• BD

Bipolar Disorder

Bipolar disorder (BD) in children is characterized by mood instability with prolonged episodes of mania (lasting a week or more), followed by episodes of depression. The condition was called “manic-depression” before 1980. It was changed to “bipolar disorder” to better describe the polarity of the condition and make it inclusive of those with less pronounced episodes of mania or depression. 

A person suffering from BD can experience “mixed episodes,” in which they’ll experience manic and depressive symptoms at the same time. Manic episodes are distinct periods of time, usually lasting a week or more. During a manic episode, a child may experience inflated self-esteem, grandiosity, decreased need for sleep, rapid speech, distractibility, paranoia, increased goal-focus and risk-taking. Children in manic episodes are sometimes are unable to distinguish reality, which is called a psychotic break. In a depressive episode, a child may sleep too much, complain about physical pain, lose interest in fun activities, overeat or lose their appetite, and/or have suicidal thoughts. Children with BD can pose a threat to themselves or others, making it imperative that they receive help as soon as possible. 

BD is far more common in adolescents than in young children, and is believed to affect from 1-3% of adolescents. It is believed that BD is caused by a chemical imbalance that misregulates moods. BD often has a hereditary component, and some patients report the onset of symptoms after a traumatic brain or spinal cord injury. Having a parent with BD increases and child’s risk of developing the condition; if both parents have the condition, the child is 3.5 times more likely to develop it. However, great strides have been met in the treatment of BD over the last decades, and it responds well to medication. Healthy lifestyle habits can minimize the frequency and severity of episodes, which we’ll discuss below. 

BD is often a co-diagnosis of ADHD, anxiety disorders, and substance abuse. Symptoms may appear similar to those of ADHD, major depression, conduct disorder, disruptive mood dysresgulation disorder (DMDD), and oppositional defiant disorder. However, the episodic mood swings, rapid cycling of mood, and feelings of euphoria are distinct to BD. While irritability is a chronic feature of ADHD, it subsides in children with BD once their manic episode is over. Children with BD often cycle through manic and depressive episodes more quickly than adults. 

There are four primary types of BD:

  • Bipolar 1 - characterized by episodes of extreme mania and severe depression.
  • Bipolar 2 - milder than bipolar 1, bipolar 2 is characterized by less severe mania (seldom requiring hospitalization) and severe depression. 
  • Cyclothymic disorder -  less severe than bipolar 1 and 2, it is characterized by milder episodes of mania and depression for at least two years. 
  • Mixed - characterized by symptoms of mania and severe depression that occur simultaneously.

Demitri Papolos, MD, author of The Bipolar Child, has developed a new diagnosis for a subtype of pediatric BD, called the “fear of harm” profile. This syndrome, thought to be hereditary, is characterized by violent nightmares, a fear of being controlled and humiliated, aggressiveness towards others, disturbed sleep, and anxiety when separated from family members. 

Children with BD can pose a threat to themselves or others, making it imperative that they receive help as soon as possible.

Conventional Treatment

Standard BD treatment involves prescribing mood stabilizers and, potentially, anti-psychotic and anti-anxiety medications. Cognitive behavioral therapy and other talk therapies, including family therapies, are usually prescribed along with medication. 

Medication is the cornerstone of most pediatric BD treatment plans. By stabilizing children’s BD cycles early in their lives, their systems can become less vulnerable to future episodes. Unfortunately, due to the complexity of the condition, most children must take a carefully calibrated combination of medications. Treatment plans usually incorporate mood stabilizers, such as lithium and valproic acid; antipsychotics, such as risperidone and seroquel; and antidepressants, such as fluoxetine and escaliatpram. Early studies have shown that the anesthetic ketamine is effective at treating the “fear of harm” subtype of BD. 

Many caregivers are concerned that treating a child with co-occurring disorders of BD and ADHD with stimulant drugs often prescribed for ADHD will trigger manic episodes. Risk factors for this depend on many variables which should be discussed in detail with your child’s psychiatrist. 

The drugs used to treat BD are known to have significant side effects and, since most children with BD will take multiple medications, their dosage can be complex. As such, it’s important to seek out experienced pediatric psychiatrists for pharmaceutical treatment. 

Consistent, long-term treatment is key; it may take time to monitor moods and other responses to medications and therapies.

Support

At The Brain Possible, our goal is to empower you to take a holistic approach to your child’s treatment. Below are ways in which you can support several aspects of your child’s recovery; before embarking on any, be sure to discuss them with your trusted health care providers.

Physical

A healthy lifestyle is a key component of a successful BD treatment plan. Caregivers should help children create consistent sleep and exercise routines. Therapies such as craniosacral, which regulates the flow of cerebrospinal fluid (CSF), myofascial release, which helps release tissue trauma, and acupuncture, which encourages the flow of energy through meridians in the head and body, may help children with BD experience greater emotional regulation. Chiropractic treatment has been shown to be effective when there was an onset event of traumatic spine or brain injury. 

Emotional/Social

Almost all BD treatment plans include talk therapy. Cognitive behavioral therapy (CBT) can help children learn coping mechanisms for mood instability. Family systems therapy can help parents, children and siblings understand how the condition is impacting the entire family. 

It’s also important to encourage a child with BD to talk about his experiences and feelings. Helping them participate in activities they enjoy will also motivate them to follow their treatment plan. Actively communicate with their guidance counselors to see how their condition may be impacting their school life. If they are taking medication at school, check in with the school nurse to make sure it’s being administered correctly. 

Have open dialogues with your kids about the need for medication to be taken on a precise schedule and find out if they’re experiencing resentment or shame from not being “normal” so that they can receive the necessary emotional support. Teens need to be counseled to stay away from alcohol and drugs, as they interact with medications and may trigger manic or depressive episodes. 

Canine therapy and equine-assisted or hippotherapy can help children learn to regulate their emotions by forming bonds with animals and their therapeutic helpers. Psychiatric service dogs can be trained to help persons with BD maintain their sleep schedule, remind them to take medication, and even interrupt manic behavior.

Sensory

Intellectual

Children with BD may need academic allowances, such as extra time for tests and tasks. Depending on their state of health, they may need a lightened academic load, decreased homework, or even temporarily withdraw from school while they focus on their health.

Nutritional/Environmental

Having a healthy lifestyle can make it easier for your child to navigate the symptoms of BD. Create as little stress at home as possible and create a consistent structure for chores, bedtime, and leisure. Foods rich in Omega-3s (such as flax seed, fish oil, and walnuts) have been shown to help lessen occurrences of depression. Diet and supplementation should be carefully discussed with your psychiatrist, as many psychiatric drugs interact negatively with herbs and some foods, such as grapefruit juice. 

Nutrition-dense diets can help stabilize moods and improve cognitive function. The Ketogenic Diet is a high-fat diet that can help stabilize moods. Low Inflammatory High Fat Diets, which include the Mediterranean Diet, have been shown to minimize ADHD and may help with other mood and cognitive disorders. The Nemechek Protocol, which inhibits bacterial overgrowth in the gut, has been linked to symptoms of mood disorders. 

Physiological

Neurofeedback can help children with BD learn to better regulate their emotions. Light therapy, in which the patient’s eyes receive direct exposure to full-spectrum lights, is used to treat depressive episodes in BD. In some cases, light therapy can trigger manic episodes and so it is important to work with your healthcare provider to make sure your child is an appropriate candidate for this treatment. 

We understand that the categorization of conditions on The Brain Possible may not perfectly describe your child.

Our goal is inclusivity, opening the door to dialogue and information sharing.