How do you treat a child with bypolar disorder?

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"I know I need to be on medication. Whatever. I'll go once a month or once every two months to the fricking psychiatrist." - Erin

"Like one of the pills I was so shaky on, oh my god, I'm like, 'Uuuuh.'" - Athena

"Thanks to the pills I'm taking, I'm really good at picking out when I'm feeling depressed or feeling hyper so I can just say, 'Ok, I'm feeling depressed or feeling hyper,' and they can help me out." - Eric

"They'll take me off medication and put me on new stuff, and I'll get violent, and I have bad reactions to medication. I don't even remember all the stuff I've tried, but a lot of it makes me pretty psychotic." - Erin

Once a family gets a diagnosis of bipolar, even the experts aren't sure what to do about it. Psychiatrist Linda Zamvil begins by trying out different mood stabilizers such as trileptol, lithium, or seraquil.

"I, like most doctors, use sometimes a lot of trial and error, and you have to tell families that from the beginning," says Zamvil.

The problem is that psychiatric drugs, like most drugs, have never been tested in children for a variety of logistical and ethical reasons. That creates a dilemma: children have distinct metabolisms and react differently to medication, so kids become pharmaceutical guinea pigs.

"I am looking at my 11 year old child and thinking, 'I am going to be putting these chemicals in my child's system,'" says Conni Rancke. "I think part of it was, we were still reeling from the diagnosis. But part of it was to try the most benign approach possible, to tamper as little as possible with this young growing body."

Psychiatrist Demitri Papolos, author of The Bipolar Child, says parents like Conni Rancke should be cautious. The FDA has warned that some anti-depressants can lead to suicidal tendencies in youth. Dr. Papolos says children who are prone to mania are especially vulnerable.

"Unfortunately for many of these kids," says Papolos, "when you put a child on stimulants or on antidepressants, you can make the course of the illness worse."

For the first time, the National Institutes of Health are sponsoring a drug trial to treat bipolar disorder in children, focusing on anti-psychotic medications.

"We're seeing a child who can't function in any sphere of life," says Dr. Barbara Geller, lead researcher for the trial. "Many of them have written notes of how they will kill themselves, of where they want to be buried. So that you are weighing these factors, what the child looks like, against the risks of the medication."

Geller is hoping to find a regimen that could actually stop the illness from progressing. Meanwhile, Dr. David Miklowitz of the University of Colorado is one of the few researchers looking at the benefits of talk therapy.

"When I started in this field doing work on bipolar in early 80s," says Miklowitz, "it was all medications. That's all anyone talked about. I think the zeitgeist is changing and psychiatrists are realizing this is a difficult illness to cope with, and that the medications are going to be more effective if delivered in conjunction with therapy."

Miklowitz uses a method he calls family psycho-education. He first tries to educate families about the disorder, then help them communicate calmly with each other - solving problems without moods escalating.

"Really the view in traditional family therapy is that the disorder reflects a dysfunctional family," says Miklowitz. "And we don't believe that about bipolar disorder. This is a biologically based illness, and the family is doing its best to cope, and our job, as we see it, is to help the family find the most effective way to cope."

Continue to part 3

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