Objectives: High rates of aggressive behaviors and severe mood disturbances are documented in children with autism spectrum disorders (ASD) and limited literature documented the presence of bipolar disorder (BPD) comorbidity in ASD populations. Also there is a high incidence of bipolar disorder (BPD) in family members of children with ASD. There is a small number of randomized controlled trials about the treatment protocol of BPD in youth with ASD and the comorbidity rates between these two disorders and there is no treatment guideline for autistic children with bipolar disorder. But this presentation aimed to make a summary of the current consensus on pharmacological treatment options and to brieşy review the evidence-based pharmacological agents.
Method: Original articles, reviews and guidelines about the treatment of bipolar disorders and autism in children and adolescents were searched on Pubmed. Key words of “autism, bipolar disorder, mood disorder, pervasive developmental disorders, Asperger syndrome, irritability, mood dysregulation” were used while searching on Pubmed.
Results: Limited literature on the treatment of comorbid BPD in children with ASD suggests that first generation antipsychotics (haloperidol, chlorpromazine, thioridazine) and traditional mood stabilizers (lithium, carbamazepine) are minimally effective for the treatment of mania. On the contrary, in a recent secondary analysis of acute atypical antipsychotic monotherapy trials in BPD youth, acceptable tolerability and robust antimanic response to atypical antipsychotics in the presence of ASD comorbidity was reported. Atypical antipsychotics especially risperidone and aripiprazole seem to be first choice in the treatment of manic or mixed episodes in youth with ASD. The combination of şuoxetine or citalopram with atypical antipsychotics or mood stabilizers seems to be good choice for the acute phase of bipolar depression in youth with ASD.
Conclusion: The actual incidence of BPD in youth with ASD is probably underestimated. BPD should be borne in mind if a child with ASD refers with episodic irritability and aggressive attacks and have a family history of BPD. In the light of the current literature, atypical antipsychotics seem to be more effective and tolerable than the mood stabilizers in children and adolescents with both ASD and BPD. There is an urgent need for randomized controlled trials with large samples, for the treatment of BPD in youth with ASD.