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Ask Dr. Sue
BIPOLAR DISORDER
Dear Dr. Sue,
I was recently diagnosed with bipolar disorder. I
have two young daughters, and I am wondering what their
risk for ending up with bipolar disorder is. When
would I begin to notice something if they did develop
this problem? And what would be the early warning
signs?
Dear Mom,
First, for those who may not be familiar with this
mental illness, I'd like to describe bipolar disorder.
This is the condition that used to be called
manic-depressive disorder, which may sound more
familiar. People who have bipolar disorder have periods
of deep depression which alternate with "mania."
Mania is a unique state of mind in which a person may
feel invincible (like nothing can hurt them), or that
anything in the world is possible for them to
accomplish. They have extreme amounts of energy
and can often go without sleep for long periods.
It may sound like this is not such a bad thing, but the
truth is that both phases can be very disruptive to
life. Severe depression can be totally disabling,
causing a person to miss work, avoid social
relationships or even attempt suicide. Mania can
cause people to do things they wouldn't normally do,
too. People may quit their jobs because they are
sure that they are going to make it big in other
investments. They may spend money they really
can't afford on things they don't need. They may
move across the country, leaving friends and other
support systems behind because they feel that a golden
opportunity is just waiting for them in another state.
In children, however, bipolar disorder can look very
different. It is rare for them to have such clear
periods of depression alternating with elation.
Instead, they are more apt to have ongoing irritability
and to be unpredictable (or perhaps explosive) and
difficult to deal with in general. Their moods can
cycle from high to low so rapidly during the day that
they just feel unsettled all the time. Many times
children will first be diagnosed as having ADHD or
simple depression, when their true diagnosis is Bipolar
Disorder. The Child and Adolescent Bipolar
Foundation (1) states that up to one-third of the 3.4
million children and adolescents diagnosed with
depression in the U.S. may actually have bipolar
disorder. (If your child receives such a diagnosis
and seems to get worse with medication, begin asking
questions about bipolar disorder.)
Actually, is is likely that bipolar disorder in the
pediatric age group is both over- and under-diagnosed.
Certainly there are still children who have bipolar
disorder who are being mislabeled and not appropriately
treated. There are also children who are diagnosed
as having bipolar disorder who do not. Dr. Kathleen
Myers, Child Psychiatrist at Children’s Hospital and
Regional Medical Center in Seattle, Washington, advises
caution in making the diagnosis. She feels that
one must be convinced that neither anxiety disorder or
pervasive developmental disorder (or Asperger’s) plus
Oppositional Defiant Disorder are present before making
a diagnosis of bipolar disorder, EVEN if there is a
family history of bipolar disorder.
Bipolar disorder can usually be well-managed with the
proper medications, if those medications are taken
regularly.
It is believed that one to two percent of adults in the
world suffer from Bipolar Disorder. It is not
clear what causes the chemical changes in the brain that
lead to Bipolar Disorder, but there is a genetic
component to the disease.
Different sources cite different levels of risk for
children of bipolar parents. The Centre for
Addiction and Mental Health in Toronto states that when
a parent has Bipolar Disorder, about one in ten of their
children will also develop it. (2) The Child and
Adolescent Bipolar Foundation states the following:
"When one parent has bipolar disorder, the risk to each
child is 15-30%. When both parents have bipolar
disorder, the risk increases to 50-75%. The risk
in siblings and fraternal (non-identical) twins is
15-25%. The risk in identical twins is
approximately 70%." (2)
The Child and Adolescent Bipolar Foundation also lists
symptoms noted by parents whose children were later
diagnosed with bipolar disorder:
-
an expansive or irritable mood
-
extreme sadness or lack of interest
in play
-
rapidly changing moods lasting a few
hours to a few days
-
explosive, lengthy, and often
destructive rages
-
separation anxiety
-
defiance of authority
-
hyperactivity, agitation, and
distractibility
-
sleeping little or, alternatively,
sleeping too much
-
bed wetting and night terrors (note:
these are common in all children, but if dramatic in
degree or if found in combination with other
symptoms might be meaningful)
-
strong and frequent cravings, often
for carbohydrates and sweets
-
excessive involvement in multiple
projects and activities
-
impaired judgment, impulsivity,
racing thoughts, and pressure to keep talking
-
dare-devil behaviors (such as jumping
out of moving cars or off roofs)
-
inappropriate or precocious sexual
behavior
-
delusions and hallucinations
-
grandiose belief in own abilities
that defy the laws of logic (ability to fly, for
example)
While bipolar disorder can begin at any time (perhaps
even as early as infancy), adolescence is a high risk
period for the development of symptoms. Hormonal
changes may contribute to its onset. Life stresses
may also bring on a first episode.
The outlook for people with bipolar disorder is much
better if they are diagnosed early in life and treatment
is begun and maintained from early in the illness.
Unfortunately, diagnosis is quite often delayed by
years. CABG urges parents to have their child
evaluated (and specifically ask about bipolar disorder)
if four or more of the symptoms in the above list are
present for longer than two weeks. Also, since
many people, teens included, try to self-medicate when
they have a mood disorder, it is important to have all
children who are found to be using drugs evaluated for a
possible mood disorder.
References:
1. www.bpkids.org.
(Go to web site and click on “Learn About Pediatric
Bipolar Disorder.”)
2.www.camh.net/About_Addiction_Mental_Health/Mental_Health_Information/when_parent_bipolar.pdf
 
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