Ziprasidone monotherapy in pediatric bipolar disorder.

Four children, aged 7-16 years, with bipolar disorder were switched to ziprasidone from mood stabilizers, anticonvulsants, or other atypical antipsychotics because of poor response, troubling side effects, breakthrough symptoms, or concern over potential toxicity. Within 3 days, patients experienced a resolution of hypomania, hallucinations, aggression, irritability, depression, and insomnia. One 16-year-old, who was switched from carbamazapine, also required adjunctive lorazepam for situational anxiety; the others either responded to, or were ultimately managed with, ziprasidone monotherapy. Side effects were mostly mild and transitory. Patients experiencing sedation or wakefulness at dose escalation were maintained at the previous 20- or 40-mg dose level until side effects resolved. Ziprasidone's efficacy, fast onset of action, and good safety profile warrant a more systematic study of this agent in pediatric patients with bipolar disorder.