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Research Review

Atypical Antipsychotic More Effective at Treating Childhood Mania

The antipsychotic medication risperidone is more effective for initial treatment of mania in children diagnosed with bipolar disorder compared with other mood stabilizing medications, but it carries the potential for serious metabolic side effects, according to a study published online in the Archives of General Psychiatry.

In the Treatment of Early Age Mania study, Barbara Geller, MD, of Washington University in St. Louis, and colleagues randomized 290 children aged 6 to 15 diagnosed with bipolar I disorder (having mixed or manic symptoms) to treatment with lithium, divalproex sodium, or risperidone for an eight-week trial. None of the children had taken an antimanic medication before. Lithium has been used to treat bipolar disorder for many years. Divalproex sodium is an anticonvulsant mood stabilizer commonly prescribed to treat bipolar disorder as well. Risperidone is an atypical antipsychotic that has been approved by the FDA for the treatment of mania in youths aged 10 and older.

After eight weeks, 68.5% of the children taking risperidone showed improvement in manic symptoms, compared with 35.6% of those taking lithium and 24% of those taking divalproex sodium. Overall, 24.7% discontinued the trial, but more children taking lithium—32.2%—discontinued the trial compared with those taking risperidone (15.7% discontinued) or divalproex sodium (26% discontinued.)

However, those taking risperidone also gained more weight than those on the other medications—an average of more than 7 lbs compared with around 3 lbs for those taking lithium and 3.7 lbs for those taking divalproex sodium. In addition, those taking risperidone were also more likely to experience other metabolic side effects, such as an increase in cholesterol levels, compared with those on the other medications.

The researchers concluded that risperidone was significantly more effective than lithium or divalproex sodium for initial treatment of childhood mania. In addition, the children were less likely to discontinue the drug compared with those taking lithium or divalproex sodium, indicating a higher tolerance for it. This finding is consistent with other studies that have compared second-generation antipsychotics like risperidone to placebo in treating childhood mania.

However, the researchers caution that risperidone is associated with adverse metabolic effects that can increase the risk for diabetes and cardiovascular problems. They note that many children responded to low doses of the medication, suggesting that clinicians should be conservative when determining how to dose the medication. A lower dose may minimize the potential for serious side effects. The researchers also caution that because diagnostic measures for childhood bipolar disorder are not always consistent across studies, and because the validity of such a diagnosis in younger children is under debate, the findings may not generalize to patients diagnosed using other measures.

— Source: National Institute of Mental Health