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Bipolar Disorder – highs and lows
Medical experts are divided about the diagnosis and treatment of children with bipolar disorder
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More children worldwide are being diagnosed with bipolar disorder (also known as manic-depression), a severe mental illness that can be fatal if not treated properly. While medical professionals seem to disagree on just about everything to do with bipolar disorder in children, it is recognised as a serious condition that requires proper diagnosis. According to global statistics, 25 to 50 percent of people diagnosed with the disorder will, at some time in their lives, attempt suicide and about 15 percent will succeed.
What is bipolar disorder?
While local statistics are in short supply, the SA Bipolar Site estimates that about one percent of the population suffers from bipolar disorder. It is categorised by mood swings from “high” episodes of mania to “low” periods of depression that differ in severity and frequency depending on the individual.
Based on their symptoms, bipolar sufferers are usually diagnosed as having bipolar I or bipolar II disorder. Bipolar I usually involves episodes of both depression and mania and is distinguished from bipolar II by the experience of delusions and the severity and duration of the manic phase, which can last from a week to several months. Bipolar II is more common and is characterised by episodes of severe depression with occasional episodes of “mild” mania, called hypomania. This differs from mania in that no delusions are experienced. While bipolar II has been described as being “milder” than bipolar I, the suicide rate is higher in those suffering from bipolar II.
Freelance writer and academic, Shellique Carby, 26, from Durban, suffers from rapid-cycling bipolar I, where she has four or more episodes of mania and depression in a year. “The highs and lows would last for about a week. I had extreme mood swings that I couldn’t control, which hindered my functioning in daily life and made me want to do dangerous things.”
Causes and symptoms
Cape Town-based child psychiatrist, Dr Bev Edwards, believes that the most common and likely cause is genetics. “When a patient has a family history of it, their chance of becoming bipolar increases.” Other theories suggest that a stressful environment and childhood post-traumatic stress can play a large role. The severity of symptoms varies between individuals but bipolar disorder is usually identified by cycles of emotional highs and lows, which may differ in frequency. The highs of mania can include rapid speech, feelings of supremacy, insomnia, disconnected thoughts, grandiose ideas, hallucinations, extreme irritability, paranoia, aggressive behaviour, an increase in strength and energy and openly promiscuous activity.
For 24-year-old Matt von Abo, of Cape Town, his behaviour during his manic stages contributed to many of his successes during high school. “I became more creative with art and music and became obsessed with learning things that interested me. I was also popular as I was always the loudest, sharpest, wittiest, most impulsive and out-there person. People love you when you are like that, even teachers. But I always took it too far; it damaged relationships and got me into a lot of trouble at school.”
Symptoms in children
“Children don’t present symptoms like adults,” explains Edwards. “In adults, you typically get manic, then depressed, followed by a break, then manic again and so on. In children, you often get the mixed-mood episode, where a child experiences depression and mania at the same time.” Children with early-onset bipolar can often experience rapid cycling. “Their mood changes rapidly,” says Edwards. “They don’t see clear happiness and sadness and this usually results in them becoming extremely irritable and often aggressive.” It is because of this that bipolar in children is often misdiagnosed as attention deficit hyperactivity disorder (ADHD) or interpreted as attention seeking or acting-out. It also explains why it is commonly diagnosed during a person’s 20s, when their moods can no longer be dismissed as typical teenage behaviour. While most sufferers are only diagnosed as adults, the symptoms can often be traced back to their pre-teenage years. “When I was about 10 years old, I was so angry at our dog that I threw her down a hill,” says Shellique. “I started showing signs of clinical depression around the age of 12. I could never control my emotions and when they were intense, I couldn’t understand why.” Bipolar usually manifests between the ages of 20 and 30 and lasts for life.
Is there a rise in child diagnoses?
The Journal of the American Academy of Child & Adolescent Psychiatry says the number of children aged two to five who have been diagnosed with bipolar disorder and prescribed powerful medication has doubled in recent years. Although there is no research to support this trend in SA, there has been some rise in the number of diagnoses. “This has a lot to do with an increase in awareness of bipolar,” says Edwards. “It has become more accepted by the mental health profession, but I still think it may be a bit over-diagnosed.” Johannesburg clinical psychologist Adele Romanis thinks that it may be the new flavour of the month. “We saw it in the 90s with the surge of children being diagnosed with ADHD. Now they are beginning to realise that the problem wasn’t ADHD and that we have been incorrectly medicating these children. Misdiagnosis can be damaging to mental health.”
Is your child bipolar?
A diagnosis is usually made when a crisis is reached and alternative medication has failed to work in the long run. Edwards believes that it takes about eight years to make an accurate diagnosis of bipolar, as a history of mood cycles needs to be identified. But for Cape Town mother of two, Melissa*, it was when her daughter started behaving in a manner that “scared the heck out of her” that she knew something was wrong. Her daughter, Kirsty*, was diagnosed with bipolar disorder two years ago at the age of 15. Melissa also suffers from the disorder.
Before you go to the child psychiatrist, keep a mood diary or calendar so that they will be able to identify any mood patterns that could help make a diagnosis. Research your family’s medical history for any occurrence of the condition.
Treatment
Mood stabilisers are the most common form of treatment and Shellique, Matt, Melissa and Kirsty have all noticed a considerable change since taking them. Antidepressants alone won’t help someone with bipolar and many psychiatrists believe that the right dosage is the key to treatment. “I think that the right medication in adults is important but in children it is difficult, making it even more important for the child and parents to attend family therapy,” says Romanis. After diagnosis, Melissa advises parents to inform their child’s school and make sure they know what bipolar is.
*Names have been changed.
Five steps for parents suffering from bipolar disorder
- Make sure that your medication is organised simply and stored in childproof containers.
- Maintain a family mood diary to monitor both your moods and your children’s, so you can recognise any signs of the disorder.
- Attend family therapy. Talk about the condition as a family. Make sure that you know how it’s affecting your children and that they understand what it is.
- Tell your children’s teachers so if there are any crises, they will know how to deal with them.
- Reduced stress can decrease your chances of manic attacks.
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