Toward prevention of bipolar disorder in at-risk children: Potential strategies ahead of the data
Open accessAbstract
BACKGROUND: Despite the well-documented negative impact of untreated bipolar illness, approaches to early intervention in childhood-onset bipolar and related disorders are not well delineated. METHODS: We reviewed the extant treatment literature on children at high risk for bipolar disorder, with definitions based on family history, childhood adversity, and prodromal symptoms. RESULTS: A panoply of approaches have been described, but most interventions are based on an inadequate database to support their routine implementation. We classify early stage interventions as a function of their safety and tolerability with the hope that these might generate more rigorous study and a stronger database. LIMITATIONS: Critics may rightly argue that identifying viable treatment methods is premature given our lack of ability to reliably predict illness trajectory in very young children. However, many of the psychosocial and pharmacological interventions we present could have nonspecific positive effects across a variety of symptoms, syndromes, and diagnoses, further enhancing the rationale for more rigorous study. CONCLUSIONS: Early stage interventions have the potential to improve functioning in prodromal illness and exert long-term positive effects on the course of illness. Many of the safest interventions deserve consideration for implementation and dissemination studies.
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Indicated prevention in bipolar disorder was developed only fifteen years ago and is rapidly emerging, but its supporting evidence lags behind that for CHR-P.
“Indicated prevention in bipolar disorder was developed, following the CHR-P template, only fifteen years ago 96,97 , and is rapidly emerging 98-101 . The supporting evidence lags behind that for CHR-P 99,102 .”
From Preventive psychiatry: a blueprint for improving the mental health of young people (2021) · cites this paper as [102]
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Medicare Payment for Behavioral Health Integration
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Self-citationThe 24‐month course of manic symptoms in children
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Self-citationMyriad of implications of acetyl- l -carnitine deficits in depression
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Self-citationThe effects on children of depressed mothers' remission and relapse over 9 months
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Treatment of Bipolar Depression
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Self-citationFeasibility of a Nutritional Supplement as Treatment for Pediatric Bipolar Spectrum Disorders
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A Pilot Pharmacotherapy Trial for Depressed Youths at High Genetic Risk for Bipolarity
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Dysphoria: a Desperate Vitality
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Treatment of bipolar illness: a casebook for clinicians and patients
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Self-citationWhat Have We Learned about Trial Design From NIMH-Funded Pragmatic Trials?
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Self-citationNimodipine Treatment of an Adolescent with Ultradian Cycling Bipolar Affective Illness
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Age at Onset of Bipolar Disorder Related to Parental and Grandparental Illness Burden
Post, R. M., Altshuler, L. L., Kupka, R., McElroy, S. L., Frye, M. A., Rowe, M., Grunze, H., Suppes, T. M., Keck, P. E., Leverich, G. S., et al. (2016) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.15m09811 · Cited by 20 · see citing works
Self-citationFurther Evidence of a Cohort Effect in Bipolar Disorder
Post, R. M., Kupka, R., Keck, P. E., McElroy, S. L., Altshuler, L. L., Frye, M. A., Rowe, M., Grunze, H., Suppes, T. M., Leverich, G. S., et al. (2016) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.15m10121 · Cited by 19 · see citing works
Self-citationCourse of neurocognitive function in first treatment bipolar I disorder: One-year follow-up study
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Treatment of Bipolar Illness: A Case Book for Clinicians and Patients
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Omega-3 Supplementation for Psychotic Mania and Comorbid Anxiety in Children
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Neuroprogression and Staging in Bipolar Disorder
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Vitamin D status of psychiatric inpatients at a community teaching hospital in the Midwest
Zeng, Q., Dellenbaugh, T., Maldonado, M., Moon, J. F., & Hornstra, R. (2015) · Nordic Journal of Psychiatry · doi:10.3109/08039488.2015.1080297 · Cited by 9 · see citing works
The Child Network for Parents to Track Their Child's Mood and Behavior
Post, R. M., Rowe, M., Kaplan, D. M., & Findling, R. L. (2017) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2017.0002 · Cited by 9 · see citing works
Self-citationDebate: Fomenting controversy regarding pediatric bipolar disorder
Goldstein, B. I., Post, R. M., & Birmaher, B. B. (2019) · Child and Adolescent Mental Health · doi:10.1111/camh.12318 · Cited by 9 · see citing works
Self-citationA Multisymptomatic Child With Bipolar Disorder
Post, R. M., Rowe, M., Kaplan, D. M., & Findling, R. L. (2017) · The Primary Care Companion For CNS Disorders · doi:10.4088/pcc.17r02122 · Cited by 8 · see citing works
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Self-citationNew perspectives on the course and treatment of bipolar disorder
Post, R. M. (2017) · Minerva Psychiatry · doi:10.23736/s0391-1772.17.01921-5 · Cited by 7 · see citing works
Self-citationNimodipine in treatment of bipolar disorder
Romanov, D. V., Sheyanov, A. M., Samsonova, M. D., & Iuzbashian, P. G. (2023) · S S Korsakov Journal of Neurology and Psychiatry · doi:10.17116/jnevro202312312120 · Cited by 7 · see citing works
Vitamin D Deficiency in Children with Psychiatric Illness in a Tertiary Care Hospital in North India
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Clinical staging in bipolar disorder: a historical perspective
Post, R. M. (2015) · Oxford University Press eBooks · doi:10.1093/med/9780198709992.003.0001 · Cited by 5 · see citing works
Self-citationLacunae in the evidence for pediatric bipolar disorder: A response to the ISBD Task Force Report
Parry, P. I., Allison, S. C., & Bastiampillai, T. J. (2018) · Bipolar Disorders · doi:10.1111/bdi.12692 · Cited by 3 · see citing works
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- Post RM, 2016b. Preventing sensitization and kindling-like progression in the recurrent affective disorders. In: Chiccetti D (Ed.), Developmental Psychopathy. John Wiley & Sons, Hoboken, NJ, pp. 971– 996.
- Post RM, Leverich GS, Kupka R, Keck PE Jr., McElroy SL, Altshuler LL, Frye MA, Rowe M, Grunze H, Suppes T, Nolen WA, 2015c. Increases in multiple psychiatric disorders in parents and grandparents of patients with bipolar disorder from the USA compared with The Netherlands and Germany. Psychiatr. Genet. 25, 194– 200. 26146875
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Quidé, Y., Tozzi, L., Corcoran, M., Cannon, D. M., & Dauvermann, M. R. (2020) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s285540 · Cited by 51 · see citing works
The Challenges of Children with Bipolar Disorder
Post, R. M., & Grunze, H. (2021) · Medicina · doi:10.3390/medicina57060601 · Cited by 32 · see citing works
Self-citationPapolos, D. F., Teicher, M. H., & Post, R. M. (2025) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13817 · Cited by 31 · see citing works
Self-citationDouble jeopardy in the United States: Early onset bipolar disorder and treatment delay
Post, R. M., Altshuler, L. L., Kupka, R., McElroy, S. L., Frye, M. A., Rowe, M., Grunze, H., Suppes, T. M., Keck, P. E., & Nolen, W. A. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113274 · Cited by 28 · see citing works
Self-citationPsychosocial Treatments for Bipolar Disorder in Children and Adolescents
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25 Years of the International Bipolar Collaborative Network (BCN)
Post, R. M., Altshuler, L. L., Kupka, R., McElroy, S. L., Frye, M. A., Grunze, H., Suppes, T. M., Keck, P. E., & Nolen, W. A. (2021) · International Journal of Bipolar Disorders · doi:10.1186/s40345-020-00218-w · Cited by 15 · see citing works
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Singh, M. K., Chang, K., Goldstein, B. I., Miklowitz, D. J., Soutullo, C. A., Youngstrom, E. A., Birmaher, B. B., Axelson, D., Post, R. M., & DelBello, M. P. (2020) · Bipolar Disorders · doi:10.1111/bdi.12987 · Cited by 6 · see citing works
Self-citationWozniak, J. R., DiSalvo, M., Farrell, A., Joshi, G., Uchida, M., Faraone, S. V., Cook, E., & Biederman, J. (2022) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2022.04.008 · Cited by 6 · see citing works
What Patients with Bipolar Disorder Need to Know about Lithium
Post, R. M., & RYBAKOWSKI, J. K. (2024) · Pharmaceuticals · doi:10.3390/ph17091223 · Cited by 5 · see citing works
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A shocking deficit in bipolar disorder treatment research funding
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Self-citationİnal, N., Ermiş, Ç., Koç, D., Aksoy, S., Karaçetin, G., Tunçtürk, M., Eray, Ş., Karabina, B., Akça, Ö. F., Ozgul, D., et al. (2021) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13333 · Cited by 5 · see citing works
Bipolar Disorder in pediatric patients: A nationwide retrospective study from 2000 to 2015
Campos, A., Ferreira, A. R., Gonçalves‐Pinho, M., Freitas, A., & Fernandes, L. P. N. S. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.10.113 · Cited by 4 · see citing works
Guillen-Burgos, H. F., Galvez-Florez, J. F., Moreno, S., Kwan, A. T. H., & McIntyre, R. S. (2024) · International Clinical Psychopharmacology · doi:10.1097/yic.0000000000000543 · Cited by 4 · see citing works
Koç, D., Ince, E., San, T., Akan, P., Paketçi, A., Böber, E., Direk, N., İnal, N., & Akay, A. P. (2022) · Psychiatry Research · doi:10.1016/j.psychres.2022.114676 · Cited by 3 · see citing works
Putative Risk Biomarkers of Bipolar Disorder in At-risk Youth
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Stigma Kills Psychiatric Patients and Is Now Killing Clinical Research Too
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Osipova, N. N., Bardenstein, L. M., Алешкина, Г. А., & Dmitrieva, E. V. (2021) · Bulletin of Siberian Medicine · doi:10.20538/1682-0363-2021-3-79-87
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Leng, Y. (2023) · Lecture Notes in Education Psychology and Public Media · doi:10.54254/2753-7048/7/2022926
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Talassi, G. G., Albuquerque, Á. A. C. N. D., Senhorinho, B. D. M. C., Camberimba, L. D. J. B., Arouche, R. B., Waquim, S. J. B., Freitas, G. A., Ferreira, K. J. M., de Araújo, G. C. C., Matos, E. F. B., et al. (2023) · Brazilian Journal of Health Review · doi:10.34119/bjhrv6n6-283
(2025) · Elsevier eBooks · doi:10.1016/b978-3-437-21835-4.00116-5
Additional file 1 of 25 Years of the International Bipolar Collaborative Network (BCN)
Post, R. M., Altshuler, L. L., Kupka, R., McElroy, S. L., Frye, M. A., Heinz Grunze, A., Suppes, T. M., Keck, P. E., & Nolen, W. A. (2021) · Figshare · doi:10.6084/m9.figshare.14368841
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Gomes, F. A. (2025) · Springer eBooks · doi:10.1007/978-3-032-01297-5_16
Korean Medication Algorithm Project for Bipolar Disorder 2026: Children and Adolescents
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Perspectives on the use of lithium as a therapeutic option for bipolar disorder in 2026
Post, R. M. (2026) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2026.2734453
Self-citation
- Authors
- Post, R. M., Goldstein, B. I., Birmaher, B., Findling, R. L., Frey, B. N., DelBello, M. P., & Miklowitz, D. J.
- Affiliations
- George Washington University (US)
- Sunnybrook Health Science Centre (CA)
- University of Pittsburgh (US)
- Virginia Commonwealth University (US)
- St. Joseph’s Healthcare Hamilton (CA)
- University of Cincinnati (US)
- University of California, Los Angeles (US)
- Corresponding author
- Post, Robert M.
- ORCID
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2020-07
- Volume
- 272
- Pages
- 508-520
- ISSN
- 0165-0327 (ISSN-L)
- PMC
- PMC8986089
- OpenAlex
- W3010067892
- Cited by
- 31
- References
- 167
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 4 · 2023: 3 · 2022: 7 · 2021: 7 · 2020: 4
- FWCI
- 0.87
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Affective Disorders (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion, cc-by-nc-nd)
- eScholarship (California Digital Library) (submittedVersion, cc-by-nc-nd)
- Funders
- Canadian Institutes of Health Research
- National Institute of Mental Health (R01MH123575, R34MH117200, R37MH085953)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- bipolar disorder, pediatric bipolar disorder, prevention, early intervention, vulnerable children, prodromal symptoms, family history (medicine), childhood adversity, psychosocial interventions, pharmacological interventions, safety and tolerability, illness trajectory
- MeSH terms
- Bipolar Disorder, Child, Child, Preschool, Humans, Prodromal Symptoms
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