Antipsychotics for child and teen bipolar disorder
Examples
Generic Name Brand Name olanzapine Zyprexa risperidone Risperdal quetiapine Seroquel These medications are available in tablet form. Olanzapine is also available in a tablet that quickly dissolves once placed in the mouth (rapid-dissolve tablet). Risperidone is also available in a liquid.
How It Works
These medications balance certain brain chemicals (neurotransmitters) that help regulate mood and control symptoms of bipolar disorder. They quickly improve manic episodes.
Why It Is Used
Olanzapine
Olanzapine acts as a mood stabilizer. It can help prevent the reckless and impulsive behaviours associated with mania, and may help treat the "losing touch with reality" that can occur with mania. Olanzapine is often used in combination with other medicines (such as mood stabilizers like lithium or valproate) to effectively treat the manic phase of bipolar disorder.1
Risperidone
Risperidone can help restore more normal thinking and a more normal mood. Preliminary studies show it to be helpful when combined with other medicines (such as mood stabilizers) for adults who experience “breakthrough” episodes of depression and mania (mood disruption that occurs while taking maintenance medications to control these episodes).2 Risperidone may be effective in the treatment of mania in young people, although research continues in this area.
Quetiapine
Quetiapine is currently being studied for effectiveness and safety when combined with other medications (such as mood stabilizers) for the treatment of mania associated with childhood and adolescent bipolar disorder. Doctors have used quetiapine to treat the "losing touch with reality" (psychosis) that is associated with schizophrenia.
How Well It Works
Olanzapine
Olanzapine has been shown to be safe and effective in adults for the short-term treatment of acute mania due to bipolar disorder. It usually eases manic symptoms after only 1 week of treatment.
Risperidone
Initial studies show risperidone is effective and safe for treating mania in children and adolescents with bipolar disorder.3 Preliminary studies show risperidone to be helpful when combined with other medications (such as mood stabilizers) for those who experience “breakthrough” episodes of depression and mania (mood disruption that occurs while taking maintenance medications to control these episodes).2 Risperidone is often used successfully to treat symptoms of psychosis associated with bipolar disorder in adults.
Quetiapine
Initial tests indicate that quetiapine effectively reduces mania in adolescents with bipolar disorder when combined with the mood stabilizer divalproex.4
Side Effects
Olanzapine
Olanzapine can cause side effects such as dry mouth, constipation, weight gain, drowsiness, increased appetite, shakiness or tremors, slurred speech, low blood pressure that makes you feel dizzy when you stand up, and sudden and sustained stiffness or muscle spasm (dystonic reaction). Unusual side effects can include headaches or the development of a skin rash due to an allergic reaction to the medication.
Risperidone
Risperidone may cause sleepiness, dystonic reaction, weight gain, menstrual irregularity, and breast tenderness. Unusual side effects include an allergic reaction (skin rash), headaches, constipation, decreased sexual desire and function, and increased heart palpitations.
Quetiapine
Quetiapine can cause side effects such as headaches, dizziness, rash, fever, weight gain, dry mouth, and other flu-like symptoms.
Other side effects of antipsychotic medications
Other possible side effects of antipsychotic medications include:
- Blood sugar problems. The U.S. Food and Drug Administration (FDA) requested that a warning be added to the prescribing information for all atypical antipsychotics indicating an increased risk of hyperglycemia (high blood sugar) and type 2 diabetes for people taking these medications. The FDA recommends blood sugar monitoring of patients taking atypical antipsychotics, especially those who are at risk for obesity or who have diabetes or a family history of diabetes.
- Weight gain. However, some antipsychotic medications appear less likely to cause weight gain. Talk to your doctor if this is a concern.
- Hyperlipidemia (abnormalities in cholesterol levels).
- Hyperprolactinemia, which is high levels of certain hormones that can lead to breast enlargement in boys and girls, and abnormal menstrual cycles in girls.
- Problems in children who have a history of seizures or with conditions that make seizures more likely.
There are other extremely rare but serious side effects that are possible with these medications:
Neuroleptic malignant syndrome (NMS), which causes life-threatening problems with your body's ability to regulate its temperature, has been reported with antipsychotic medications.
Tardive dyskinesia (TD) is a drug-induced movement disorder that can cause uncontrollable body movements. Newer medications are much less likely than older antipsychotics to cause the disorder.
Managing side effects
It make take several attempts to find the right dose and medication to treat your child's bipolar symptoms. Effectiveness and side effects for each medication vary from person to person.
Some side effects are minor, and you can manage them through lifestyle changes such as exercise, relaxation techniques, and diet changes. Other side effects can be more serious and require changes to the dose or type of medication.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
While these medications have been well studied for use in adults, there are few long-term studies that confirm the effectiveness and safety of antipsychotics in children and adolescents with bipolar disorder. Be sure to use these medications exactly as your doctor prescribes them. If your child develops intolerable side effects to any of these medications, call your doctor immediately.
Before your child takes an antipsychotic medication, be sure to tell your doctor if your child has:
- A heart condition.
- A seizure disorder.
- Problems with liver function.
- Problems with blood pressure.
- Diabetes or high blood sugar.
- Constipation.
- A history of breast cancer.
- Problems with swallowing.
- Problems with fainting.
Adolescents who could be pregnant or have had neuroleptic malignant syndrome should not take these medications.
These medications should be started in low doses. Talk with your doctor about any other medications your child may be taking to make sure there are no negative drug interactions.
Your child may require regular liver tests, blood tests, and blood pressure monitoring while taking an antipsychotic medication.
Avoid herbal stimulants (such as ma huang, ginseng, or kola) while taking an antipsychotic medication.
Talk to your doctor or pharmacist about drinking grapefruit juice while you are taking an antipsychotic medicine. Grapefruit juice can increase the level of these medicines in your blood. Having too much medicine in your blood increases your chances of having serious side effects.
Newer antipsychotics should be used with caution in people who drink alcohol or take other medications.
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| Author: | Jeannette Curtis Carrie Henley Ralph Poore | Last Updated: July 10, 2007 |
| Medical Review: | Michael J. Sexton, MD - Pediatrics Andrew Swan, MD, CCFP, FCFP - Family Medicine Lisa S. Weinstock, MD - Psychiatry | |
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| Topic Contents | |
| Examples | |
| How It Works | |
| Why It Is Used | |
| How Well It Works | |
| Side Effects | |
| What To Think About | |
| References | |