(dailyRx News) For children who suffer from manic, or bipolar, disorder there are many drug therapies available. But the side effects can be a problem, and until now no one has really studied which medication is the best for children.
According to a study led by Barbara Geller, M.D. of Washington University in St. Louis, there are many mood stabilizers and antipsychotic drugs commonly prescribed to children diagnosed with bipolar disorder.
Yet no prior study has looked into the question of which medication to try first.
The researchers concluded that risperidone was significantly more effective as the initial treatment for childhood bipolar disorder, and noted that children on this drug treatment were less likely to discontinue.
Dr. Geller's team conducted a randomized study of 290 children between the ages of six and 15, all diagnosed with bipolar disorder, in order to assess the risks and effectiveness of various drug treatments. None of the children had taken an anti-manic medication before, and each was treated with either lithium, divalproex sodium (commonly Depakote) or risperidone (commonly Risperdal) for an eight-week trial.
Lithium is an older, widely used drug treatment for bipolar disorder. Divalproex sodium is an anticonvulsant mood stabilizer, and risperidone is an atypical antipsychotic drug approved by the FDA for the treatment of mania in youth aged 10 or older.
After eight weeks, 68.5 percent of the children taking risperidone showed improvements in their manic symptoms, compared with only 35.6 percent of the children taking lithium and 24 percent of those taking divalproex sodium.
However, some side effects were recorded among the participants taking risperidone.
They gained more weight than the other children; an average of seven pounds compared to three pounds for those on lithium and 3.7 pounds for those taking divalproex sodium. The risperidone group was also more likely to experience metabolic side effects such as increase in cholesterol levels.
Overall, 24.7 percent of the children discontinued the trial before the eight-week period was over; most of those who discontinued were taking lithium (32.2 percent), while 26 percent taking divalproex sodium discontinued and 15.7 of those taking risperidone discontinued.
However, the research team also cautioned about the possible adverse side effects and their increased risk for diabetes and cardiovascular problems. Many children in the study responded to low doses of risperidone, suggesting that physicians should be conservative when dosing; a lower dose may minimize serious side effects.
The National Institute of Mental Health funded the study.The findings were published in the January 2012 issue of the Archives of General Psychiatry.