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Review
. 2025 Mar;27(2):125-142.
doi: 10.1007/s40272-024-00669-z. Epub 2024 Nov 27.

Pediatric Bipolar Disorder: Challenges in Diagnosis and Treatment

Janet Wozniak  1   2 , Hannah O'Connor  3 , Maria Iorini  3 , Adrian Jacques H Ambrose  4
Affiliations
Review

Pediatric Bipolar Disorder: Challenges in Diagnosis and Treatment

Janet Wozniak et al. Paediatr Drugs. 2025 Mar.

Abstract

Despite an opportunity to prevent adult psychopathology associated with bipolar disorder through early diagnosis in children, there is insufficient information and awareness among healthcare providers about the unique features and treatment of mania and its comorbid conditions in children. Converging evidence from disparate sites describe a developmentally distinct presentation of bipolar disorder in youth that is highly morbid, persistent and responds to treatment with the mood stabilizer medications used in the treatment of adult bipolar disorder, such as divalproex sodium and carbamazepine. Some are additionally approved for use in pediatric populations including, for manic or mixed states, risperidone, aripiprazole, and asenapine for those aged 10-17 years and also including lithium and olanzapine for ages 13-17 years. Quetiapine is approved as monotherapy or as adjunct to lithium or divalproex sodium for manic states in those aged 10-17 years. Delayed or missed diagnosis, inappropriate treatment, worsening course, and treatment resistance unfortunately still occur. While an array of mood-stabilizing medications is available for treatment, such as second-generation antipsychotics, lithium, and anticonvulsants, these can be only partially effective and fraught with annoying and serious side effects. This article will review current practice in the diagnosis and treatment of pediatric bipolar disorder and its comorbid conditions, highlighting areas of need for future research.

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Conflict of interest statement

Declarations. Funding: No source of funding to report. Conflicts of Interest: Dr Janet Wozniak receives research support from PCORI, Demarest Lloyd, Jr. Foundation, and the Baszucki Brain Research Fund. In the past, Dr Wozniak has received research support, consultation fees or speaker’s fees from Eli Lilly, Janssen, Johnson and Johnson, McNeil, Merck/Schering-Plough, the National Institute of Mental Health (NIMH) of the National Institutes of Health (NIH), Pfizer, and Shire. She is the author of the book “Is Your Child Bipolar” published May 2008, Bantam Books. Her spouse receives royalties from UpToDate; consultation fees from Indorsia, Cozen O’Connor, Noctrix, FoxRothschild, Sterne Kessler Goldstein & Fox, Teladoc Health, Inc., and The International Law Firm of Winston & Strawn LLP; and research support from Merck, NeuroMetrix, American Regent, NIH, NIMH, the RLS Foundation, and the Baszucki Brain Research Fund. In the past, he has received honoraria, royalties, research support, consultation fees or speaker’s fees from Emalex, Disc Medicine, Avadel, HALEO, OrbiMed, CVS, Otsuka, Cambridge University Press, Advance Medical, Arbor Pharmaceuticals, Axon Labs, Boehringer-Ingelheim, Cantor Colburn, Covance, Cephalon, Eli Lilly, FlexPharma, GlaxoSmithKline, Impax, Jazz Pharmaceuticals, King, Luitpold, Novartis, Neurogen, Novadel Pharma, Pfizer, Sanofi- Aventis, Sepracor, Sunovion, Takeda, UCB (Schwarz) Pharma, Wyeth, Xenoport, Zeo. Hannah O’Connor, Maria Iorini, and Dr Adrian Jacques H. Ambrose have no conflicts of interest relevant to this article to disclose. Ethics approval: Not applicable. Consent to participate: Not applicable. Consent to Publish: Not applicable. Availability of data and material: Not applicable. Code availability: Not applicable. Author contributions: All four authors, Janet Wozniak, Hannah O’Connor, Maria Iorini and Adrian Jacques H. Ambrose have contributed significantly to writing the manuscript. All authors have read and approved the final version of the manuscript and agree to be accountable to the work.

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