaviours and other serious adverse events.
• Monotherapy or adjunctive therapy with lamotrigine may be effective based on limited evidence in open-label studies.
• Relapse and mood instability can have potentially disruptive effects on cognitive and emotional development, so the need for long-term prophylaxis should be considered.
• 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.