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Lithium safe and effective in children with bipolar disorder

Early results show symptom reduction with lithium, without the adverse effects of antipsychotics

Louise Prime

Tuesday, 13 October 2015

Lithium is a safe and effective treatment for bipolar disorder in children, at least in the short term, and also seems to avoid the weight gain commonly seen with some antipsychotics, according to new research.* The researchers behind the US study, published in Pediatrics, said analyses of the drug’s longer-term safety in children and adolescents are now underway.

Lithium is the drug of choice for adults with bipolar disorder, as well as one of the oldest, but its safety and effectiveness had never been rigorously studied in children, even though about 1% of teenagers suffer from bipolar disorder. So researchers led from the Johns Hopkins Children’s Center set up a randomised, placebo-controlled prospective study to find out. They recruited 81 girls and boys with bipolar disorder, aged 7 to 17 years, from nine centres across the US.

The children first had a washout period, to allow them to clear other drugs from their bodies. Then 28 started taking placebo while the other 53 started taking lithium at a standard dose, titrated upwards over the following eight weeks until mood symptoms were controlled, to a maximum tolerated dose.

During the first four weeks the children’s symptoms were assessed weekly using the 60-point Young Mania Rating Scale and other standard assessment tools for bipolar disorder symptoms and therapies; then the frequency was reduced to fortnightly. In addition, the children were asked about side effects and had a physical examination including a weight check.

Young people taking lithium benefited from far more significant improvement in their symptoms during the eight weeks than those on placebo – 47% of those taking lithium scored ‘very much improved’ or ‘much improved’ on the Clinical Global Impressions Scale, compared with 21% of those taking placebo. And those taking lithium dropped an average of almost six more points on the YMRS, compared with those taking placebo.

The researchers also reported that – in contrast to antipsychotics such as risperidone and olanzapine – the children taking lithium suffered no significant weight gain; nor did they experience serious side effects.

The study authors said their research 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 – but they are awaiting analyses of any potential effect of long-term use of the drug, for example, weight gain, reduced kidney function or diminished thyroid function.

They concluded that as well as being superior to placebo in reducing manic symptoms in children with bipolar disorder, “lithium was generally well tolerated in this patient population and was not associated with weight gain, distinguishing it from other agents commonly used to treat youth with bipolar disorder.”

* Findling RL, Robb A, McNamara NK et al. Lithium in the acute treatment of bipolar I disorder: a double-blind, placebo-controlled study. Pediatrics. Published online 12 October 2015. DOI: 10.1542/peds.2015-0743

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