Bipolar Disorder (BPD) is a disorder of mood that may be characterized by recurrent episodes of depression, mania or hypomania (American Psychiatric Association [APA], 2000). When the mood diagnosis is first made, it may not be clear if it is going to progress to bipolar disorder. A manic episode must include:
A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week or requiring hospitalization. Children with mania are often very irritable. They also may have tantrums. Following the period of mood disturbance, three or more of the following symptoms have persisted and been present to a significant degree (four if the mood is only irritable):
These last two are very significant in adolescents, because of all the risks involved, including taking drugs and drinking alcohol, driving under the influence, unsafe sex. A sudden or significant increase in risk-taking behavior in a teenager, along with some of these other symptoms, is a red flag. Parents need to be aware of this.
These symptoms must interfere with functioning in usual social situations with others, at home or at school, or may be severe enough to need hospitalization. They are not caused by another illness or medication.
A major depressive disorder must include a number of criteria that can be reported by the patient or observed by others. Five or more of these must be observed; at least one must be depressed mood or loss of interest.
Teenagers especially may think about committing suicide. Anyone who expresses this needs to be taken seriously. It is a red flag for depression and for the need to get immediate professional help.
Again, these symptoms must interfere with functioning in usual social situations with others, at home or at school, or may be severe enough to need hospitalization. They are not caused by another illness or medication. They are also not caused by a recent loss of a loved one; within two months after a loss, improvement can be expected.
Bipolar disorder can be diagnosed in patients that have had a single manic episode, recurrent manic or hypomanic episodes, recurrent depressive episodes, or recurrent manic and depressive episodes. A hypomanic episode is similar to mania but not as severe. In children and adolescents the symptoms must be present for at least a year. Most people who develop bipolar disorder are late teens or young adults. It is called early-onset bipolar disorder when it develops in children, and can be more severe than BPD in adults, with higher frequency of mood swings. Some children cycle back and forth between depression and mania every day (Geller, 1997).
Overall, it is estimated that the prevalence of BPD is around 1% of the population (Coghill, 2003). There is disagreement about how frequently it actually occurs in children and adolescents. Mania can be confused with attention deficit hyperactivity disorder (ADHD). Bipolar disorders occur more frequently to children of parents with the disorders, and to children of parents with alcohol or drug addiction. There is definitely a genetic component. Adolescents have symptoms more like adults with bipolar disorder. Any child or adolescent with severe mood swings should be evaluated. Obviously this can be difficult, especially in a teenager, when some of these behaviors can be normal. It is a question of degree, of the severity of the symptoms and how risky the behavior is. An adolescent may actually ask for help, especially when depressed. It is easier to get a teenager to see a healthcare provider when they are depressed than when they are in an episode of mania.
Treatment of bipolar disorder depends on a number of factors, including the age of the patient and the specific disorder – whether it is recurrent depression or whether there are manic episodes. Treatment is not curative. Treatment aims at decreasing symptoms. Control may be difficult in the child or adolescent with BPD. The specific drugs used will be different in children than teenagers and than adults. First, there are medications to help control mania. Lithium is used for both adults and children with mania. They can also be treated with carbamazepine or valproate to stabilize their moods. Valproate may affect hormones and is not a good treatment for young girls. Other possible mood stabilizers including lamotrigine, gabapentin and tobiramate are currently being studied. Second, there are many medications useful for the recurrent depression. However, if given before mania is treated, these can trigger mania. There are antidepressants approved for teenagers (Cheung et al., 2007). These must be taken regularly. Treatment may change over time as the child matures. “Talk” therapy or psychotherapy has also proved useful for children and teenagers with bipolar disorder, as has cognitive therapy, where they learn how to deal with inappropriate thoughts or actions (National Institute of Mental Health [NIMH], 2007).
Antidepressant therapy in teenagers has been associated with an increased risk of suicide. Ongoing studies are trying to find the best medicine and the safest. Research is also continuing to try and find the best way to identify BPD in the young. Children with BPD may have a difficult
time getting diagnosed and treated (Freeman, 2009). There are questions about whether BPD in children always progresses to BPD in adults (Geller, 1997).
As with any chronic problem, there are always ideas of finding alternative ways to handle bipolar disorder. Most alternative practitioners do stress the need to continue with regular medical treatment and to discuss changes with the treating doctor. They often suggest adding a variety of vitamins and supplements, as well as suggest acupuncture, meditation, biofeedback, and similar practices (Ford-Martin, 2009). The key to any additional treatment is to make sure any supplements do not interact badly with prescribed medication, and not to stop taking prescribed medication.
References:
American Psychiatric Association. (2000). Diagnostic criteria from DSM-IV-TR. Washington, DC: Author.
Cheung, A. H., Zuckerbrot, R. A., Jensen, P. S., Ghalib, K., Laraque, D., Stein, R. E., et al.
(2007). Guidelines for adolescent depression in primary care (GLAD-PC): II.Treatment and ongoing management. [Electronic form]. Pediatrics, 120, e1313-e1326.
Coghill, D. (2003). Current issues in child and adolescent psychopharmacology. Part 1: Attention deficit hyperactivity and affective disorders. [Electronic form]. Advances in Psychiatric Treatment, 9. 86–94.
Ford-Martin. P. (2009). Bipolar disorder. Encyclopedia of Alternative Medicine. Retrieved March 26, 2009 from http://findarticles.com/p/articles/mi_g2603/is_0002/ai_2603000204
Freeman, A. J., Youngstrom, E. A., Michalak, E., Siegel, R., Meyers, O. I., & Findling, R. L. (2009). Quality of life in pediatric bipolar disorder. [Electronic form]. Pediatrics, 12. e446-e452.
Geller B., Luby J. (1997). Child and adolescent bipolar disorder: a review of the past 10 years. Journal of the American Academy of Child and Adolescent, 36 (9), 1168-76.
National Institute of Mental Health. (2007). Bipolar Disorder. NIMH Publications. Retrieved March 26, 2009, from http://www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml