Health and Psychology

I'm very concerned.  A couple of weeks ago I saw a child in preschool diagnosed with bipolar disorder. PRESCHOOL!  The treating physician had wanted to start the child on an antipsychotic drug known to cause diabetes.  The parent was skeptical about the treatment being suggested.  

Let me explain a couple of things.  First, bipolar disorder used to be known as manic-depressive disorder and was diagnosed exclusively in adults with the onset of a manic episode, a highly expansive mood marked by rapid, pressured speech, grandious ideas, inappropriate sexual conduct, and feelsings of euphoria.  Because manic exhaustion can be fatal, it's important to treat it early and manage the symptoms of extreme mood shifts.

A few years ago someone proposed that bipolar disorder occurred in children but looked different.  It was marked not by a manic episode, but by irritability, tantrums, attention and conduct problems.  Huh?  We have diagnostic labels for depression, attention problems and conduct problems in children.  Why do we need a new label?  Has anyone studied these children to see if they in fact develop into bipolar disordered adults?  

Yes there have been several studies.  None of the pediatric cases has become classically bipolar as adults.  The first age in which bipolar disorder that continues into adulthood can safely by diagnosed appears to be around age 15. Bipolar adults are usually diagnosed between ages 20 and 30.  

Most children can be treated by non-drug measures, including family therapy, behavior therapy, and cognitive behavior therapy, but stimulant medication for attentional problems has proven to be helpful.  The prescribing of multiple drugs is of concern to all since most drugs have not been studied with multiple drug interactions.  The more medications someone is prescribed the more likely the risk of side-effects and drug-drug interactions.  Drug "cocktails" have been studied for asthma, HIV/AIDS and some forms of cancer.  

Most psychiatric medications have not been approved by the FDA to be used on children.  Some have long term serious side-effects such as weight gain, diabetes and uncontrolled motor movements.  Antidepressants of the SSRI class have been known to increase nightmares, thoughts of self-harm, and suicide in children and young adults.

View the diagnosis of bipolar disorder in young children with skepticism.  Seek non-medication treatments as a first line type of management strategy.  Understand that bipolar disorder in childhood, does not appear to lead to bipolar disorder in adults and we have little understanding of the disorder.  Use psychiatric medications with caution in children.