Comparing Medications for Bipolar in Teens

Risperidone is best for improving function for children and teens with bipolar but with side effects

(RxWiki News) Bipolar disorder in children and teens is difficult to treat. Many medications on the market have not been tested in young people. A new study compares the safety and effectiveness of three drugs for bipolar disorder.

Three medications, lithium, an antipsychotic, and a drug specifically approved for mania, were given to children and teens with bipolar disorder. 

After eight weeks of treatment, the antipsychotic Risperdal (risperidone) was most effective for symptoms of mania, but it also caused severe weight gain.

Researchers recommend caution and close monitoring when using risperidone in children and teens.

"Discuss your child’s manic symptoms with their psychiatrist. "

Recent research by Barbara Geller, MD, at Washington University in St. Louis, MO, with others, enrolled 279 children and teens, aged 6 to 15, who had bipolar disorder. The patients were in a manic or mixed state and had not ever taken medication for their symptoms, prior to starting the study.

Patients in the study were randomly assigned to take either lithium, Depakote (divalproex sodium), or Risperdal (risperidone) for eight weeks.  Their symptoms, side effects and global functioning were measured each week.  

Risperidone was the best at reducing manic symptoms, but it also had the most severe side effects. Patients taking risperidone showed weight gain over the eight week period. Increased weight may lead to other health problems, so this side effect causes concern.

Lithium and divalproex sodium did not differ in their effectiveness. However, more patients taking lithium dropped out of the study compared to the other two drugs.

For all three drugs, common side effects were headaches, drowsiness, weight gain, and nasal congestion.

The researchers conclude, “Response rates at relatively low doses of risperidone suggest that clinicians can be more conservative with this medication.” Keeping doses low may lower the number or severity of side effects while still having benefits for mania symptoms.

Lithium is the oldest medication used to treat bipolar disorder but has been linked to serious side effects. Risperidone is an antipsychotic medication that is also used in the treatment of schizophrenia. Divalproex sodium is currently approved in the US for the treatment of mania.

Lithium is the lowest cost drug in this study, at about $16 per month. Risperidone averages about $125 a month, and divalproex sodium is about $184 per month.

The study was published in the May 2012 issue of the Archives of General Psychiatry. The study was funded by a grant from the National Institute of Mental Health (NIMH).

Dr. Geller reports affiliations for financial gain with NIMH and the FDA. Other authors report financial affiliations with Abbot, APA, Merck, Pfizer and various publishing groups.

Review Date: 
May 8, 2012