A boy and his service dog, iggy

Most people have heard of ADHD and know what that is, but what happens when a child has that, plus other problems?  Not many people understand what BiPolar is... or Manic Depression.... and most don't realize that children can have it, as well as adults.

I'm going to try to describe it to you, yet keep it as simple as possible.

It's like a roller coaster! 

How's that?  Understand now? OK.. OK.. I'll tell you what I mean.

One day (or hour, minute, second)  You may be feeling way up. The next you may be feeling way down.  Here's my definitions of such.

UP: 
Hyper, thoughts racing, full of energy, not thinking before you act, so on

Down:
Tired, no energy, sad, depressed, lazy, gloomy

Rages:
Anger, Hitting, Kicking, Punching, Screaming, Swearing, Spitting, Pinching

Mixed State:
All of the above at the same time... Not Pretty

Andrew's biggest area of problems is his rages.  When he don't want to do what he was asked, when he's told "no," and so on, he tends to go into rages.
He raged at my mother's so bad one day, got so violent, that she had call the police to get him off her, and they had to stay until I could get to her house from work.
He has done physical damage to his teacher (broke her finger, split her lip open) and left marks on myself as well.  He has allot of anger control issues, and tends to 'blow' at the drop of a hat.
He can be a very mean, spiteful child at times.  Yet other times he's just the most loving boy you'd ever want to meet!

Bipolar disorder involves marked changes in mood and energy. In most adults with the illness, persistent states of extreme elation or agitation accompanied by high energy are called mania. Persistent states of extreme sadness or irritability accompanied by low energy are called depression.

However, the illness looks different in children than it does in adults. Children usually have an ongoing, continuous mood disturbance that is a mix of mania and depression. This rapid and severe cycling between moods produces chronic irritability and few clear periods of wellness between episodes.

Symptoms may include:

• an expansive or irritable mood
• depression
• 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
• 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
• inappropriate or precocious sexual behavior
• delusions and hallucinations
• grandiose belief in own abilities that defy the laws of logic (ability to fly, for example)

Symptoms of bipolar disorder can emerge as early as infancy. Mothers often report that children later diagnosed with the disorder were extremely difficult to settle and slept erratically. They seemed extraordinarily clingy, and from a very young age often had uncontrollable, seizure-like tantrums or rages out of proportion to any event. The word "no" often triggered these rages.

Several ongoing studies are further exploring characteristics of affected children. Researchers are studying, with promising results, the effectiveness and safety of adult treatments in children. CABF will report all new findings on early-onset bipolar disorder and will include the more important articles in our Learning Center whenever possible.

What are the symptoms of bipolar disorder in adolescents?

In adolescents, bipolar disorder may resemble any of the following classical adult presentations of the illness.

Bipolar I. In this form of the disorder, the adolescent experiences alternating episodes of intense and sometimes psychotic mania and depression.

Symptoms of mania include:

• elevated, expansive or irritable mood
• decreased need for sleep
• racing speech and pressure to keep talking
• grandiose delusions
• excessive involvement in pleasurable but risky activities
• increased physical and mental activity
• poor judgment
• in severe cases, hallucinations

Symptoms of depression include:

• pervasive sadness and crying spells
• sleeping too much or inability to sleep
• agitation and irritability
• withdrawal from activities formerly enjoyed
• drop in grades and inability to concentrate
• thoughts of death and suicide
• low energy
• significant change in appetite

Periods of relative or complete wellness occur between the episodes.

• Bipolar II. In this form of the disorder, the adolescent experiences episodes of hypomania between recurrent periods of depression. Hypomania is a markedly elevated or irritable mood accompanied by increased physical and mental energy. Hypomania can be a time of great creativity.
• Cyclothymia. Adolescents with this form of the disorder experience periods of less severe, but definite, mood swings.
• Bipolar Disorder NOS (Not Otherwise Specified). Doctors make this diagnosis when it is not clear which type of bipolar disorder is emerging.

For some adolescents, a loss or other traumatic event may trigger a first episode of depression or mania. Later episodes may occur independently of any obvious stresses, or may worsen with stress. Puberty is a time of risk. In girls, the onset of menses may trigger the illness, and symptoms often vary in severity with the monthly cycle.

Once the illness starts, episodes tend to recur and worsen without treatment. Studies show that after symptoms first appear, typically there is a 10-year lag until treatment begins. CABF encourages parents to take their adolescent for an evaluation if four or more of the above symptoms persist for more than two weeks. Early intervention and treatment can make all the difference in the world during this critical time of development.

Although there is no cure for bipolar disorder, in most cases treatment can stabilize mood and allow for management and control of symptoms.

A good treatment plan includes medication, close monitoring of symptoms, education about the illness, counseling or psychotherapy for the individual and family, stress reduction, good nutrition, regular sleep and exercise, and participation in a network of support.

The response to medications and treatment varies. Factors that contribute to a better outcome are:

• access to competent medical care
• early diagnosis and treatment
• adherence to medication and treatment plan
• a flexible, low-stress home and school environment
• a supportive network of family and friends

Factors that complicate treatment are:

• lack of access to competent medical care
• time lag between onset of illness and treatment
• not taking prescribed medications
• stressful and inflexible home and school environment
• the co-occurrence of other diagnoses
• use of substances such as illegal drugs and alcohol

The good news is that with appropriate treatment and support at home and at school, many children with bipolar disorder achieve a marked reduction in the severity, frequency and duration of episodes of illness. With education about their illness (as is provided to children with epilepsy, diabetes, and other chronic conditions) they learn how to manage and monitor their symptoms as they grow older.

Mood Stabilizers

• Lithium (Eskalith, Lithobid, lithium carbonate) - A salt that occurs naturally in the earth, lithium has been used successfully for decades to calm mania and prevent mood cycling. Lithium has a proven anti-suicidal effect. An estimated 70 to 80 percent of adult bipolar patients respond positively to lithium treatment. Some children do well on lithium, but others do better on other mood stabilizers. Lithium is often used in combination with another mood stabilizer.
• Divalproex sodium or valproic acid (Depakote) - Doctors frequently prescribe this anti-convulsant for children who have rapid cycling between mania and depression.
• Carbamazepine (Tegretol) - Doctors prescribe this anti-convulsant because of its anti-manic and anti-aggressive properties. It is useful in treating frequent rage attacks.
• Gabapentin (Neurontin)-This is a newer anti-convulsant drug that seems to have fewer side effects than other mood stabilizers. However, doctors do not know how effective this drug is, and some parents report activation of manic symptoms in young children.
• Lamotrigine (Lamictal)-This newer anti-convulsant medicine can be effective in controlling rapid cycling. It seems to work well in the depressive, as well as the manic, phase of bipolar disorder. Any appearance of rash must be immediately reported to the doctor, as a rare but severe side-effect may occur (for this reason Lamictal is not used in children under l6).
• Topiramate (Topamax)-This newer anti-convulsant drug may control rapid-cycling and mixed bipolar states in patients who have not responded well to divalproex sodium or carbamazepine. Unlike other mood stabilizers, it does not have weight gain as a side effect, but its efficacy in children has not been established.
• Tiagabine (Gabitril) -This newer anti-convulsant drug has FDA approval for use in adolescents and is now being used in children as well.

Other Medications

Doctors may prescribe antipsychotic medications (Risperdal, Zyprexa, Seroquel) for use during manic states, particularly when children experience delusions or hallucinations and when rapid control of mania is needed. Some of the newer antipsychotic medications are very effective in controlling rages and aggression. Weight gain is often a side effect of anti-psychotic medications.

Calcium channel blockers (verapamil, nimodipine, isradipine) have recently received attention as potential mood stabilizers for treating acute mania, ultra-ultra-rapid cycling, and recurrent depression.

Anti-anxiety medications (Klonopin, Xanax, Buspar, and Ativan) decrease anxiety by diminishing activity in brain arousal systems. They reduce agitation and over-activity, and help promote standard sleep. Doctors commonly use these medications as add-ons to mood stabilizers and antipsychotic drugs in acute mania.

We have been through allot of different Meds.

Stimulants: Focalin, Ritalin, Concerta, Strattera, Adderal and more
These all caused him to rage something terrible and we can't use these with him., which is very typical for BP kids on stimulants.

Others:
Clonadine, Risperdal, Abilify, Seroquel, Lithium, Depakote, Celexa, Haldol, Triliptal

Current Meds:

(As of 09/24/08)

(Always Changing so it seems)

(I am BP, as is my father, his mother, and my brother)

The illness tends to be highly genetic, but there are clearly environmental factors that influence whether the illness will occur in a particular child. Bipolar disorder can skip generations and take different forms in different individuals.

The small group of studies that have been done vary in the estimate of risk to a given individual:

• For the general population, a conservative estimate of an individual's risk of having full-blown bipolar disorder is 1 percent. Disorders in the bipolar spectrum may affect 4-6%.
• When one parent has bipolar disorder, the risk to each child is l5-30%.
• When both parents have bipolar disorder, the risk increases to 50-75%.
• The risk in siblings and fraternal twins is 15-25%.
• The risk in identical twins is approximately 70%.

In every generation since World War II, there is a higher incidence and an earlier age of onset of bipolar disorder and depression. On average, children with bipolar disorder experience their first episode of illness 10 years earlier than their parents' generation did. The reason for this is unknown.

The family trees of many children who develop early-onset bipolar disorder include individuals who suffered from substance abuse and/or mood disorders (often undiagnosed). Also among their relatives are found highly-accomplished, creative, and extremely successful individuals in business, politics, and the arts.