Lithium monotherapy appears to be safe and effective for treating children and adolescents with bipolar disorder, according to a study published in European Psychiatry.

For this systematic review, researchers examined various databases for studies involving children and adolescents who were treated with lithium for bipolar disorder. They identified 30 articles, of which 12 were randomized controlled trials.

Results from 3 of these randomized controlled trials showed that lithium monotherapy improved manic or mixed episodes and overall functioning in children and adolescents with bipolar disorder, with over 50% of patients meeting response and remission criteria. The authors noted that “lithium showed a greater response in manic episodes without psychotic symptoms, and in the absence of ADHD comorbidity.” In addition, the use of lithium monotherapy for long-term maintenance was also found to be efficacious, particularly in those who responded to acute treatment.

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With regard to safety, treatment with lithium in this patient population was considered “generally safe, at least in the short term.” Gastrointestinal adverse effects, polyuria, and headache were found to be the most common side effects, with a small number of patients experiencing hypothyroidism; neither acute kidney injury nor chronic kidney disease were reported in these trials.

Based on the findings, the authors concluded that “though the available literature is mostly short-term, there is evidence that lithium monotherapy is reasonably safe and effective in children and adolescents, specifically for acute mania and for prevention of mood episodes.”

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