Considering medication for your young child or teen can be scary, but educating yourself can help ease these feelings.

Medications continue to be an effective treatment option for many people with bipolar disorder. There’s a variety of medication options to choose from to help manage the symptoms and mood changes that are common with this condition.

Treatment for bipolar disorder often involves a combination of medications, psychotherapy, and lifestyle changes. A strong emotional support network and other options, like support groups, can also be key tools for successfully managing bipolar disorder.

If medication has been recommended for your child or teen, it’s natural to be concerned.

But knowing more about the medications prescribed, how these different “classes” or types work, and which questions to ask can help you on your journey toward finding the best treatment for your child.

Bipolar disorder is a mental health condition characterized by extreme shifts in mood. There are three main types of bipolar disorder, each having its own symptoms and diagnostic criteria.

Two primary features of bipolar disorder are manic and depressive episodes. Symptoms of bipolar disorder might look different in your child than in an adult.

In a manic episode, for example, your child may be hyperactive, chatty, and unable to sleep. In a depressive episode, they may shut themselves off from the world, and seem hopeless and disinterested in friends or hobbies.

Prior to the 1990s, bipolar disorder was underdiagnosed in youth.

While the average age of onset is mid-20s, bipolar disorder can affect people of any age. In fact, children as young as 5 years old have been diagnosed with bipolar disorder.

A survey of studies from multiple countries found nearly a 4% rate of bipolar disorder in young adults under 21, up from a previous estimate of 1.8%.

It can be challenging to diagnose bipolar disorder in children and teens, who may already seem more emotional, unpredictable, or energetic than adults. Symptoms of bipolar disorder may overlap with those of anxiety, depression, and attention deficit hyperactivity disorder (ADHD). This overlap may make it difficult to diagnose bipolar disorder in your child.

While the reality or possibility of a bipolar disorder diagnosis for your child may seem scary and overwhelming, the condition is treatable, and medication can be an essential part of your child’s treatment plan.

Lithium is FDA-approved to treat bipolar disorder in children and teens ages 7 to 17 years old.

Lithium is among the most common medications for bipolar disorder. You may hear it called “the gold standard” or “first-line” choice. It’s derived from a naturally occurring element and was first proven to help with bipolar disorder in the 1950s and ’60s.

Lithium, originally used in salt form, was observed to have a noticeable “calming” effect regarding mania in particular. It was later connected to significant reductions in suicidal behavior.

Experts believe lithium works by balancing the brain’s neurotransmitters, which are the chemical messengers your central nervous system uses to communicate.

Put simply, lithium can help stabilize your child’s moods and also help prevent future episodes.

Research has proven the drug — now taken as an oral tablet — to be a safe and reliable treatment option for children or teens with bipolar disorder.

Lithium requires consistent blood work to determine what dose is best for your child. Also, because lithium can affect the thyroid and kidneys, monitoring your child’s diet, blood work, and side effects is critical.

Other side effects may include:

  • drowsiness
  • headache
  • nausea or vertigo
  • diarrhea
  • excessive thirst
  • increased urination
  • weight gain
  • weakness or fatigue
  • memory or concentration problems

Aside from Depakote, anticonvulsants do not have FDA approval for use in children, so these are considered “off label” use for bipolar disorder.

Anticonvulsants refer to medications originally used to help prevent seizures, especially in patients with epilepsy. Their effectiveness in treating bipolar disorder was first discovered in the 1960s, although usually an anticonvulsant was only tried if a patient didn’t respond to lithium.

So, why do antiseizure medications work for a mood disorder?

Well, anticonvulsants help your brain calm down, which is a good thing for both epilepsy and bipolar disorder!

Researchers point to the fact that epilepsy and bipolar disorder share an “episodic nature,” and despite their obvious differences, are both influenced by overexcitability in the brain’s nerve cells (neurons).

They’re believed to work by decreasing this nerve activity, or neuron firing, in the brain.

Common anticonvulsants used include:

  • carbamazepine (Tegretol)
  • lamotrigine (Lamictal)
  • topiramate (Depakote)

Common side effects are:

  • dizziness
  • drowsiness
  • tremor
  • weight gain
  • nausea
  • diarrhea

Prozac is the only FDA-approved antidepressant for use in children. Both Prozac and Lexapro are approved for teens.

As you can tell by the name, antidepressants specifically target the depression phase of bipolar disorder. Common symptoms of depression include hopelessness, sadness, and worthlessness.

Antidepressants alone are not often the first choice for bipolar disorder because it has been shown to cause symptoms of mania in some people.

There are two major types of antidepressants used for bipolar disorder: serotonin and noradrenaline reuptake inhibitors (SNRIs) and selective serotonin reuptake inhibitors (SSRIs).

SNRIs work by raising the levels of serotonin and norepinephrine — neurotransmitters in the brain responsible for mood — which helps to stabilize their moods. Common SNRIs used include duloxetine (Cymbalta) and venlafaxine (Effexor).

SSRIs work by blocking serotonin from quickly leaving the brain. This raises the level of serotonin so there’s more available to help regulate your child’s mood.

Examples of SSRIs prescribed include:

  • citalopram (Celexa)
  • escitalopram (Lexapro)
  • fluoxetine (Prozac)
  • sertraline (Zoloft)

Side effects of both SNRIs and SSRIs differ, but common ones they both share include:

  • stomach upset or nausea
  • dry mouth
  • headaches
  • insomnia or other sleep issues
  • dizziness
  • sexual dysfunction
  • appetite or weight changes

Certain atypical antipsychotics are FDA-approved to treat bipolar disorder in children under 17 years old. These include Risperidone, Abilify, and Zyprexa.

Atypical antipsychotics, or “second-generation antipsychotics,” are a class of medication being used with increased frequency to treat bipolar disorder.

In particular, these drugs treat the manic phase of bipolar disorder or psychosis — the inability to differentiate between reality and unreality.

Atypical antipsychotics have a strong sedative, or calming, effect, but often fewer side effects.

Like many other types of medications used to treat bipolar disorder, atypical antipsychotics adjust the chemicals in your brain, including dopamine and serotonin.

Research suggests that both mood stabilizers like lithium and atypical antipsychotics are particularly good at reducing the likelihood that the episode will happen again. This combination can help maintain stability while at the same time preventing manic and depressive episodes.

Common atypical antipsychotics used include:

Side effects may include:

  • feeling tired
  • dizziness
  • nausea
  • dry mouth
  • weight gain

Having your child start a medication for bipolar disorder might seem overwhelming, but educating yourself about the different options may help ease some of your anxiousness.

Many people living with bipolar disorder respond well to medication and find it helpful for managing their symptoms.

Remember: When it comes to starting or continuing a medication regimen, communication is key!

It’s important that young patients and their guardians know they have the right to ask their healthcare professionals questions at any time. Doctors and pharmacists want you to have all the information you need when making decisions about your child’s care.

Questions to consider before the appointment:

  • Does my child have any other known health conditions?
  • Is my child currently on any other medications that may interact with a new one?
  • Does my child have any known medication allergies?
  • Have other members of my family been on this medication before? How did they respond?

Questions to ask your doctor or pharmacist:

  • Why is this your first-choice medication for my child?
  • What is the average starting dose?
  • What are both the common and rare side effects of starting this medication?
  • If my child starts this medication, when will we know if it’s “working”?
  • If the medication doesn’t have the intended effect, will we raise the dose or change to another medication?
  • If my child has to go off this medication, how do we do that? What side effects could occur?
  • Is this medication covered by my insurance? If not, how much does it cost out-of-pocket?

Questions to discuss with your child:

  • Do you trust this doctor?
  • How do you feel about potentially starting a medication?
  • Are you willing to be totally honest with me about any side effects?
  • Are you willing to try your best to take your medication as directed?
  • Do you understand there are foods and substances that can interact in dangerous ways with these medications?
  • If this treatment option isn’t working, can you agree to let me know so we can seek alternatives?

It might be easy to think discussing a medication is a conversation for “adults,” mainly between parents and doctors.

But remember that your child or teen is the one who will be experiencing the changes brought about by a new medication and shouldering the responsibility of sticking to a new regimen.

Consider talking with your child, and try to make space for their feelings and opinions. Let them know you’re a supportive partner on their journey to stability and healing, of which medication is only one part.

Below are some useful resources to offer further education and support: