Lithium Safe and Effective For Children With Bipolar Disorder

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A new study suggests that the drug lithium, which has been used for decades in the treatment of bipolar disorder, is also safe and effective for children with the condition.

Robert Findling, MD, a professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine, Baltimore, Md., and colleagues conducted a randomized, placebo-controlled prospective study with  81 patients seen at nine academic medical centers. The participants, about equally split between the sexes, ranged in age from 7 to 17, and had bipolar disorder.

After first undergoing a washout period, 53 started with lithium at a standard dose, gradually increasing to the maximum tolerated dose over eight week if symptoms weren’t controlled. The others received a placebo. During weekly visits the first four weeks, and every other week the last four, patients’ symptoms were determined with the Young Mania Rating Scale. They were also asked about side effects and given a physical exam.

At weekly visits for the first four weeks, and then every other week for the remainder of the study period, patients' symptoms were assessed using a survey called the Young Mania Rating Scale, along with other standard assessment tools for bipolar disorder symptoms and therapies. Patients were also questioned about side effects and given a physical exam, including a weight check.

Lithium patients showed much more significant improvement in their symptoms over the study period compared to placebo patients, the researchers reported in the journal Pediatrics. About 47% of those on lithium scored in the range of “very much improved” or “much improved” on the Clinical Global Impressions Scale, compared to 21% of those on the placebo.

Lithium Safe and Effective For Children With Bipolar Disorder
Children on lithium showed much more significant improvement in their symptoms over the study period compared to placebo patients.

A multicenter study of young patients with bipolar disorder provides what may be the most scientifically rigorous demonstration to date that lithium—a drug used successfully for decades to treat adults with the condition—can also be safe and effective for children suffering from it.

The study, led by a researcher at the Johns Hopkins Children's Center and published in Pediatrics, affirms what clinicians who prescribe this drug have observed for years and suggests that doctors can now more confidently add lithium to the armamentarium of available treatments for this vulnerable population — at least in the short term, the authors say.

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