Bipolar Disorder Prescribing for Children and Adolescents essay
Prescribing for Children and Adolescents
Off-label prescribing involves the use of medications in a manner not specified in the Food and Drug Administration’s (FDA) approved packaging label, such as for an unapproved age group, dosage, or form of administration (Rusz et al., 2021). It is common in children and adolescents for the management of bipolar disorder because the FDA has approved only a limited number of medications for pediatric use. This scarcity of approved treatments drives clinicians to rely on off-label prescribing to manage symptoms and improve the quality of life for young patients, despite the need for careful consideration of efficacy and safety.
FDA-Approved Drug: Aripiprazole
Aripiprazole is an atypical antipsychotic that has been approved by the FDA for the management of bipolar disorder in children and adolescents between the ages of 10 and 17 years. It has been used in the treatment of bipolar affective disorder for its mood-stabilizing effects and for the management of mania and mixed episodes. The advantages of the use of aripiprazole are the lower risks of developing weight gain, metabolic syndrome, and other unfavorable side effects compared to other antipsychotics (Yee et al., 2019). However, it retains the risk factors like extrapyramidal syndromes (tremor, rigidity), akathisia (restlessness), and, in rare instances, tardive dyskinesia (involuntary movements.
Off-Label Drug: Lamotrigine
Lamotrigine is used off-label to treat bipolar disorder in children and adolescents as a maintenance therapy. It is particularly useful in preventing episodes of depression. The main advantage of lamotrigine is its anti-depressive effect without affecting weight or metabolic parameters. However, the drug poses the danger of a very serious form of skin reaction called Stevens-Johnson syndrome which may be fatal (Hashimoto et al., 2020). To manage this side effect, initiation of lamotrigine is done at a low dose with a gradual increase of dosages. Other possible side effects include dizziness, headache, and double vision. Despite these risks, lamotrigine is preferred due to its low rates of depressive episodes and its safety profile compared to other mood stabilizers.
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Nonpharmacological Intervention: Cognitive-behavioral therapy (CBT)
Cognitive Behavioral Therapy (CBT) is one of the notable non-pharmacological approaches to tackling bipolar disorder in children and adolescents. CBT involves the alteration of negative patterns of thinking and behavior, the improvement of coping strategies, and the management of emotions. The advantages of CBT include the absence of side effects from medications and the acquisition of skills that may be helpful in the future even after the completion of the treatment sessions (Nakao et al., 2021). However, it may not be effective if administered infrequently or by a therapist with minimal exposure to pediatric bipolar disorder.
Risk Assessment and Clinical Practice Guidelines
Comprehensive medication risk assessment is based on factors such as the intensity and frequency of mood episodes experienced, the age of the child, other existing or coexisting medical conditions, possible side effects, and the family’s compliance ability with the regimes. For aripiprazole, the advantages include approval in treating acute manic and mixed episodes and demonstrated effectiveness compared to the risks of developing metabolic changes and extrapyramidal side effects. Lamotrigine has efficacy in the prevention of depressive episodes and boasts a lower risk of inducing metabolic side effects but risks severe rash if the patient is not properly titrated Bipolar Disorder Prescribing for Children and Adolescents essay.
Clinical practice guidelines for bipolar disorder in children and adolescents, such as those from the American Academy of Child and Adolescent Psychiatry (AACAP), support the use of FDA-approved medications like aripiprazole and the consideration of off-label options like lamotrigine when first-line treatments are inadequate (Gautam et al. 2019). These guidelines emphasize the importance of combining pharmacotherapy with psychotherapy, such as CBT, to achieve optimal outcomes. In the absence of specific guidelines, clinicians should rely on the latest evidence-based research, clinical expertise, and patient and family preferences to guide treatment decisions.
References
Gautam, S., Jain, A., Gautam, M., Gautam, A., & Jagawat, T. (2019). Clinical practice guidelines for bipolar affective disorder (BPAD) in children and adolescents. Indian Journal of Psychiatry, 61(8), 294. https://doi.org/10.4103/psychiatry.indianjpsychiatry_570_18
Hashimoto, Y., Kotake, K., Watanabe, N., Fujiwara, T., & Sakamoto, S. (2020). Lamotrigine in the maintenance treatment of bipolar disorder. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd013575
Nakao, M., Shirotsuki, K., & Sugaya, N. (2021). Cognitive–behavioral therapy for management of mental health and stress-related disorders: Recent advances in techniques and technologies. BioPsychoSocial Medicine, 15(1), 1–4. https://doi.org/10.1186/s13030-021-00219-w
Rusz, C.-M., Ősz, B.-E., Jîtcă, G., Miklos, A., Bătrînu, M.-G., & Imre, S. (2021). Off-label medication: From a simple concept to complex practical aspects. International Journal of Environmental Research and Public Health, 18(19), 10447. https://doi.org/10.3390/ijerph181910447
Yee, C. S., Hawken, E. R., Baldessarini, R. J., & Vázquez, G. H. (2019). Maintenance pharmacological treatment of juvenile bipolar disorder: Review and meta-analyses. International Journal of Neuropsychopharmacology, 22(8), 531–540. https://doi.org/10.1093/ijnp/pyz034 Bipolar Disorder Prescribing for Children and Adolescents essay
