Lithium for the treatment of adolescents with bipolar depression.

Title
Open-label lithium for the treatment of adolescents with bipolar depression.
Source
Journal of the American Academy of Child & Adolescent Psychiatry. 45(3):289-97, 2006 Mar.
Abstract


OBJECTIVES:

To investigate the effectiveness and tolerability of lithium for the treatment of acute depression in adolescents with bipolar disorder. We hypothesized that patients receiving open-label treatment with lithium during a 6-week period would experience a statistically and clinically significant decrease in depressive symptoms and tolerate lithium treatment fairly well.

The results from the present study have clinical significance given the lack of published data from treatment studies in children and adolescents with bipolar depression. This study provides preliminary evidence supporting the effectiveness and safety of lithium in the treatment of acute symptoms of bipolar depression in youths. Although the response rate was low in this study, it may be considered reasonable, especially for a disorder for which available treatment options are limited. Lithium monotherapy may alleviate psychotic symptoms associated with bipolar depression as seen in adult psychotic mania. Further studies, including head-to-head comparisons with antipsychotics, are needed to confirm this hypothesis.

In female adolescents of childbearing potential or who are pregnant, treatment planning should consider the risk of fetal exposure to lithium as it is in the U.S. Food and Drug Administration pregnancy category D. First-trimester use of lithium is associated with increased risk of Ebstein's anomaly and exposure in late pregnancy is also associated with adverse effects, including polyhydramnios and premature delivery. Similar caution should be exercised in nursing mothers because the use of lithium in breast-feeding is contraindicated.

Double-blind, placebo-controlled trials of lithium in depressed adolescents with bipolar disorder are needed to evaluate the acute and longitudinal efficacy and safety. With these data, the therapeutic role of lithium for the treatment of bipolar depression in adolescents will be better defined. Treatment regimens associated with higher response rates and favorable side effect profiles are clearly needed.

CONCLUSIONS:

The findings of this study indicate that lithium may be effective and is relatively well tolerated for the treatment of an acute episode of depression in adolescents with bipolar disorder. Controlled studies of lithium in adolescent bipolar depression are needed.