TY - JOUR
T1 - Pharmacologic treatments for pediatric bipolar disorder
T2 - A review and meta-analysis
AU - Liu, Howard Y.
AU - Potter, Mona P.
AU - Woodworth, K. Yvonne
AU - Yorks, Dayna M.
AU - Petty, Carter R.
AU - Wozniak, Janet R.
AU - Faraone, Stephen V.
AU - Biederman, Joseph
N1 - Funding Information:
This work was supported in part by the Pediatric Psychopharmacology Council Fund.
Funding Information:
Disclosures: Dr. Liu is a secondary investigator for a clinical trial by Eli Lilly and Co. and participation personnel for a clinical trial by Shire. Dr. Wozniak receives royalties from Bantam Books. She has served on the speakers' bureau for McNeil and Primedia/Massachusetts General Hospital (MGH) Psychiatry Academy. She has served on the advisory board for Pfizer and Shire. She has received research support from the National Institute of Mental Health (NIMH), McNeil, Shire, and Eli Lilly and Co. Dr. Faraone, has, this year, received consulting fees from and has served on the advisory board for Shire Development. He has received research support from Pfizer, Shire, and the National Institutes of Health (NIH). In previous years, Dr. Faraone has received consulting fees from, has served on the advisory boards for, or has participated in continuing medical education programs sponsored by Shire, McNeil, Janssen, Novartis, Pfizer, and Eli Lilly and Co. In previous years he has received research support from Eli Lilly and Co., Shire, Pfizer, and NIH. Dr. Faraone receives royalties from Guilford Press. Dr. Biederman is currently receiving research support from Elminda, Janssen, McNeil, Next Wave Pharmaceuticals, and Shire. This year, he gave a single unpaid talk for Juste Pharmaceutical Spain and received honoraria from the MGH Psychiatry Academy for a tuition-funded continuing medical education (CME) course. He also received an honorarium from Cambridge University Press for a chapter publication. He has received departmental royalties from a copyrighted rating scale used for ADHD diagnoses, paid by Eli Lilly and Co., Shire, and AstraZeneca; these royalties are paid to the Department of Psychiatry at MGH. In previous years, he received a speaker's fee from a single talk given at Fundación Dr. Manuel Camelo A.C. in Monterrey, Mexico and served on the speaker's bureau for Fundacion Areces (Spain), Medice Pharmaceuticals (Germany), and the Spanish Child Psychiatry Association. He served as a consultant for Shionogi Pharma and Cipher Pharmaceuticals. The honoraria for these consultations were paid to the Department of Psychiatry at MGH. He received honoraria from the MGH Psychiatry Academy for a tuition-funded CME course. He has received research support, consultation fees, or speaker's fees for/from Abbott, Alza, AstraZeneca, Bristol Myers Squibb, Celltech, Cephalon, Eli Lilly and Co., Esai, Forest, Glaxo, Gliatech, Janssen, McNeil, Merck, the National Alliance for Research on Schizophrenia and Depression (NARSAD), the National Institute on Drug Abuse (NIDA), New River, the National Institute of Child Health and Human Development (NICHD), NIMH, Novartis, Noven, Neurosearch, Organon, Otsuka, Pfizer, Pharmacia, The Prechter Foundation, Shire, The Stanley Foundation, UCB Pharma, and Wyeth. Dr. Potter, Ms. Woodworth, Ms. Yorks, and Mr. Petty report no biomedical financial interests or potential conflicts of interest.
PY - 2011/8
Y1 - 2011/8
N2 - Objective: A growing body of literature has documented pediatric bipolar disorder to be a severely impairing form of psychopathology. However, concerns remain as to the inadequacy of the extant literature on its pharmacotherapy. Furthermore, treatment studies have not been systematically reviewed for treatment effects on core and associated symptoms. Thus, a systematic evaluation and synthesis of the available literature on the efficacy of antimanic pharmacotherapy for pediatric bipolar disorder on symptoms of mania, depression, and attention-deficit/hyperactivity disorder was undertaken. Method: A systematic search was conducted through PubMed from 1989 through 2010 for open-label and randomized controlled trials published in English on the pharmacotherapy of pediatric mania. Results: There have been 46 open-label (n = 29) and randomized (n = 17) clinical trials of antimanic agents in pediatric bipolar disorder encompassing 2,666 subjects that evaluated a range of therapeutic agents, including traditional mood stabilizers, other anticonvulsants, second-generation antipsychotics, and naturopathic compounds. This literature has documented that the available armamentarium has different levels of efficacy in the treatment of pediatric mania. Because all psychotropic classes are associated with important adverse effects, a careful risk-benefit analysis is warranted when initiating pharmacologic treatment with any of these compounds. In the limited data available, the effects of antimanic agents on depression and symptoms of attention-deficit/hyperactivity disorder have been, in general, modest. Few studies have evaluated the effects of antimanic agents in children younger than 10 years. Conclusions: A substantial body of scientific literature has evaluated the safety and efficacy of various medicines and drug classes in the treatment of mania in pediatric bipolar disorder. More work is needed to assess the safety and efficacy of psychotropic drugs in children younger than 10 years, to further evaluate the efficacy of naturopathic compounds, and to further evaluate the effects of antimanic treatments for the management of depression and attention-deficit/hyperactivity disorder.
AB - Objective: A growing body of literature has documented pediatric bipolar disorder to be a severely impairing form of psychopathology. However, concerns remain as to the inadequacy of the extant literature on its pharmacotherapy. Furthermore, treatment studies have not been systematically reviewed for treatment effects on core and associated symptoms. Thus, a systematic evaluation and synthesis of the available literature on the efficacy of antimanic pharmacotherapy for pediatric bipolar disorder on symptoms of mania, depression, and attention-deficit/hyperactivity disorder was undertaken. Method: A systematic search was conducted through PubMed from 1989 through 2010 for open-label and randomized controlled trials published in English on the pharmacotherapy of pediatric mania. Results: There have been 46 open-label (n = 29) and randomized (n = 17) clinical trials of antimanic agents in pediatric bipolar disorder encompassing 2,666 subjects that evaluated a range of therapeutic agents, including traditional mood stabilizers, other anticonvulsants, second-generation antipsychotics, and naturopathic compounds. This literature has documented that the available armamentarium has different levels of efficacy in the treatment of pediatric mania. Because all psychotropic classes are associated with important adverse effects, a careful risk-benefit analysis is warranted when initiating pharmacologic treatment with any of these compounds. In the limited data available, the effects of antimanic agents on depression and symptoms of attention-deficit/hyperactivity disorder have been, in general, modest. Few studies have evaluated the effects of antimanic agents in children younger than 10 years. Conclusions: A substantial body of scientific literature has evaluated the safety and efficacy of various medicines and drug classes in the treatment of mania in pediatric bipolar disorder. More work is needed to assess the safety and efficacy of psychotropic drugs in children younger than 10 years, to further evaluate the efficacy of naturopathic compounds, and to further evaluate the effects of antimanic treatments for the management of depression and attention-deficit/hyperactivity disorder.
KW - attention-deficit/hyperactivity disorder
KW - depression
KW - mania
KW - pediatric bipolar disorder
KW - psychopharmacology
UR - http://www.scopus.com/inward/record.url?scp=79960835197&partnerID=8YFLogxK
U2 - 10.1016/j.jaac.2011.05.011
DO - 10.1016/j.jaac.2011.05.011
M3 - Review article
AN - SCOPUS:79960835197
SN - 0890-8567
VL - 50
SP - 749-762.e39
JO - Journal of the American Academy of Child and Adolescent Psychiatry
JF - Journal of the American Academy of Child and Adolescent Psychiatry
IS - 8
ER -