Antianxiety Medication for Bipolar Disorder

As we've seen, if a bipolar youngster has an anxiety disorder, it often appears worse during the depressive phase of the illness. Once the mood is stabilized, the remaining anxiety symptoms should be addressed if they are excessive. In some bipolar children, anxiety symptoms disappear completely or almost completely as soon as the depression has been effectively treated. For many youngsters, behavior therapy becomes a much more effective tool once they are stable and can fully make use of it.

Although I usually prescribe a mood stabilizer first for bipolar kids, there are some youngsters who are extremely anxious and can't wait for a mood stabilizer to be fully effective. These kids are almost paralyzed by their anxiety. For them, I might select one of a class of medications known as benzodiazepines—Klonopin (clonazepam), Ativan (lorazepam), Xanax (alprazalam), and Valium (diazaepam). Of these, only Valium is approved for use in young children, but this is for treatment of certain seizure disorders and muscle spasms. Buspar, a nonbenzodiazepine antianxiety agent that is sometimes used in bipolar youngsters, is not FDA approved for children, and it's effectiveness in this population is unclear. Generally, I prefer not to use most of these medications for a lengthy period, as some benzodiazepines have a potential for physical addiction.

Excerpted from: