Individualizing Treatment Selection for Pediatric and Adult Patients With Bipolar Depression

Drs Findling and Golberg offer expertise on the diagnosis and treatment of bipolar disorder in patients of all ages.

Abstract

Approximately 60% of patients with bipolar disorder who present with depression are misdiagnosed as having recurrent unipolar depression, which may lead to inappropriate treatment and potential worsening of symptoms. Bipolar depression in youth has a negative effect on numerous domains of life. Early treatment is crucial, yet diagnosis is difficult. The standard of treatment often requires life-long psychopharmacologic management, and treatments have various adverse effects that should be considered when the clinician tailors the regimen for each patient. By facilitating effective communication with patients, referring to diagnostic criteria, and using assessment tools before diagnosis and as treatment continues, clinicians can identify indicators of the disorder, recommend individualized treatment, and help patients work toward greater success in relationships, at home, and at school or work.

From the Series: Individualizing Treatment Selection for Pediatric and Adult Patients With Bipolar Depression

To cite: Findling RL, Goldberg JF. Individualizing treatment selection for pediatric and adult patients with bipolar depression. J Clin Psychiatry. 2021;82(6):SU20014AH3C.

To share: https://doi.org/10.4088/JCP.SU20014AH3C

© Copyright 2021 Physicians Postgraduate Press, Inc.

Target Audience

Psychiatrists, psychiatric nurse practitioners and physician assistants, and primary care physicians

Learning Objectives

  • Develop an age-appropriate, evidence-based treatment plan for patients with bipolar depression
  • Facilitate continuous care as pediatric patients transition to adult care
Activity summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Participation
Activity opens: 
09/28/2021
Activity expires: 
12/31/2023
Cost:
$0.00
Rating: 
0

Support Statement

Supported by an educational grant from Sunovion Pharmaceuticals Inc..

Learning Objective

After completing this educational activity, you should be able to:

  • Develop an age-appropriate, evidence-based treatment plan for patients with bipolar depression
  • Facilitate continuous care as pediatric patients transition to adult care

Release, Review, and Expiration Dates

This Academic Highlights CME activity was published in September 2021 and is eligible for AMA PRA Category 1 Credit™ through December 31, 2023. The latest review of this material was September 2021.

Statement of Need and Purpose

Because the symptoms of bipolar depression and unipolar depression overlap, clinicians too often misdiagnose bipolar depression as unipolar depression. As a result, patients often wait years for an accurate diagnosis. During this period, patients are either not being treated or are receiving treatments that may worsen symptoms. Education is needed, therefore, on accurately identifying bipolar disorder, including risk factors and warning signs, and assessment strategies that can help them detect often subtle indicators of bipolarity.  Additionally, clinicians are not comfortable with treatment options for pediatric bipolar depression, and few up-to-date guidelines and rigorous clinical trial data in this population are available. Also, as youths with bipolar disorder age out of pediatric systems, they are losing contact with mental health care, and providers are failing to ensure continuity of care with adult facilities. Therefore, clinicians need education on current evidence for the safety and efficacy of treatments for pediatric bipolar depression to enable them to select a regimen most likely to alleviate a patient’s symptoms without causing an undue burden of side effects. They also need education on the unique needs of transition-age patients with bipolar disorder and information on how to coordinate the transition from pediatric to adult mental health services. Often in adults, clinicians prescribe inappropriate treatment for patients with bipolar depression. Moreover, many clinicians fail to use measurement-based care to assess whether treatment changes are necessary. Clinicians have had fewer treatment choices for bipolar depression than for bipolar mania and need education on how to manage symptoms with evidence-based options. Education on how to use assessment tools to monitor treatment outcomes for bipolar disorder would be beneficial.

Disclosure of Off-Label Usage

Dr Findling has determined that, to the best of his knowledge, quetiapine, lithium, lamotrigine, and divalproex sodium are not approved by the US Food and Drug Administration (FDA) for the treatment of pediatric bipolar depression. Dr Goldberg has determined that, to the best of his knowledge, divalproex, carbamazepine, pramipexole, ketamine, esketamine, levothyroxine, N-acetylcysteine, and transcranial magnetic stimulation are not approved by the FDA for the treatment of adults with bipolar depression, and lamotrigine is not approved to treat acute bipolar mania or acute bipolar depression.

Review Process

The faculty members agreed to provide a balanced and evidence-based presentation and discussed the topics and CME objectives during the planning sessions. The faculty’s submitted content was validated by CME Institute staff, and the activity was evaluated for accuracy, use of evidence, and fair balance by the Chair and a peer reviewer who is without conflict of interest.

Acknowledgment

This activity is derived from the teleconference series “Individualizing Treatment Selection for Pediatric and Adult Patients With Bipolar Depression,” which was held in October and November 2020 and supported by Sunovion Pharmaceuticals. The opinions expressed herein are those of the faculty and do not necessarily reflect the opinions of the CME provider and publisher or the commercial supporter.

Faculty Affiliation


Robert L. Findling, MD, MBA
Virginia Commonwealth University School of Medicine, Richmond, Virginia


 


Joseph F. Goldberg, MD
Icahn School of Medicine at Mount Sinai, New York, New York



Financial Disclosure

The faculty for this CME activity and the CME Institute staff were asked to complete a statement regarding all relevant personal and financial relationships between themselves or their spouse/partner and any commercial interest. The Accreditation Council for Continuing Medical Education (ACCME) defines a commercial interest as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The ACCME defines relevant financial relationships as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. The CME Institute has resolved any conflicts of interest that were identified. No member of the CME Institute staff reported any relevant personal financial relationships. Faculty financial disclosure is as follows:

Dr Findling is a consultant for Acadia, Adamas, Afecta, Akili, Alkermes, Allergan, Arbor, Axsome, Gedeon Richter, Genentech, Idorsia, Intra-Cellular, Luminopia, Lundbeck, MedAvante-ProPhase, Neurim, Noven, Nuvelution, Otsuka, PaxMedica, Q BioMed, Receptor Life Sciences, Roche, Signant Health, Sunovion, Supernus, Syneos, Takeda, Teva, and Tris; has received grant/research support from Akili, Allergan, Lundbeck, National Institutes of Health, Neurim, Patient-Centered Outcomes Research Institute, Pfizer, Roche, Sunovion, Supernus, SyneuRx, and Takeda; has received honoraria from the American Academy of Child and Adolescent Psychiatry; is a member of the speaker/advisory board for Tris; and has received other financial or material support from the American Psychiatric Press. Dr Goldberg is a consultant for Jazz Pharmaceuticals, Lundbeck, Otsuka, Sunovion, Sage, and BioXcel; has received honoraria from Allergan, Intra-Cellular, Web MD, and Sunovion; is a member of the speakers/advisory boards for Alkermes, Allergan, Intra-Cellular, Sunovion, Otsuka, and BioXcel; and has received royalties from American Psychiatric Publishing and Cambridge University Press.

Accreditation Statement

The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation

The CME Institute of Physicians Postgraduate Press, Inc., designates this enduring material for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Note: The American Nurses Credentialing Center (ANCC) and the American Academy of Physician Assistants (AAPA) accept certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.

To obtain credit for this activity, study the material and complete the CME Posttest and Evaluation.

Available Credit

  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Participation

Price

Cost:
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