title: Pharmacologic treatments for pediatric bipolar disorder: a review and meta-analysis.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: University of Nebraska Medical Center, Omaha, USA.
authors.forename: Howard Y
authors.initials: HY
authors.lastname: Liu
authors.forename: Mona P
authors.initials: MP
authors.lastname: Potter
authors.forename: K Yvonne
authors.initials: KY
authors.lastname: Woodworth
authors.forename: Dayna M
authors.initials: DM
authors.lastname: Yorks
authors.forename: Carter R
authors.initials: CR
authors.lastname: Petty
authors.forename: Janet R
authors.initials: JR
authors.lastname: Wozniak
authors.forename: Stephen V
authors.initials: SV
authors.lastname: Faraone
authors.forename: Joseph
authors.initials: J
authors.lastname: Biederman
mesh_terms: D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use; D018692:Antimanic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy; D001714:Bipolar Disorder / Q000188:drug therapy*; D002220:Carbamazepine / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003866:Depressive Disorder / Q000188:drug therapy; D004359:Drug Therapy, Combination; D006801:Humans; D016651:Lithium Carbonate / Q000009:adverse effects / Q000627:therapeutic use; D014635:Valproic Acid / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000927:Anticonvulsants; D018692:Antimanic Agents; D014150:Antipsychotic Agents; D016651:Lithium Carbonate; D002220:Carbamazepine; D014635:Valproic Acid