Once a child or adolescent is diagnosed with bipolar disorder, treatment for the disorder is the next step a parent needs to consider. However, this is not the easiest decision for parents to make since the basic psychiatric treatments in most clinics today are still based almost exclusively on clinical treatment experiences with adults.
Relying on adult treatment modes has never been the most effective way to treat children and teens but as yet there is very limited data on the efficacy and safety of mood stabilizing medications in our youth populations. So there is very little choice available at this time except to follow along with what has been effective treatments for adults. And please bear in mind that any treatment used will depend on an appropriate diagnosis of a bipolar disorder which can be difficult to diagnose in youngsters.
The best advice available is that if your child or adolescent appears to be depressed and exhibits ADHD-like symptoms that are very severe, with excessive temper outbursts and mood changes, they should be evaluated by a psychiatrist or psychologist with experience in treating adolescents with bipolar disorder. This is particularly urgent if there is a family history of the illness.
This evaluation is especially important since psychostimulant medications, often prescribed for ADHD, may worsen manic symptoms. There is also limited evidence suggesting that some of the symptoms of ADD, ADHD or similar symptoms may be a forerunner of full-blown mania. Therefore a misdiagnoses of ADD or ADHD could have very negative outcomes for your child. Like I said proper diagnosis is difficult to make but essential if your child is to receive proper treatment.
While it can be hard to determine which young patients will become manic, there is a greater likelihood among children and adolescents who have a family history of bipolar disorder and therefore take this into consideration if the possibility exists. Also, If manic symptoms develop or markedly worsen during antidepressant or stimulant use, a physician should be consulted immediately, and diagnosis and treatment for bipolar disorder should be considered.
Treatment
The essential treatment for this disorder in adults involves the use of appropriate doses of mood stabilizers, most typically lithium and/or valproate, which are often very effective for controlling mania and preventing recurrences of manic and depressive episodes. Research on the effectiveness of these and other medications in the treatment of children and adolescents with bipolar disorder however is still ongoing.
In addition, studies are investigating various forms of psychotherapy, including cognitive-behavioral therapy, to complement medication treatment for this illness in young people. Some youngsters have even shown improvement when treated by professionals trained in compounding more natural substances for more organic forms of treatment. This is a possibility that many parents are looking into instead of medicating their child or adolescent.
Concerns About Valproate Use In Young Females
According to studies conducted in Finland in patients with epilepsy, valproate use may increase testosterone levels in teenage girls and can even produce polycystic ovary syndrome in women who begin taking the medication before the age of 20.5. Increased testosterone can lead to polycystic ovary syndrome with irregular or absent menses, obesity, and abnormal growth of hair. Therefore, it’s imperative that young female patients taking valproate be monitored carefully by a physician.
Ongoing Studies
The National Institute of Mental Health is attempting to fill these current gaps in treatment knowledge with carefully designed studies involving children and adolescents with bipolar disorder. Data from adults do not necessarily apply to younger patients since growing children are going through so many developmental and hormonal changes. These differences in development may have implications for treatment efficacy and safety that could drastically alter our present forms of treatment.
Specifically, these studies aim to determine how well lithium and other mood stabilizers prevent recurrences of mania or depression and control sub clinical symptoms in adolescents; to identify factors that predict outcome; and to assess side effects and overall adherence to treatment. Only time will tell what the outcome will be and hopefully we will have more knowledge about what treatments are most effective for adolescents with bipolar disorder in the near future.