Bipolar Disorder in Children and Teens - Treatment

For parents of patients or teens: Describe the types of treatment you are receiving for bipolar disorder.

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What can children and teens with bipolar disorder expect from treatment?

There is no cure for bipolar disorder, but it can be treated effectively over the long term. Doctors and families of children with bipolar disorder should keep track of symptoms and treatment effects to decide whether changes to the treatment plan are needed.

Sometimes a child may switch from one type of bipolar disorder to another. This calls for a change in treatment. In the largest study to date on childhood bipolar disorder, the NIMH-funded Course and Outcome of Bipolar Illness in Youth (COBY) study, researchers found that roughly one out of three children with BP-NOS later switched to bipolar I or II. Also, roughly one out of five children who started out with a diagnosis of bipolar II switched to bipolar I. Because different medications may be more helpful for one type of symptom than another (manic or depressive), your child may need to change medications or try different treatments if his or her symptoms change.

The COBY study also showed that treatment helped around 70 percent of children with bipolar disorder recover from their most recent episode (either manic or depressive). In this study, recovery meant having two or fewer symptoms for at least eight weeks in a row. On average, it took a little over a year and a half to recover. However, within the next year or so, symptoms returned in half of the children who recovered. Children with bipolar I or II tended to recover faster than those with BP-NOS, but their symptoms returned more frequently as well.

If your child has other psychiatric illnesses, such as an anxiety disorder, eating disorder, or substance abuse disorder, he or she may be more likely to experience a relapse -- especially depressive symptoms. Scientists are unsure how these co-existing illnesses increase the chance of relapse.

Working closely with your child's doctor and therapist and talking openly about treatment choices can make treatment more effective. You may need to talk about changing the treatment plan occasionally to help your child manage the illness most effectively.

Also, you may wish to keep a chart of your child's daily mood symptoms, treatments, sleep patterns, and life events, which can help you and your child better understand the illness. Sometimes this is called a mood chart or a daily life chart. It can help the doctor track and treat the illness more effectively. Examples of mood charts can be found on the Internet.

Recently, NIMH funded a clinical trial called the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). This was the largest treatment study ever conducted for bipolar disorder. In a study on psychotherapies, STEP-BD researchers compared people in two groups. The first group was treated with collaborative care (three sessions of psychoeducation over six weeks). The second group was treated with medication and intensive psychotherapy (30 sessions over nine months of CBT, interpersonal and social rhythm therapy, or family-focused therapy). Researchers found that the second group had fewer relapses, lower hospitalization rates, and were better able to stick with their treatment plans. They were also more likely to get well faster and stay well longer.

NIMH is supporting more research on which combinations of psychotherapy and medication work best. The goal is to help people with bipolar disorder live symptom-free for longer periods and to recover from episodes more quickly. Researchers also hope to determine whether psychotherapy helps delay the start of bipolar disorder in children at high risk for the illness.

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