Emerging treatment options in bipolar disorder in adolescents: focus on ziprasidone

Bipolar disorder is a debilitating, and chronic condition in adolescents. The rate of diagnosis and treatment is increasing in adolescents despite considerable controversy regarding criteria for diagnosis. Atypical antipsychotics have been studied extensively for adult and adolescent bipolar disorder. Ziprasidone is an atypical neuroleptic with novel receptor-binding activity and a favorable side effect profile. It has been marketed in the US since 2000, and now has several indications approved by the US Food and Drug Administration. Emerging case reports, open-label studies, and randomized controlled trials suggest that it may have a role in the management of adolescent bipolar disorder. Somnolence, akathisia, tachycardia, and prolonged corrected QT intervals are major safety concerns. There are no definitive guidelines for dosing ziprasidone in adolescents based on current literature. However, optimal treatment may involve dosages near the adult range. Given minimal data and understanding of its effects on cardiac conduction, it might be prudent to obtain electrocardiograms prior to initiation and during treatment. While not a first-line medication choice for adolescents struggling with bipolar disorder, it may be considered in certain situations in which metabolic side effects and weight gain are of concern.