Patient Groups

Children and Adolescents

Recent US studies reveal a 40% increase in the diagnosis of bipolar disorder in children and adolescence between 1994 and 2003, and this figure continues to rise. Some experts believe this is because bipolar disorder, once believed to have an average of onset between 17-24 years, probably starts earlier in life than previously believed and psychiatrists are now detecting and treating the condition earlier. Others criticize the increase in diagnoses, believing bipolar disorder has become the new catch all diagnosis for a vast assortment of behavioral problems.

Bipolar Medications in Youth

More research is needed in the area of treating bipolar disorder in children. At present the same principles used to guide treatment in adults is being applied to youth. This includes a combination of medications such as a mood stabilizer, antidepressant, and antipsychotic when needed. The FDA has recently approved the antipsychotic Risperdal for bipolar disorder in children and adolescents. Children require close monitoring for liver and kidney toxicities with bipolar medications parents should watch carefully for signs of suicidal thinking in children requiring antidepressants and report these immediately to the health care provider. Food selections and exercise are important to counter the weight gain associated with anti-psychotics. A number of children diagnosed with bipolar disorder are also diagnosed with ADHD. Stimulants can trigger a manic episode; it is therefore important for parents and educators to watch closely to see what type of effects a stimulant is having on a child.

Bipolar Disorder Symptoms in Youth

Although the bipolar disorder symptoms in youth are similar to those found in adults, they are often acted out quite differently. Irritability in youth is often manifested as destructive outbursts, rage, anger and explosive behaviors. Depression is often articulated in the form of physical complaints such as such as headaches, muscle aches, stomachaches or tiredness, rather than feelings of sadness. Poor school performance, social isolation, poor communication, difficulty with relationships, extreme sensitivity, and alcohol or substance abuse are common ways youth act out feelings of depression or irritability.

Bipolar Disorder Effects on Youth

Treatment of bipolar disorder in youth is important in order to minimize the negative impact the illness can have on education and social development. Children have fewer problem solving strategies at their disposal than adults, making the disorder even more difficult for this age to handle. In addition, their moods appear to cycle more rapidly and with greater intensity than those of adults. Psychotherapy to help with problem solving and help youth learn how to detect and cope with mood changes is an important part of treatment for youth suffering from bipolar disorder.

Pregnancy

Bipolar Disorder poses some treatment challenges during pregnancy. Medications such as lithium, carbamazepine, or divalproex should not be taken during pregnancy. ECT, which has been shown to be effective in more than 70% of patients experiencing Bipolar Disorder, offers a useful alternative;2 the unborn child is at greatest risk for developing drug induced abnormalities, during the first three months of pregnancy.

Elderly

When a first episode of bipolar disorder is experienced in an elderly patient is it important to rule out another medical illness, or medication treatment as the cause of the symptoms. Some recurrent episodes in the elderly are related to the individual not taking their medications on a regular basis. Sometimes an elderly patient has a large number of medications to try to keep track of. Many pharmacies offer a service, at no extra charge, where they package all the medications to be taken the same time in blister packages which are clearly labeled with the time of day they should be taken. This type of service is not always advertised, so you should ask your pharmacist if this service is available if it appears that it may be the solution to the problem. When the elderly are treated with medications they frequently must go on the medication at lower doses and increase the dosage more slowly to avoid side effects. Because their bodies may eliminate the medication more slowly, their final dosage is frequently lower.