Diagnosis and Pharmacotherapy of Bipolar Depression in Pediatric Patients


What are the evidence-based pharmacologic treatment approaches for pediatric patients with bipolar depression?

Target Audience

Psychiatrists, Psychiatric Nurse Practitioners and Physician Assistants, and Primary Care Physicians

Learning Objective 

Individualize evidence-based pharmacologic treatment approaches for pediatric patients with bipolar depression


Bipolar depression in youth has a negative effect on numerous domains, including physical and emotional well-being, school and family functioning, friendships, and academic success. Early treatment is crucial, yet diagnosis is difficult. The standard of treatment often requires life-long psychopharmacological management, and most treatments increase risk of adverse effects. Pediatric patients who have at least 1 parent with bipolar disorder are considered to be at higher risk for also developing bipolar depression, although there is currently no clear evidence of efficacious pharmacotherapy for these patients.

From the Series: Individualizing Treatment Selection for Pediatric and Adult Patients With Bipolar Depression
To cite: Findling RL. Diagnosis and pharmacotherapy of bipolar depression in pediatric patients. J Clin Psychiatry. 2021;82(4):SU20014BR2C.
To share: https://doi.org/10.4088/JCP.SU20014BR2C
© Copyright 2021 Physicians Postgraduate Press, Inc.

Activity summary
Available credit: 
  • 0.50 AMA PRA Category 1 Credit™
  • 0.50 Participation
Activity opens: 
Activity expires: 

Support Statement

Supported by an educational grant from Sunovion Pharmaceuticals Inc.

Learning Objective

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

  • Individualize evidence-based pharmacologic treatment approaches for pediatric patients with bipolar depression

Release, Review, and Expiration Dates

This activity was published in June 2021 and is eligible for AMA PRA Category 1 Credit™ through June 30, 2023. The latest review of this material was May 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. This activity was designed to meet the needs of participants in CME activities provided by the CME Institute of Physicians Postgraduate Press, Inc., who have requested information on bipolar depression.

Disclosure of Off-Label Usage

Dr Findling has determined that, to the best of his knowledge, quetiapine, lithium, paroxetine, and divalproex sodium are not approved by the US Food and Drug Administration for the treatment of 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.


This activity is derived from the teleconference series “Individualizing Treatment Selection for Pediatric and Adult Patients With Bipolar Depression,” which were held in October and November 2020 and supported by an educational grant from Sunovion Pharmaceuticals Inc. 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

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.

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 0.50 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

  • 0.50 AMA PRA Category 1 Credit™
  • 0.50 Participation


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