ADVERTISEMENT

Are anticonvulsants safe for pediatric bipolar disorder?

Current Psychiatry. 2005 August;04(08):31-48
August 1, 2005|Current Psychiatry
Elizabeth B. Weller, MD;Angelica L. Kloos, DO;Stacie Hitchcock, MD;Ronald A. Weller, MD
Author and Disclosure Information

Elizabeth B. Weller, MD
Professor of psychiatry and pediatrics, University of Pennsylvania, Children’s Hospital of Philadelphia
Angelica L. Kloos, DO
Resident, Department of psychiatry, Thomas Jefferson University, Philadelphia, PA

Stacie Hitchcock, MD
Resident, Department of psychiatry, Cambridge Hospital, Harvard University Boston, MA

Ronald A. Weller, MD
Professor of psychiatry, University of Pennsylvania, Philadelphia

Using antiepileptic agents as mood stabilizers requires caution.

A randomized, controlled trial of topiramate for acute mania in youths with type I bipolar disorder43 was recently halted because of lack of efficacy in adul trials. Preliminary data from 56 of the pediatric patients—analyzed before the study was halted—showed improved YMRS scores. Although results were not statistically significant, the authors suggest topiramate might be effective in treating children and adolescents with bipolar disorder.

Safety: FDA warning. Decreased sodium bicarbonate leading to hyperchloremic metabolic acidosis has been reported in youths treated with topiramate for seizure disorder,44 leading to an FDA warning to prescribers.3 Although no monitoring guidelines exist, we recommend baseline and periodic serum bicarbonate measurements and acidbase evaluations during topiramate treatment, especially when adding other antiepileptics.44

Other rare but serious reactions include:

  • impaired sweat production and resultant hyperthermia45
  • ophthalmologic symptoms characterized by secondary acute angle closure glaucoma and acute myacute myopia (usually within 1 month of starting treatment)46
  • sedation and cognitive difficulties.47
Body weight. Body weight declined an average 5.8 kg across 8 weeks among 36 bipolar adults using topiramate (mean 176 mg/d).47 We find that bipolar teens like topiramate because of weight loss, compared with weight gain with divalproex or lithium, but any pediatric weight loss requires monitoring.

Cognitive effects? Reports of “word finding difficulties” with topiramate47 may suggest cognitive effects. Thus, be very cautious about using this medication in children and adolescents.

Related resources

  • Kowatch R, Fristad M, Birmaher B, et al. Treatment guidelines for children and adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry. 2005;44(3):213-35.
  • Yonkers K, Wisner K, Stowe Z, et al. Management of bipolar disorder during pregnancy and the postpartum period. Am J Psychiatry 2004;161(4):608-20.
  • American Academy of Child and Adolescent Psychiatry. Treatment guidelines for childhood psychiatric disorders. www.aacap.org
Disclosures

Dr. Kloos, Dr. Hitchcock, and Dr. Ronald Weller report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.

Dr. Elizabeth Weller has been a consultant to or received research grants from GlaxoSmithKline, Johnson & Johnson, Novartis Pharmaceuticals Corp., Abbott Laboratories, and Shire Pharmaceuticals.

Drug brand names

  • Carbamazepine • Tegretol
  • Divalproex • Depakote
  • Lamotrigine • Lamictal
  • Lithium • Eskalith, Lithobid, others
  • Oxcarbazepine • Trileptal
  • Topiramate • Topamax

ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT