COLUMBUS, Ohio -- Very young children treated with normally prescribed amounts of the psychoactive medication lithium will likely experience adverse side effects during the first weeks of treatment.

Researchers at Ohio State University reviewed the medical records of children under age 7 who began inpatient lithium therapy for severe aggressive behavior or bipolar disorder (also called manic-depressive disorder) over a five-year period. They found that 60 percent of children experienced one or more side effects during the first two weeks of lithium therapy.

Further, they found that among these children, one-third suffered serious impairments of the central nervous system (CNS), such as slurred speech, confusion and loss of coordination.

"People must be very careful when giving lithium to very young children," said Elizabeth Weller, a professor of psychiatry and pediatrics at Ohio State and a co-author of the study. "There are a lot of side effects in children that just can't be


Children with bipolar disorder, conduct disorder and extreme aggressive behavior have been shown to improve with lithium treatment, Weller said. Bipolar disorder is characterized by alternating episodes of mania and depression. Conduct disorder is characterized by violent, disobedient behavior, such as lying, stealing and being cruel to animals.

"We always discourage lithium treatment; it's nearly always a last resort," Weller said. "However, if the choice is between being able to keep children in preschool or kindergarten or having them expelled because of aggression, then it's appropriate to try them on it." Untreated conduct disorders and aggressive behavior can lead to chronic antisocial behavior and substance abuse in adulthood, she added.

Weller conducted this research with Owen R. Hagino, an instructor in psychiatry and pediatrics at Brown University, and four colleagues from Ohio State: Ronald A. Weller, a professor of psychiatry; Douglas Washing, a medical student; Mary A. Fristad, an associate professor of psychiatry; and Stella B. Kontras, professor emeritus of psychiatry and pediatrics. The group's work was published in the Journal of the American Academy of Child and Adolescent Psychiatry.

For their study, the researchers reviewed the medical records of 20 children under 7 who were treated with lithium in the children's inpatient psychiatric unit at Ohio State University Medical Center. Twelve children received lithium to reduce aggression; the other eight received it for mood stabilization. For each child, the researchers noted the initial lithium dose, subsequent dose adjustments, blood lithium levels at different points in time and frequency and severity of side effects. If during the course of treatment a child experienced serious CNS side effects, lithium therapy was suspended.

The results:

Weller says she hopes these findings will encourage physicians to proceed with extreme caution when prescribing lithium for very young children. Specifically, she recommends that physicians start these children on lithium doses of no more than 30 mg/kg per day, measure blood lithium level every other day for the first two weeks of treatment and use extra care when prescribing lithium for a child who is ill.

In addition, Weller says she hopes these findings will encourage parents to be conscientious medical consumers.

"Parents should be very careful if someone wants to put their child on lithium," she said. "They should be sure the person prescribing it has a lot of experience with it. Regional referral centers generally have more expertise with psychotropic medications. It's always safer to go to places that have experience."

Contact: Elizabeth Weller, (614) 293-8230;

Written by Kelly McConaghy Kershner, (614) 292-8308

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