Child & Adolescent Bipolar Foundation Lithium testing in children: a Public Health Necessity June 11, 2002 Martha Hellander, J.D., Executive Director

CABF Parents Age 30s-50s 98% female 71% married 26% hold graduate degrees 42% employed full-time

CABF Children Age % Age % Age 12-l837% Age 19+ 4% Hospitalized 1-9+ times 54% Never hospitalized 46%

Addiction 39-60% risk of developing Substance Use Disorder Wilens, et al. “Risk for Substance Use Disorders in Youths With Child and Adolescent-Onset Bipolar Disorder.” JAACAP 38(6): , 1999

Addiction (cont’d) Lithium reduces adolescent substance use and stabilizes mood in RCT Geller B et al (1998). Double-blind and placebo controlled study of lithium for adolescent bipolar disorders with secondary substance dependency. JAACAP 37:

Incarceration In 50 kids consecutively screened on intake in Texas detention center, 20% had acute mania (another 20% depression) Pliszka, et al, “Affective Disorder in Juvenile Offenders: A Preliminary Study,” Am J Psychiatry 157:1, Jan. 2000

Suicidality in BP Children 25% serious thoughts, plan or intent in prepubertal kids with mania Geller et al: Two-year prospective follow-up of children with a prepubertal and early adolescent bipolar disorder phenotype. Am J Psychiatry 159: , 2002

Suicidality and Death In BP Adults 18 % mortality Lithium reduces suicide regardless of whether it stabilizes mood Tondo and Baldessarini, “Reduced Suicide Risk During Lithium Maintenance Treatment,” J Clin Psychiatry 2000:61 (suppl)

Timeline 1949 John Cade treats mania w/lithium cases of pediatric mania reported 1970 Lithium approved by FDA for mania 1975 NIMH recognizes pediatric depression 1995 NIMH recognizes pediatric mania 2002 No standard treatment for pediatric mania

Medications used to treat pediatric bipolar disorder symptoms ~ 40+ medications used clinically Indicated for mania >12 = 1 (Lithium) Indicated for mania <12 = 0 Indicated for BP depression = 0

CABF Survey 2002 n=854 Medication Use: Lifetime No. of Meds 1-315% 4-520% % % % > 20 6%

Medication Use: Current No. of Meds 113% 230% 328% 415% 5 7% %

Medication Use: Class Anticonvulsants 79% Atypical anti-psychotics 68% AD/SSRIs33% Lithium 30% Stimulants26% Typical antipsychotics 11% Anxiety/Sleep 9%

Summary Lithium is widely used in children and adolescents with bipolar disorder Lithium is off patent and unlikely to be tested by pharmaceutical industry Lithium lacks data for pediatric use New studies would produce benefits for children with pediatric bipolar disorder