Bipolar Medications for Teens

Medication is usually part of treating bipolar disorder in a teenager, alongside therapy, sleep routines and family support. Several medicines have FDA approval for bipolar I disorder in young people, most from age 10, and some lithium products from age 7. Others commonly used in adults are not approved for youth. This page lists the approvals by name and age, explains what monitoring each group of medicines needs, and covers consent. It gives no doses: dosing is an individual decision for the prescriber.

Before anything else: safety and steady treatment

NIMH makes two points every family should hear early. Steady treatment works better than treatment that starts and stops, and stopping medication suddenly can be dangerous. Providers also try to use the fewest medicines at the lowest effective doses. If a medicine is causing problems, call the prescriber rather than stopping it.

Guidelines for young people are older and thinner than for adults. A 2007 AACAP practice parameter, which AACAP now lists as historical, said mood stabilizers and atypical antipsychotics were generally considered first-line, often with psychosocial therapy. According to a 2023 summary of the CANMAT/ISBD 2018 guidelines, the pediatric section lists lithium, risperidone, aripiprazole, asenapine and quetiapine as first-line options for acute mania in youth, and lurasidone for acute depression.

FDA-approved ages, medicine by medicine

These approvals come from each product’s current FDA label. They cover bipolar I disorder unless stated otherwise. Brand names appear in parentheses for reference only.

“Not approved for youth” does not mean never used. Prescribing outside a label is legal and sometimes reasonable, but it should come with a clear explanation of why, what the evidence is, and how it will be monitored. Lumateperone (Caplyta), approved for bipolar depression, is approved for adults only. For the adult picture of each drug class, see bipolar medication explained.

Lithium in teenagers

Lithium is the oldest mood stabilizer and has pediatric approval on its current generic label for children 7 and older, based on an acute trial followed by a randomized withdrawal phase in ages 7 to 17. Its boxed warning says toxicity is closely related to blood levels and can occur at doses close to the therapeutic range, which is why lithium always comes with regular blood tests.

Before starting, the label lists kidney function, vital signs, electrolytes, thyroid function, other medicines and pregnancy status. For teens, everyday life matters too. Dehydration from sports in the heat, a stomach bug or fever can raise levels, and over-the-counter anti-inflammatory painkillers such as ibuprofen can as well; NICE advises avoiding them. Lithium can increase thirst and urination, which may need a plan at school (see school support). More detail is in lithium for bipolar disorder and lithium levels.

Antipsychotics: weight and metabolic monitoring in youth

Most of the approved options for young people are second-generation antipsychotics. They can be effective, but weight gain and changes in blood sugar and cholesterol are a real concern at this age. The olanzapine label states that adolescents have a higher potential for weight gain and abnormal lipids than adults, which “may lead clinicians to consider prescribing other drugs first in adolescents.” The cariprazine label’s metabolic warning was revised in December 2025.

NICE recommends checking weight or BMI, pulse, blood pressure, fasting glucose or HbA1c, and lipids before an antipsychotic is started, then weight weekly for the first six weeks, and weight, glucose and lipids again at 12 weeks, then at least yearly. NICE also advises that antipsychotics in young people should not routinely continue past 12 weeks without a review of whether they are still needed. U.S. practices vary in how they schedule these checks; the point is that a plan should exist. General lab schedules are covered in psychiatric medication lab monitoring, and weight specifically in bipolar medication and weight gain.

Lamotrigine: higher rash risk in young people

Lamotrigine is widely used for bipolar maintenance in adults but has no pediatric bipolar approval. Its boxed warning matters even more for teens: serious rashes, including Stevens-Johnson syndrome, occur in about 0.3% to 0.8% of patients aged 2 to 17, compared with about 0.08% to 0.3% of adults.

• Risk is higher when lamotrigine is taken with valproate, or when the starting dose or the pace of increases is exceeded.
• Since October 2025 the boxed warning also names the HLA-B*1502 gene variant as a risk factor.
• Nearly all life-threatening rashes began within 2 to 8 weeks of starting.
• Serious rash can still happen without any of these risk factors.

Our page on lamotrigine rash explains what to look for and when it is an emergency.

Valproate and carbamazepine

Neither is approved for pediatric bipolar disorder. The valproate (Depakote) boxed warning covers liver damage, pancreatitis and serious fetal risk, including neural tube defects and lower IQ after exposure in the womb, which is a major consideration for any teenage girl. NICE advises against offering valproate to young people unless no other effective, tolerated treatment exists. Carbamazepine carries a boxed warning for severe skin reactions linked to HLA-B*1502 and for rare blood disorders. Whether either is appropriate is a decision for the prescriber; the pregnancy side is covered in psychiatric medication in pregnancy.

Consent and assent: who decides

Who can agree to psychiatric medication for a minor is set by state law, and the rules differ between the states Willow & Stone serves. In Texas, a parent or legal guardian generally consents to psychiatric medication for a teen; read Texas teen mental health consent for the details and the exceptions. The rules for New Mexico, Florida, Arizona, Colorado and Washington are on their own pages.

Legal consent is only part of it. A teen’s assent, their own understanding and agreement, makes a big difference to whether medication is actually taken. Teens do better when they hear the reasons, the side effects to report and the plan for checking whether it works, in their own words.

Questions to ask the prescriber

• Is this medicine FDA-approved for my teen’s age and type of episode? If not, why is it the right choice?
• Which blood tests and measurements are needed, and when?
• What side effects should we report the same day, and which can wait for the next visit?
• How will we know if it is working, and how long until we can tell?
• What should we do about missed doses, illness or dehydration?
• What happens if we want to stop it later?

At Willow & Stone, medication options for teens are discussed at the evaluation, labs are ordered as needed, and the teen and parent hear the plan together. Learn about bipolar disorder treatment at Willow & Stone or return to the teen bipolar disorder guide.

Common Questions

Sources & Further Reading

• FDA label: lithium carbonate (PLR generic label, eff. 2026-04-27), DailyMed
• FDA label: VRAYLAR (cariprazine), pediatric indication 12/2025, DailyMed
• FDA label: LAMICTAL (lamotrigine), boxed warning (eff. 2025-10-10), DailyMed
• FDA label: olanzapine (generic), adolescent use, DailyMed
• FDA label: LATUDA (lurasidone), DailyMed
• NICE CG185: Bipolar disorder, assessment and management (last updated 2 Sept 2025)
• NIMH: Bipolar Disorder in Children and Teens (NIH Pub. 23-MH-8081, 2023)
• Keramatian K, Chithra NK, Yatham LN. CANMAT/ISBD guidelines for bipolar disorder: update of evidence. Focus 2023

This article is general education, not a diagnosis or advice for your situation. Do not start, stop, or change a medication without talking to the clinician who prescribes it; stopping a mood stabilizer suddenly can trigger relapse.