Childhood bipolar disorder is a scary proposition and that’s what makes the treatment of bipolar disorder in children so critical. I recently came across a Psychiatric Times article by Chris Aiken, MD that talks about treating children with bipolar disorder with lithium and I wanted to outlay the research findings Dr. Aiken talks about as well as my own thoughts.

Treatment and the Stages of Bipolar Disorder in Children

Bipolar disorder is a degenerative condition when not treated. This means that the longer you leave bipolar to fester, the worse it gets. According to Dr. Aiken, the following are the stages of childhood bipolar disorder:

  • Stage 0: Risk factors, such as family history, but no symptoms.
  • Stage 1: Prodromal symptoms (early, not serious), often in non-specific forms like anxiety and inattention.
  • Stage 3: First episode and recurrence.
  • Stage 4: Frequent episodes, treatment resistance and a clinical picture marked by cognitive problems, disability and loss of brain volume.

I know those stages sound really scary but keep in mind, with proper childhood bipolar treatment, the progression through those stages can be halted. Several treatments are available of which lithium is one. (Lithium is Food and Drug Administration approved in ages 12 and up.)

Lithium in the Treatment of Bipolar Disorder in Children

Dr. Aiken states there are seven reasons why lithium is a good choice for the treatment of children with bipolar disorder.

  1. Lithium excels in long-term episode prevention. There is evidence both in adults and children that lithium treatment is one of the only treatments that predicts recovery in the long term. In other words, in the long term, lithium may prevent bipolar disorder from proceeding through the stages mentioned above.
  2. Lithium works best when started early. In bipolar I disorder, there is evidence that those who tried lithium after their first manic episode were more likely to respond to it.
  3. Lithium prevents suicide. Children and young adults with bipolar disorder can be at an even greater risk of suicide than adults with bipolar disorder. The risk of suicide is six times less in those who take lithium. This can mean major peace of mind for parents of children with bipolar disorder. (Other mood stabilizers do not have this anti-suicide effect.)
  4. Lithium prevents hospitalizations. Lithium has been shown to prevent hospitalizations more than other mood stabilizers (anticonvulsants) and antipsychotics.
  5. Lithium as medical benefits. You need to carefully weigh how true you feel this one is. Some medical benefits definitely do exist but so do some risks. On average, bipolar disorder shortens the lifespan by nine years. This fact can be crushing for parents of children with bipolar disorder, but it’s important to understand that many of the risks have lifestyle factors involved. The medical causes that decrease the lifespan in bipolar disorder are primarily: heart disease, stroke, cancer, diabetes and chronic obstructive pulmonary disease (COPD). The good news is that lithium lowers the risk of stroke, heart attacks and cancer. The bad news is that lithium increases the risk of “renal insufficiency;” more on that later.
  6. Lithium improves longevity. Lithium has actually been shown to increase lifespans in those with bipolar disorder and the population in general. It is not known exactly why this is.
  7. Lithium protects the brain. Most psychiatric medications enhance neuroplasticity (simply put, this means the brain’s ability to create new neural connections) but as lithium affects more regions of the brain, it might preserve cognitive function and prevent brain volume loss. Lithium treatment in adolescents has been linked to neuroplastic changes in regions of the brain associated with emotion processing.

Risks of Lithium Treatment in Children with Bipolar Disorder

Treatment of children with bipolar disorder can be difficult but is it a good or bad idea to treat childhood bipolar disorder with lithium? What are the risks?For a complete list of risks associated with lithium treatment, click here. Side effects lists are always scary but keep in mind that just because it’s listed, doesn’t mean a particular person will experience it.

That said, I want to focus on one particular side effect risk: lowered kidney function / renal toxicity.

In my opinion, doctors wildly underrepresent this risk. With long-term lithium treatment in children (who will turn into adults, likely on the same medication) lowered kidney function to the point of chronic renal failure is a real issue.

I mostly have gathered this through anecdotal reports, but in 2015, some pretty clear evidence was presented on this topic.

In a study of 630 adults on lithium for 10 years or more:

  • There was a yearly increase in median serum creatinine levels (This is an indicator of diminished kidney function. Small changes don’t mean much, but big differences do.)
  • About 33% of patients who had taken lithium for 10-29 years had evidence of chronic renal failure; however, only 5% were in the “severe” or “very severe” category.

I’m not saying this to scare you, I’m not saying people shouldn’t take lithium and I’m definitely not suggesting you throw your lithium out the window. What I’m saying is, you should know these numbers going in. And you should absolutely, positively, make sure kidney function is monitored at all times with lithium treatment. (Blood lithium levels must be consistently tested as well. Too high a lithium level is toxic.)

And you should absolutely know these number if you plan on putting a child with bipolar disorder on lithium treatment. Keep in mind, lithium might be the right choice for the child, but it still pays to be cognizant of the risks (and communicate the risks to your child so that when your child becomes an adult, he or she can make informed choices too).

But as I stated above, there are many possible benefits to lithium treatment as well, and only you and your child’s doctor can weigh these factors to come up with the best treatment for your child.

Sources

Aiff, H et al, Effects of 10 to 30 Years of Lithium Treatment on Kidney Function. Journal of Psychopharmacology. May 2015.

Aiken, Chris MD, 6 Pearls to Consider When Treating Pediatric Bipolar Disorder. Psychiatric Time. Jun 14, 2018.

Banner image by Flickr user r. nial bradshaw.

Image by James Heilman, MD [CC BY-SA 4.0 ], from Wikimedia Commons.