Psychiatric Uses of Lithium for Children and Adolescents

Clinical management, adverse effects, and response patterns of children and adolescents given lithium appear to be similar to those of adults. Although no clear set of therapeutic predictors has been established, best results are likely in patients with bipolar affective disorder who also have a family history of lithium-responsive affective disorder. Lithium may prove useful in some cases of treatment-resistant aggression, explosiveness, and hyperactivity, but it is generally regarded as an ineffective treatment for attention deficit disorder per se.

For serious affective illness, most experts agree that treating children and early adolescents with lithium for longer than six months should be avoided if possible. When long-term therapy is indicated, the possibility of adverse developmental effects of lithium should be weighed against the disruptive effects of untreated illness.

For very young children, lithium should be given only in extreme cases and only after consultation with a physician experienced in the use of lithium for young children. The Food and Drug Administration has not approved the labeling of lithium for use in conduct disorder or attention deficit disorder or in treating children under 12 years of age. The 1987 package insert reads: "Since information regarding the safety and effectiveness of lithium carbonate in children under 12 years of age is not available, its use in such patients is not recommended at this time." Nevertheless, in view of the many published reports of beneficial responses, lithium use may be justified in certain conditions when more conventional forms of therapy have failed.

Regardless of the indication for lithium in children and adolescents, the medication should not be prescribed alone, but rather in conjunction with psychosocial interventions.