P03.15. Myo-inositol for Comorbid Anxiety in Children and Adolescents With Bipolar Disorder: Promise and Pitfalls

Focus Areas: Integrative Approaches to Care, Pediatrics, Mental Health Bipolar disorder, formerly known as manic-depressive disorder, consists of often recurrent and severe mood episodes. Roughly 1% of children are diagnosed with bipolar disorder; the prevalence doubles in adulthood. The intense mood swings and periods of depression contribute to the significant morbidity and mortality associated with this disorder, which ranks seventh among worldwide causes of nonfatal disease burden. Patients with bipolar disorder commit suicide at a rate that is nearly 25 times that of the general population. The adverse effects—cognitive, functional, substance abuse rates—are exacerbated by co-occurring illnesses. Half of pediatric bipolar disorder patients have an anxiety disorder and thus a worse clinical outcome. With worsened morbidity and higher suicide risk, the treatment of anxiety in patients with bipolar disorder is imperative; however, options are limited, especially in youth. Benzodiazepines have not been efficacious in pediatric anxiety disorder trials and carry the risk of addiction, sedation, and adverse cognitive effects. The mainstays of pharmacological treatment are the selective serotonin reuptake inhibitors (SSRIs). Although generally well-tolerated, long-term medication side effects have not been researched extensively in youth. Also, SSRIs carry a blackbox FDA warning, and many providers are concerned about the risks of switching patients with bipolar disorder into a manic state. In this setting, myo-inositol, a natural structural isomer of glucose, is a promising treatment option that is both naturally derived and generally well tolerated. It has been shown to be useful in the treatment of depression, obsessive compulsive disorder, and panic with similar efficacy to SSRIs. This poster outlines the clinical utility of myo-inositol for the treatment of anxiety in youths with bipolar disorder. Treatment strategies, limitations, and clinical outcomes are discussed both through treatment experiences and a review of the literature. Further avenues for research also are explored.