Children and Bipolar Disorder: Part II of II

Dan Haupt, M.D. Health Guide
  • Readers have commented on and asked follow-up questions about my July 3, 2006 entry on Children and Bipolar Disorder. Some expressed sadness that children’s lives have become more complicated and stressful. While this may be true, it is not clear that there are more children with bipolar disorder than in the past. Instead, it is likely that more children are being diagnosed with bipolar disorder now that psychiatrists have become more proficient at identifying bipolar symptoms in children. In the past, these children would be considered abnormal, but would have been diagnosed with behavioral disorders, or perhaps attention deficit disorder. Now that more psychiatrists are diagnosing bipolar disorder in children, it creates the illusion of an epidemic.
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    Another important question is how well these children function as they mature into adulthood. These are the kinds of questions that are being answered by studies that are currently underway. Unfortunately, the frustrating thing about these studies is that there is no quick way to do them. Once the investigators design the study as well as possible, we have to wait for kids to enroll and grow up before we can analyze the results and draw any conclusions.

    Going hand-in-hand with the concerns about the psychological well-being of children with bipolar disorder are concerns about appropriate treatment. On the one hand, bipolar disorder in children can be severe, and is associated with marked impairment in functioning at a critical time in one’s life, and can lead to suicide. On the other hand, concerns have been raised about the risks that can be associated with treatments for bipolar disorder.

    Commonly used treatments for bipolar disorder can be associated with increases in weight, and related increases in risk for diabetes and heart disease. Because of this, the prospects of increasing someone’s risk for heart disease at an early stage of their life is especially concerning. In addition, puberty is associated with normal disturbances in glucose regulation, but it is possible that these changes could be worsened, perhaps to dangerous levels, by antipsychotic medications.

    We have just begun a large study funded by the National Institute of Mental Health to investigate the effects of antipsychotic medications on changes in weight, fat distribution in the body, and risk factors for diabetes and heart disease (Metabolic Effects of Antipsychotics in Children). Antipsychotics are increasingly used for the treatment of bipolar disorder in adults. While there are no FDA approved treatments for bipolar disorder in children, these medications are also commonly used to treat bipolar disorder in children. The results of our studies will allow children and their parents to more fully understand the potential risks of these treatments, and hopefully choose the safest and most effective treatments possible.
Published On: October 10, 2006