Novel Treatments One novel treatment that has helped is sleep deprivation. This
has relieved depression for a short while in some patients.
Thyroid
hormones, particularly thyroxin (T4), have been reported to be useful in the
treatment of bipolar disorder, particularly rapid cycling.
A Word of
Caution Antidepressants Antidepressants can precipitate episodes of mania.
Strattera By now everybody knows that I like to pick on Strattera. Well,
I am going to do it again.
Taking Strattera may not be quite so benign
in bipolar patients. It is a selective norepinephrine reuptake inhibitor, with a
mechanism of action that is similar to many antidepressants. Early reports
suggest that Strattera has a tendency to induce mania.
Rapid Cycling
Rapid cycling is difficult to treat. An important first step is to assess for
and treat medical conditions that may contribute to cycling, such as
hypothyroidism or drug or alcohol use. Medications, particularly
antidepressants, may also contribute to cycling.
Rapid cycling is
relatively unresponsive to lithium. Still, the initial treatment for patients
who experience rapid-cycling episodes of illness should include lithium or
valproic acid an alternative treatment is lamotrigine.
Maintenance
Treatment Once the patient has the presenting episode under control, the goal of
treatment is to prevent relapse and to reduce the risk of suicide. Goals also
include the reduction of cycling frequency and mood instability as well as
improvement in overall functioning.
The most common maintenance drugs
are lithium or valproic acid possible alternatives are lamotrigine,
carbamazepine, or oxcarbazepine.
In general, the medication that was
used successfully to treat the most recent depressive or manic episode is used
for maintenance. Maintenance ECT may also be used for patients whose acute
episode responded to ECT.
Treatment in Children Very little research has
been done in children with bipolar disorder. Most of the treatment protocols are
extrapolations from adult studies.
Lithium is the most researched drug
for children and seems to be effective. Other drugs such as antiseizure drugs
like valproic acid or divalproex seem to have good response rates in initial
studies.
Psychotherapy
Since bipolar disorder is probably a
physiological brain disorder, psychotherapy plays no real role in treating the
actual condition. However, therapy can help the patient and the patient’s family
to adjust to the emotional difficulties that go along with having this disorder.
Advice to Parents If you are concerned about your child's behavior, then
you should have your child immediately evaluated by a professional familiar with
the symptoms and treatment of early-onset bipolar disorder.
Finding the
Right Doctor Ideally, a child psychiatrist should evaluate your child.
Teaching hospitals affiliated with reputable medical schools are often a
good place to start looking for an experienced child psychiatrist. You can also
ask your child's pediatrician for a referral.
Another option is to take
your child to nationally a known doctor for diagnosis and stabilization. Then
you can use a local professional in consultation with the expert for long-term
medical management.
Conclusion There is no cure for bipolar disorder.
However, treatment can help your child and improve the quality of his life. With
this in mind, and considering the potentially catastrophic consequences of
leaving bipolar disorder untreated, we have to do our utmost to ensure our
children get the proper diagnosis.
Making the diagnosis of bipolar
disorder is hard. Unfortunately, the diagnosis is even harder to make in
children than it is in adults. The worst mistake anyone can make is not to
consider it as a possibility.
The other thing to remember is that
bipolar disorder is nobody’s fault. You can’t blame your child and you can’t
blame yourself. What we as parents must do is to try to stay aware of what is
happening in the field and strive to be the best advocates for our children that
we can be.
Good luck-
Anthony Kane, MD
P S
I know that what I have presented makes
bipolar disorder look like a very bleak diagnosis. You should know that it does
not have to be that way. Bipolar disorder is a problem, and like other problems
in life it is possible to live with it and overcome it. There are many people
throughout history who have used this disability to elevate themselves to
greatness.
I am including a list of famous people who had bipolar
disorder. I am not trying to convince you that your child will be like them. The
list is just so that you know the diagnosis of bipolar disorder does not mean
that everything is hopeless.
Here is a short list of bipolar people who
shaped the world around them, in some cases for centuries:
Abraham Lincoln
Winston Churchill
Theodore Roosevelt
Goethe
Balzac
Handel
Schumann
Berlioz
Tolstoy
Virginia Woolf
Hemingway
Robert Lowell
Anne Sexton
Beethoven
Newton
Dickens
Anthony Kane, MD is a physician and international
lecturer.
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Article added to SearchWarp.com on 12/27/2004 10:15:54 AM. View other articles written byAnthony Kane MD(3,030)
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