Bipolar Disorder Part 5



Posted: Monday, December 27, 2004

by Anthony Kane MD
ADD ADHD Child Behavior Treatment and Medication

Novel Treatments One novel treatment that has helped is sleep deprivation. This has relieved depression for a short while in some patients.

Thyroid hormones, particularly thyroxin (T4), have been reported to be useful in the treatment of bipolar disorder, particularly rapid cycling.

A Word of Caution Antidepressants Antidepressants can precipitate episodes of mania.

Strattera By now everybody knows that I like to pick on Strattera. Well, I am going to do it again.

Taking Strattera may not be quite so benign in bipolar patients. It is a selective norepinephrine reuptake inhibitor, with a mechanism of action that is similar to many antidepressants. Early reports suggest that Strattera has a tendency to induce mania.

Rapid Cycling Rapid cycling is difficult to treat. An important first step is to assess for and treat medical conditions that may contribute to cycling, such as hypothyroidism or drug or alcohol use. Medications, particularly antidepressants, may also contribute to cycling.

Rapid cycling is relatively unresponsive to lithium. Still, the initial treatment for patients who experience rapid-cycling episodes of illness should include lithium or valproic acid an alternative treatment is lamotrigine.

Maintenance Treatment Once the patient has the presenting episode under control, the goal of treatment is to prevent relapse and to reduce the risk of suicide. Goals also include the reduction of cycling frequency and mood instability as well as improvement in overall functioning.

The most common maintenance drugs are lithium or valproic acid possible alternatives are lamotrigine, carbamazepine, or oxcarbazepine.

In general, the medication that was used successfully to treat the most recent depressive or manic episode is used for maintenance. Maintenance ECT may also be used for patients whose acute episode responded to ECT.

Treatment in Children Very little research has been done in children with bipolar disorder. Most of the treatment protocols are extrapolations from adult studies.

Lithium is the most researched drug for children and seems to be effective. Other drugs such as antiseizure drugs like valproic acid or divalproex seem to have good response rates in initial studies.

Psychotherapy

Since bipolar disorder is probably a physiological brain disorder, psychotherapy plays no real role in treating the actual condition. However, therapy can help the patient and the patient’s family to adjust to the emotional difficulties that go along with having this disorder.

Advice to Parents If you are concerned about your child's behavior, then you should have your child immediately evaluated by a professional familiar with the symptoms and treatment of early-onset bipolar disorder.

Finding the Right Doctor Ideally, a child psychiatrist should evaluate your child.

Teaching hospitals affiliated with reputable medical schools are often a good place to start looking for an experienced child psychiatrist. You can also ask your child's pediatrician for a referral.

Another option is to take your child to nationally a known doctor for diagnosis and stabilization. Then you can use a local professional in consultation with the expert for long-term medical management.

Conclusion There is no cure for bipolar disorder. However, treatment can help your child and improve the quality of his life. With this in mind, and considering the potentially catastrophic consequences of leaving bipolar disorder untreated, we have to do our utmost to ensure our children get the proper diagnosis.

Making the diagnosis of bipolar disorder is hard. Unfortunately, the diagnosis is even harder to make in children than it is in adults. The worst mistake anyone can make is not to consider it as a possibility.

The other thing to remember is that bipolar disorder is nobody’s fault. You can’t blame your child and you can’t blame yourself. What we as parents must do is to try to stay aware of what is happening in the field and strive to be the best advocates for our children that we can be.

Good luck-

Anthony Kane, MD



P S

I know that what I have presented makes bipolar disorder look like a very bleak diagnosis. You should know that it does not have to be that way. Bipolar disorder is a problem, and like other problems in life it is possible to live with it and overcome it. There are many people throughout history who have used this disability to elevate themselves to greatness.

I am including a list of famous people who had bipolar disorder. I am not trying to convince you that your child will be like them. The list is just so that you know the diagnosis of bipolar disorder does not mean that everything is hopeless.

Here is a short list of bipolar people who shaped the world around them, in some cases for centuries:

Anthony Kane, MD is a physician and international lecturer.

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