Lithium is a drug that has been used for decades to treat adults with bipolar disease. A new multicenter study of young patients has now revealed that lithium can also be safe and effective for children suffering from the said condition. Bipolar disorder affects approximately 1 percent of teens and is one of the leading causes of disability in adolescence. The disorder usually begins during adolescence or young adulthood.
The research was led by a researcher at the Johns Hopkins Children’s Center. Published recently in Pediatrics, affirms that doctors can now more confidently add lithium to the arsenal of available treatments for this vulnerable populationat least in the short term.
Bipolar disorder is a chronic condition of the brain marked by spontaneous bouts of abnormally high moods and depression. Lithium has been used to treat this condition in adults since ages as it stabilizes mood extremes. But, it has not been seriously tested in young people for safety and effectiveness. So, physicians are in two minds about prescribing it to children and teenagers. Typically, it has been the custom to exclude children and women of childbearing age from many clinical drug trials out of an abundance of caution and ethical concerns. However, in recent years, many have raised concerns that excluding such populations may be detrimental for them, as drugs are either withheld or found to react differently than they do in other groups.
Robert Findling, M.D., M.B.A., a professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine and director of child and adolescent psychiatry at the Johns Hopkins Children’s Center said that even though lithium is like the grandfather of all treatments for bipolar disorder, it has never been rigorously studied in children. He initiated the work when he was working in the capacity of director of child and adolescent psychiatry at Case Western Reserve University School of Medicine.
Often medications used to treat schizophrenia and other such conditions are prescribed to treat bipolar disorder in children. But, Findling said that since, those drugs side effects like – substantial weight gain, etc., many discontinue taking them.
To establish the safety of Lithium use in children, Findling and his colleagues performed a randomized, placebo-controlled prospective study. It involved 81 patients – ranging in age from 7 to 17, diagnosed with bipolar disease – seen at nine academic medical centers across the United States.
53 of these children started a regimen of lithium at a standard dose, which was gradually increased to a maximum tolerated dose over the next eight weeks if mood symptoms weren’t controlled. The remaining 28 patients received placebo. 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 at weekly visits for the first four weeks, and then every other week for the remainder of the study period. Patients were also assessed for any possible side effects, including a weight check.
The results revealed that the patients on lithium experienced far more significant improvement in their symptoms over eight weeks compared with those on the placebo. Also, unlike antipsychotic agents, such as risperidone or olanzapine, lithium treatment was not associated with significant weight gain, and none of the patients experienced serious side effects due to the lithium treatment.
Findling says that their study reveals that lithium is safe and reliable for treating children in the short term. He also added that further analyses are currently in progress to examine the long-term implications of lithium use. The areas, the research team is focusing on include evaluation of any potential side effects, such as weight gain, reduced kidney function or diminished thyroid function. All of these are important considerations, as those with bipolar disorder may need a lifetime of medication and behavioral therapies.