As you've read, antidepressants and mood-stabilizing medications can make up one portion of a plan to treat and support your child's bipolar experience. And while such medications have been a blessing for many children and teens in balancing bipolar symptoms, for others it may not be enough. We may speculate that antidepressants and mood-stabilizing medications may not be at their most effective for any of the following reasons:

• The child's system simply isn't affected by the medication.

• The child's body is not absorbing the medication properly.

• The child isn't bipolar and experiences one of the bipolar mimics profiled in Chapter 3.

• The length of time using the antidepressant or mood stabilizer wasn't sufficient.

• The therapeutic blood level hasn't been attained (may be too low).

• The prescribed dosage of medication isn't sufficient and may need to be increased.

Even when mood-stabilizing medications are prescribed, your family may not have the luxury of waiting up to six weeks for them to begin to take hold. This may be especially true if your child is increasingly becoming a danger to herself and others. In situations like this, your child's doctor may consider prescribing a short-term medication to be used in conjunction with a mood-stabilizing medication. The short-term medication will likely be an atypical antipsychotic used to target your child's most severe symptoms with the goal of providing your child and your family with timely relief. (Hence the name, anti-psychotic—although it may seem offensive in reference to your child, remember, it's only a name and a clinical one at that.) These medications also have mood-stabilization properties and may be used long-term instead of some mood stabilizers.

The following atypical antipsychotic medications (shown with generic and their most-recognizable brand names) have been used in treating children and adolescents:

• Risperidone, marketed as Risperdal

• Olanzapine, marketed as Zyprexa

• Quetiapine, marketed as Seroquel

• Ziprasidone, marketed as Geodon

• Aripiprazole, marketed as Abilify

Another medication, Clozaril (generic name, clozapine) should be mentioned here, although its safety and efficacy hasn't been established for children under sixteen. Its side effects are many and can be significant, and for this reason, other medications have been favored over the use of Clozaril (like Abilify, which seems more effective and better tolerated in kids). The most severe potential side effect from taking Clozaril is that 1 percent of its users develop agranulocytosis, a severe drop in white blood cells, which can be fatal if unrecognized. Its symptoms are fever, lethargy, sore throat, and overall weakness. In addition to this, Clozaril's possible side effects include many of the usual cautions found with similar medications.

None of the atypical antipsychotic medications was created for use by children and teens; they were designed for use in treating adult mental-health symptoms. As such, none has been approved by the FDA for use by kids; when prescribed for kids, these medications are being used “off label.” As always, the use of any medication prescribed for your child will require careful and cautious monitoring.