Bipolar disorder in children

Patients and family members must be educated about bipolar disorder (including any comorbidities). Parents should be reminded to keep medications secure and administer them reliably. Young people and their parents/caregivers may find recommended online information helpful. Royal College of Psychiatrists (UK): bipolar disorder - information for young people Opens in new window MindEd (UK) Opens in new window

In the US, standard practice is that valproate and its analogs are only prescribed for the treatment of manic episodes associated with bipolar disorder during pregnancy, if other alternative medications are not acceptable or not effective.[125]American Epilepsy Society. Position statement on the use of valproate by women of childbearing potential. Jun 2021 [internet publication]. https://aesnet.org/about/about-aes/position-statements/position-statement-on-the-use-of-valproate-by-women-of-childbearing-potential ​ Divalproex is not recommended for use in girls and women of childbearing potential by the World Health Organization (WHO).[126]Brohan E, Chowdhary N, Dua T, et al. The WHO mental health gap action programme for mental, neurological, and substance use conditions: the new and updated guideline recommendations. Lancet Psychiatry. 2023 Nov 16:S2215-0366(23)00370-X. http://www.ncbi.nlm.nih.gov/pubmed/37980915?tool=bestpractice.com ​ Other international guidelines stipulate that valproate and its analogs must not be used in female patients of childbearing potential unless other options are unsuitable, there is a pregnancy prevention program in place, and certain conditions are met.[118]National Institute for Health and Care Excellence. Bipolar disorder: assessment and management. Dec 2023 [internet publication]. https://www.nice.org.uk/guidance/cg185 ​[127]European Medicines Agency. New measures to avoid valproate exposure in pregnancy endorsed. Mar 2018 [internet publication]. https://www.ema.europa.eu/news/new-measures-avoid-valproate-exposure-pregnancy-endorsed ​​

An example of one such program was launched in 2018 by the European Medicine Agency (EMA), for use across the EU, and includes the following:

• An assessment of the patient's potential for becoming pregnant

• Pregnancy tests before starting and during treatment as needed

• Counseling about the risks of valproate treatment and the need for effective contraception throughout treatment

• A review of ongoing treatment by a specialist at least annually

• A risk acknowledgment form that patients and prescribers will go through at each such annual review to confirm that appropriate advice has been given and understood.