This paper is Melissa DelBello's contribution to The Balanced Mind Foundation's series, Translation of the Scientific Evolution of Pediatric Bipolar Disorder.  The series presents the leading researchers' contribution to the field.  It describes the programmatic approach and direction of the labs, the seminal questions which drive their research, a listing of their most important findings and a summary of how their work impacts the field.  The Balanced Mind Foundation is very grateful to Dr. DelBello for sharing her vision with our readers.

• Diagnosing Bipolar with Brain Imaging
• The Balanced Mind Foundation in This Month's Bp Magazine
• The Next Step: Treatment
• Worried About a Moody Teen?

Kim   
What are your feelings on stability for kids with BP--what's the best you have seen and how much break-through symptoms should we expect?

Janet Wozniak, MD   
Stability is difficult to achieve. There are no studies addressing this, most medication and treatment studies are too short term. In clinical practice, we are always rolling with the punches. Children are a moving target with changes occurring due to age, course of illness and stressors. Usually we must settle for a reduction of symptoms, a decrease in frequency and intensity. If we try to stamp out symptoms 100% we run into med side effects. 

This is a common question in follow up visits: Should we try for better control with unknown side effects or unknown new med effects? Or should we settle for what we have? The answer is guided by how impairing the current state of affairs is. If a child is really struggling, we try to address better mood control or treatment of co-morbid conditions.

bsm   
If a child is on the highest amount of Abilify or any other medication, and the mood is still not stabilized, would you add another type of medication or try something new altogether?

Melissa DelBello, M.D., is Assistant Professor of Psychiatry and Pediatrics at the University of Cincinnati College of Medicine, and Director of the Child and Adolescent Psychiatry Division, Psychotic and Bipolar Disorder Research Program. She also has a clinical practice at the Children’s Hospital Medical Center in Cincinnati, where she co-directs the Mood Disorders Program.