The nature of depression in children with bipolar disorder makes it more difficult to treat. Also known as manic-depressive disorder (MDD), sufferers alternate between states of mania, or euphoria, and depression. Treating these mood swings is difficult in adults. Given the current state of medical knowledge, children with bipolar illness are given the same type of medication. Alarming statistics published in the Journal of the American Academy of Child & Adolescent Psychiatry show that the use of antipsychotic drugs to treat children with bipolar disease has doubled from 2000 to 2007.
A multitude of factors can make it difficult to diagnose and manage bipolar disorder in your child.
Many children act hypomanic by nature. Symptoms of bipolar depression and bipolar mania are often confused with other childhood disorders that are on the increase. Most commonly, symptoms of bipolar disease are mistaken for those of attention deficit disorder (ADD). It also shares psychotic symptoms with schizophrenia. The co-existence of more than one disorder, especially Conduct Disorder, also makes identification difficult.
One way of differentiating between bipolar disorder and ADHD in your child is to observe how they respond to medication, according to Dr. Elizabeth Weller, a specialist in pediatric psychiatry in an article in Psychiatric News. Bipolar children will respond very well to mood stabilizers, which may not have a significant effect on ADHD children. ADHD stimulants, on the other hand, can push a bipolar child into manic episodes.
At different ages, children will exhibit different symptoms. Preschool children are more likely to show signs of irritability, but as the child ages mania becomes more prevalent. Chronic irritability without mania is also a symptom of ADHD, according to the National Mental Health Institute’s How is Bipolar Disorder Detected in Children and Teens. In differentiating between bipolar and ADHD, the NIMH also considers family history and brain function.
Experts agree that parents must play a vital role in monitoring and charting symptoms and watching closely for any changes, which can be dramatic in children with bipolar affective disorder. In the treatment of all mental disorders, positive results are being produced from the movement to more talk therapy over medication. Pediatric mental health workers can also help you zone in on the underlying causes of your child’s mood swings.
Pharmacogenetics, although still a new science, is already helping fine-tune drug dosages and treatment length in children with bipolar disorder. The fatal overmedication of a Washington state four-year-old with bipolar disorder highlights the dangers of prescribing the right doses to children. Signs of severe depression and fatigue in children on antipsychotic drugs could indicate overmedication.
Pharmacogenetics has been successfully used on children with mood disorders to determine how the child will metabolize a drug. A normal dosage of Risperdal, for example, on a New York state five-year-old boy with a slow metabolism was determined to be an overdose. Like the young girl in Washington state, both children showed signs of depression and lethargy as a result of the overdose.
These cases underscore the usefulness of relying on more professional resources to help diagnose and treat a child with mood disorders. Notably, it raises the question of whether, in some cases, the drugs are contributing to depression in children. The bipolar boy from New York was first diagnosed with attention deficit disorder, and only developed mood swings after he began taking an antipsychotic drug.
Advances in genetic research hold the greatest promise of using gene therapy in the prenatal or early years to treat bipolar disorder. A recent study in BMC Psychiatry has identified malfunctioning circadian clock genes in the development of bipolar disorder in children. Disturbed sleeping patterns, or circadian rhythms, are not prevalent in children with ADD.