Does your child have severe mood swings? Is he or she overly silly, then very sad? Does your child’s mood or behavior disrupt his/her life at home or school?
Chronic changes in mood and behavior could be a sign of bipolar disorder. Affecting about 4 percent of the population, bipolar disorder or manic-depression is a brain disorder that causes wide fluctuations in mood. A person with bipolar disorder may have sudden mood swings that vary from excessively happy (manic) to excessively sad (depressed). Thoughts of suicide and attempts at suicide may develop. During manic episodes, patients may become euphoric (intensely excited and happy) for no apparent reason.
In children, obvious manic and depression mood swings are unusual before puberty. Symptoms of Attention Deficit Hyperactivity Disorder (ADHD) with poor focus, inattention, over-activity, impulsivity and fidgetiness may precede the development of mood swings. Often mood shifts in kids are more rapid than they are in adults.
During the manic phase, children may:
- Exhibit feelings of special powers and superiority
- Be overly optimistic and talk excessively with what is described as “pressured speech”
- Be restless and sleep as little as four hours a night
- Have racing thoughts and laugh inappropriately
- Spend money inappropriately and engage in inappropriate sexual activity (adolescents)
- Have difficulty maintaining relationships with family and friends
Note: Hypomania, a less severe form of mania, can appear just as excessive happiness, making the diagnosis of bipolar disorder more difficult.
Episodes of mania or hypomania may be interspersed with episodes of depression. Kids may experience:
- Fatigue or loss of energy
- Anger or irritability
- Guilt and anxiety
- Suicidal thoughts or actions
- Weight loss or weight gain
- Trouble sleeping or sleeping too much
- Inability to concentrate and make decisions
When compared with the general population, those with bipolar disorder (including children) have a higher risk of abusing alcohol and drugs.
Bipolar disorder does run in families. During patient evaluation and discussion, health care providers often discover other family members who also suffer from the disorder. While there is no specific diagnostic test for bipolar disorder, there are screening tools available. Typically, the diagnosis is reached by observing and recording the common symptoms associated with the disorder. Genetic testing is not currently offered for the condition, although researchers have begun to identify specific genes linked with bipolar disorder.
Some scientists believe patients with bipolar disorder have a chemical imbalance in the brain, which can be effectively treated with medications. Bipolar patients also seem to have a higher number of stressful events, as well as grow up in harsher environments during their early lives.
Diagnosis is Difficult, But Key
Diagnosing bipolar disorder isn’t easy. In fact, the correct diagnosis is often delayed or never made. When seen, patients may only show depression or happiness (hypomania). For proper diagnosis, non-mental health issues should be ruled out (e.g., lead intoxication, mononucleosis and thyroid disease). There are also other conditions that can occur at the same time as bipolar disorder, including ADHD, fetal alcohol syndrome and anxiety. Because the treatment prescribed varies by condition, it is vital to make an accurate diagnosis as early as possible.
Successfully managing bipolar disorder depends on support from a variety of medical professionals. Primary care providers will often seek consultation with psychologists, psychiatrists, neuro-psychologists and/or neurologists, who may provide mental health education, cognitive behavioral therapy, and individual and family counseling.
Therapy is designed to:
- Reduce exposure to symptom triggers
- Help patients and family members recognize early symptoms
- Reduce/stabilize full-blown mood swings
- Relieve other core symptoms
- Prevent substance abuse
Medications prescribed for bipolar disorder include mood stabilizers and anti-psychotics, such as Risperdal, Abilify, Depakote, Carbamazepine, Zyprexa, Lithium and Geodon. Because side effects and tolerance widely vary from patient to patient, these medications should be closely monitored by experienced health care providers. It is also not uncommon for bipolar patients to require other medications along with mood stabilizers to address ADHD, anxiety or severe depression.
Eric J. Slosberg is board certified in adolescent medicine and pediatrics. For an appointment or more information, call ProMed Physicians-Pediatrics in Richland at (269) 552.2500.