Although there are research studies designed to study the effectiveness of mood stabilizers for adults with bipolar disorder, there are no studies designed specifically for children. With this in mind, psychiatrists need to infer which adult medications may be effective for children and at which dose from studying the pharmacological research studies in adults.
Medications are tried and discontinued based on how well the child responds to the medication rather than on baseline research studies utilizing children as the subjects. This in and of itself is a frustrating and long journey for families. Months can be spent experimenting with different medications before a medication is found that is effective.
Setting the Medication Dosage
Once a medication is found effective, the problems are not over. The next challenge is setting the medication dosage. Again, this can take months of readjusting the dosage before an effective dose is found. Even once a dose is found, it may not be effective for very long because children are growing and their body mass is constantly fluctuating.
Psychiatrists are often very conservative with raising the dosage because of the unknown side effects of some of these medications on children. Again, with adult pharmacological studies, side effects are documented and are posted with the medication description. The side effects of these medications on children are unknown.
Family members, teachers, and medical professionals need to constantly monitor bipolar children for any changes in behavior that might suggest that the children have outgrown their current dosage. Unfortunately, bipolar behavior can spiral quickly out of control before the cause is identified as a decrease in effectiveness of the medication.
Over-Sedating is Not the Answer
Another concern with children is that the doses need to be carefully balanced so that the medication is maximally effective without the side effect of drowsiness. Children diagnosed with bipolar disorder need to be alert in school and able to function at an optimal level. Over-sedating a child is not the answer.
Children need to be able to interact with their peers and work through the daily challenges of their emotions. Sedating the child to keep the child from over-reacting to the stimulation around him/her will not help the child to learn to function in society.
However, children with bipolar do have difficulty with sleep patterns and may be over tired from time to time. If this occurs, allow the child a quiet place to rest. When the child awakes, allow the child to continue with his/her classroom activities.
Hormone Surges and Medication Dosage
Another concern when working with medication and children is the effect of hormone surges as the child approaches puberty. Hormones can exacerbate a child’s bipolar condition. Careful attention needs to be paid to extreme fluctuations in behavior as the child approaches puberty. This might also indicate the need for an increase in the dosage of medication.
Managing medication for pediatric bipolar disorder is an on-going challenge. Fluctuations in body mass and hormones can make an effective medication ineffective very quickly. Close observation by all involved in the child’s care is critical to catching a potential medication problem early.