WHAT IS BIPOLAR DISORDER?
Bipolar disorder is a form of mood instability characterized by periods of increased arousal and periods of depression. Most often it is also accompanied by a high level of anxiety and an intense internal awareness.
IS BIPOLAR DISORDER MANIC DEPRESSION?
Not always. Manic depression is a severe form of bipolar disorder, but there is a spectrum of severity and a spectrum of symptoms that can be seen in bipolar disorder.
CAN YOU BE A LITTLE BIT BIPOLAR?
Yes. Because the disorder can appear with varying severity there is a spectrum of symptoms with different degrees of intensity.
HOW CAN I TELL IF MY CHILD HAS BIPOLAR DISORDER?
The diagnosis should be made by a child psychiatrist experienced in diagnosing and treating bipolar disorder. The diagnosis should also be made longitudinally, over a period of time. An evaluation should always include: present symptoms, developmental history, and family history. My book lists some indicators in these three categories that may be a helpful starting place.
HOW EARLY CAN A CHILD HAVE BIPOLAR DISORDER?
Bipolar disorder is an inherited condition, which means that the vulnerability to bipolar disorder is inherited at birth. The disorder can show up at various ages depending on how much stress a child is subject to and how vulnerable the child is.
WHAT KINDS OF STRESS CAN BRING ON BIPOLAR DISORDER?
In a vulnerable child stress can come from normal developmental tasks, from hormonal changes, and from problems that originate in the child’s environment. A chemical insult—a prescribed or a “recreational” drug—can also cause a child or adolescent to become symptomatic.
HOW EARLY CAN BIPOLAR DISORDER BE DIAGNOSED?
The diagnosis should be made longitudinally—over a period of time. When the condition has an early onset it is most commonly diagnosed because a child has difficulty with early developmental tasks: sleeping, accepting limits, managing in the school situation. The earliest I have made the diagnosis—tentatively—is at the age of five or six.
IS BIPOLAR DISORDER BEING OVER-DIAGNOSED?
It is hard to tell. There are no records of how many children are diagnosed. In my experience it is more frequent that a child fails to be diagnosed early enough and either receives no treatment or inappropriate treatment.
ARE CHILDREN WITH BIPOLAR DISORDER BEING OVER-MEDICATED?
There are many cases in which a child or adolescent with bipolar disorder is inappropriately medicated. There are not enough doctors who are experienced in recognizing treating bipolar disorder in children. Appropriate medication can vary greatly from one child to another both in regard to what medications are used and what is the proper dose. It is also too common for a child to be medicated but not to receive appropriate psychotherapy.
WHAT IS POLYPHARMACY?
Polypharmacy refers to the practice of using several medicines at the same time to treat one condition.
IS POLYPHARMACY DANGEROUS?
It depends. It is often better to use several medications than just one because bipolar disorder can have a variety of symptoms and different symptoms are reached by different drugs. Different drugs also target different areas in the brain. Care must be taken, however, to insure that there are no harmful interactions between the drugs. There is actually a disturbing trend to use certain major tranquilizers (antipsychotics) as a single treatment for bipolar disorder. This approach can sacrifice subtelty and increase the risk for side effects.
WHY SHOULD A CHILD BE PLACED ON MEDICATION?
If a child is unable to manage important developmental tasks and is not adequately helped by psychotherapy alone, medication may be needed. Appropriate medication can also prevent symptoms and developmental problems from getting worse. The decision needs to be made by parents in consultation with an experienced child psychiatrist. The decision also needs to be reviewed periodically.
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