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Lithium là ổn định tâm trạng lâu đời nhất và nghiên cứu nhiều nhất ở người lớn. Nó được phê duyệt thực phẩm Mỹ và Cục Quản lý dược (FDA) cho điều trị rối loạn lưỡng cực ở thanh thiếu niên từ 12 tuổi trở lên, nhưng không phải ở trẻ em trước tuổi dậy thì. Varanka et al. [86] báo cáo trên mười bệnh viện trước tuổi dậy thì | BIPOLAR DISORDER IN CHILDREN AND ADOLESCENTS 149 Lithium Lithium is the oldest and most studied mood stabilizer in adults. It is approved by the US Food and Drug Administration FDA for treatment of bipolar disorder in adolescents who are 12 years of age or older but not in pre-pubertal children. Varanka et al. 86 reported on ten hospitalized pre-pubertal manic children with bipolar I disorder. Lithium was used according to dosing guidelines provided by Weller et al. 87 . These children tolerated lithium well and reached therapeutic blood levels in a very short period of time. Response rate was comparable to adults. Other open trials also report response rates similar to adults 88 . To date there is only a single published double-blind randomized controlled trial of lithium in adolescents. This was a prospective placebo-controlled investigation of lithium in adolescents with bipolar disorder and comorbid substance abuse n 25 . In this study the adolescents diagnosis of bipolar disorder preceded their substance abuse by several years. After 6 weeks of treatment subjects treated with lithium showed a statistically significant decrease in positive urine toxicology screens and a significant improvement in GAF 46 in the lithium-treated group versus 8 in the placebo group . This study demonstrated the efficacy of lithium for the treatment of substance use disorders in bipolar adolescents but did not report on the effect of lithium on the bipolar disorder in these adolescents 89 . Strober et al. 90 conducted a naturalistic prospective follow-up study of 37 hospitalized bipolar adolescents treated successfully with lithium. Those who discontinued lithium treatment against medical advice were three times more likely to relapse than those who continued lithium. The largest systematic treatment trial to date was a recent study conducted by Kafantaris et al. 91 . This study examined the initial response to lithium treatment and potential predictors of non-response in a sample .
