From the Guidelines
For 15-year-old patients with bipolar disorder or major depressive disorder, lithium is the only FDA-approved mood stabilizer for ages 12 and older, and it should be considered as a first-line treatment option, typically starting at a low dose of 300mg daily and gradually increasing based on blood levels and response. Other mood stabilizers like valproate (Depakote) and lamotrigine (Lamictal) can also be considered, although they are not FDA-approved for this age group 1. Second-generation antipsychotics like risperidone, aripiprazole, and quetiapine are also options for adolescents with bipolar disorder, but they should be used with caution due to potential side effects like weight gain and metabolic problems 1.
Some key points to consider when prescribing mood stabilizers to 15-year-old patients include:
- Regular blood work to check therapeutic levels and monitor for side effects, such as lithium levels, renal and thyroid function, and urinalyses for lithium, and liver function tests, complete blood cell counts, and pregnancy tests for valproate 1
- Slow titration of lamotrigine to avoid serious rash complications, usually starting at 25mg daily for two weeks before gradually increasing 1
- Monitoring for extrapyramidal side effects, including tardive dyskinesia, with atypical antipsychotics 1
- Regular reassessment of treatment plans as the young person develops, taking into account specific symptoms, potential side effects, and medical history 1
Treatment should always be initiated and monitored by a child psychiatrist, and psychotherapy, particularly cognitive behavioral therapy or dialectical behavior therapy, should accompany medication treatment 1. It is also important to advise patients and families about presenting symptoms of potential adverse effects, as periodic monitoring does not ensure that abnormalities will be readily identified 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Mood Stabilizers for 15-Year-Old Patients
Mood stabilizers are a crucial part of managing bipolar disorder and major depressive disorder in adolescents. The following mood stabilizers have been studied for their safety and efficacy in this age group:
- Lithium: Lithium has been shown to be effective in the treatment of bipolar disorder in adults 2, 3. A study on adolescents with bipolar depression found that lithium was effective and relatively well-tolerated in this age group 4.
- Lamotrigine: Lamotrigine has been studied in adults with bipolar disorder and has been found to be effective in delaying time to intervention for any mood episode 5, 6. However, there is limited research on the use of lamotrigine in adolescents.
Safety Considerations
When prescribing mood stabilizers to 15-year-old patients, it is essential to consider the potential risks and side effects. Lithium, for example, requires blood monitoring due to the risk of toxicity 2. Lamotrigine has been associated with a risk of serious rash, although this is rare 5, 6.
Dosage and Administration
The dosage and administration of mood stabilizers in adolescents may differ from those in adults. For example, the dosage of lamotrigine is titrated over a 6-week period to minimize the risk of serious rash 5, 6. Lithium dosing in adolescents is typically adjusted to achieve a therapeutic serum level 4.
Future Research
More research is needed to fully understand the safety and efficacy of mood stabilizers in adolescents. Controlled studies of lithium and lamotrigine in adolescent bipolar disorder are necessary to provide more definitive answers about their use in this age group 4.