When bipolar disease is appropriately diagnosed in an adolescent, treatment must be chosen judiciously. Dr. Cohen said he an his associates recently performed a meta-analysis of 41 controlled studies that examined treatment with second-generation antipsychotics in more than 4,000 children and adolescents, including 12 studies that involved youths with bipolar disorder. "Compared with adults, youths were found to be more vulnerable to the adverse effects of second-generation antipsychotics." These adverse effects included somnolence and sedation, weight gain, metabolic changes including prolactin effects, and extrapyramidal motor symptoms. "Tolerability profiles should be considered in making treatment decisions," he said. (see table). Patients who fail to adequately respond to at least two second-generation antipsychotic drugs can be considered candidates for electroconvulsive therapy (ECT).
"In cases of no response to pharmacological treatment, ECT has proven to be safe and effective for both manic and depressive episodes in adolescents with severe illness," Dr. Cohen said. In addition, these patients have generally had favorable reactions to ECT. "Despite negative views about ECT in public opinion, adolescent recipients and their patients share overall positive attitudes toward ECT," he said.
Dr. Cohen said he has received funding from Schering-Plough, Bristol-Myers Squibb. Otsuka, Janssen, Sanofi-Aventis, and Shire.
*9/5/11 -- Dr. Diler's statement and further clarification were added this story.