Lithium Treatment in Children and Adolescents

There is a resurgence of interest in lithium treatment of bipolar disorders in part related to its unique anti-suicidal and neuroprotective effects.

This is a narrative review of key studies pertaining to the effectiveness and tolerability of lithium treatment in pediatric populations.

Evidence supports that lithium is an effective and generally well-tolerated acute treatment for pediatric mania compared to placebo. Lithium may be less effective than risperidone for treating chronic mixed/manic symptoms in young children but comparable to anticonvulsants. However, in comparison, risperidone was associated with higher weight gain and prolactin levels. There is a lack of evidence inform maintenance treatment in children who benefit from lithium. Other indications that require further study include treatment of refractory or recurrent major depression in children at confirmed familial risk of bipolar disorder, as well as the treatment of acute suicidal ideation/behavior and refractory aggression.

There is inadequate data about the full variety of benefit and tolerability of lithium treatment in pediatric patients. However, given the potential for protection against suicide and neurotoxic effects of illness, further studies should be a priority.