Bipolar disorder in children, adolescents and young adults. Part 2. Therapeutic management. Recommendations under the patronage of the Executive Board of the Polish Psychiatric Association, National Consultants in the field of Psychiatry and National Consultants in Child and Adolescent Psychiatry.

Bipolar disorder is characterized by recurrent episodes of depression, mania, hypomania, or mixed states. Early diagnosis and comprehensive treatment, including pharmacotherapy and psychosocial interactions, are associated with a more favorable prognosis. The general principles for the use of drugs in bipolar disorder in children and adolescents remain similar to those in adults. The basic drugs in bipolar disorder are mood stabilizers of the first and second generation; however, their efficacy and safety profile in children and adolescents differ from those in adults. In addition, prophylactic treatment is necessary to prevent recurrence. Lithium, aripiprazole, quetiapine, risperidone, olanzapine, asenapine, ziprasidone are recommended for the treatment of mania and mixed states. For the treatment of depressive episodes in bipolar disorder in children and adolescents, experts recommend lurasidone as monotherapy or olanzapine + fluoxetine as combination therapy. Although long-term treatment is a key aspect of bipolar disorder management in children and adolescents, consistent efficacy data are still lacking. Safety data indicate that the most commonly reported adverse reactions in children and adolescents treated with mood stabilizers are gastrointestinal and neurological adverse reactions, while the use of antipsychotics is mainly associated with weight gain and sedation.