Pharmacotherapy for Pediatric Bipolar Disorder

The onset of bipolar disorder (BD) most commonly occurs in adolescence; about 60% of bipolar adults exhibit their first mood symptoms before 19 years. The worldwide prevalence rate of BD in youth varies by report from 0% in the United Kingdom to 4% in India and Spain. In the United States, an overall lifetime prevalence rate for bipolar disorders, including bipolar I disorder (BD-I), bipolar II disorder (BD-II), and cyclothymia was reported to be 1% in a community sample of adolescents. Differences in methodology, diagnostic criteria used, and varying levels of access to mental health professionals may account for this disparity in prevalence rates. Children and adolescents with BD have significantly high rates of psychosocial morbidity and mortality. Youth with BD reportedly have a 10-fold increased risk of suicide, compared with the general population. Moreover, children and adolescents with BD demonstrate high rates of mixed episodes, rapid cycling, psychosis, and co-occurring illnesses. They also exhibit low rates of recovery and high rates of recurrences. Overall, the presentation of early-onset BD is associated with a poor prognosis. Typically, there is a lag period of about 8 to 10 years before BD is diagnosed and treatment is initiated. There is a 10% lower likelihood of recovery for each year of untreated illness. Therefore, it is important to recognize and treat BD early in the illness course.