For the treatment of a manic episode in childhood or adolescence, lithium salts – like neuroleptics – are the medication of choice. A combination treatment of lithium with neuroleptics is possible, but requires especially careful monitoring.
If a child or adolescent suffering from unipolar depressive episodes does not respond sufficiently to treatment with antidepressants, adding lithium salts during the depressive episode – to increase the effectiveness of overall therapy – and then continuing lithium treatment as long-term prophylaxis can be beneficial. After approximately 3 years, the need for further treatment should be assessed.
For adolescents, as well as adults, lithium salts are considered to be the medication of choice in the long-term prophylactic treatment of bipolar affective disorders. In contrast to the treatment of these disorders in adults, however, the unique developmental conditions which characterize young adulthood make it advisable to begin treatment in adolescents at an early stage, i.e. already during the first episode. In the event of non-response, carbamazepine can be administered as an alternative treatment.
Lithium salts can lead to improvements in patients with strongly pronounced explosive aggressive behavioral disorders, as well as in those who exhibit impulsive, self-destructive behavior (i.e. auto-aggression). Therapy should take place in an inpatient setting for at least the first 6 to 8 weeks of treatment. As is the case with the above mentioned affective disorders, there is only minimal evidence of benefit when carbamazepine is used in this indication.
If pedagogical approaches and behavioral therapy have been unsuccessful, child and adolescent patients with intellectual deficiency and who exhibit explosive aggressive and/or auto-aggressive, self-destructive behavior may benefit from inpatient treatment with lithium salts.
The recommended dosage and serum levels of lithium salts, as well as side-effects and contraindications, are the same in adolescents as they are in adults. However, lithium therapy is currently not recommended for children under the age of 12, unless it is administered on a strictly inpatient basis.
Even when therapy with lithium salts is clearly indicated in child or adolescent patients, it should nevertheless be regarded as only one component of a larger, comprehensive, and multifaceted treatment plan that takes into account each patient’s symptoms, state of development and function, as well as his or her specific psychosocial circumstances.