Our Uphill Battle: Guiding Our Bipolar Daughter Through Adolescence

One family's journey to find a diagnosis and effective treatment for their daughter.

Our 19-year-old daughter was diagnosed with bipolar disorder at age 17, after six years of variable psychiatric symptoms. Many cases of bipolar illness feature onset during childhood, adolescence or young adulthood. With the myriad of normally-occurring changes during this age, it can be hard for a parent to identify and understand the early, often-subtle symptoms of psychiatric problems -- especially bipolar disorder. At age 11, our daughter had obsessive thoughts and was diagnosed with obsessive compulsive disorder. At age 13, she had crying spells and was diagnosed with depression. At age 14, her school performance dropped and extensive testing resulted in an attention deficit disorder diagnosis (ADD).

On Sept. 11, 2001, our daughter was 15 years old, and taking an antidepressant and a stimulant for ADD. Following the terrorist attacks, she cried for about four days. Six weeks later she made a suicide attempt and started a two-year period that involved seven hospitalizations, five attempts at running away, a month-long addiction treatment and whole semesters of school missed. Toward the end of these chaotic years, she was diagnosed as bipolar type II. We've learned that part of the delay in a family being informed of a definitive diagnosis can be reluctance of a health care provider to deliver a diagnosis that represents a 'life sentence' to a child until the illness evolves into something more chronic.

Throughout our daughter's illness we have used psychiatrists who were child and adolescent board-certified, and psychologists and social workers who specialized in adolescents. Finding a psychiatrist with whom our daughter 'clicked' took years, but now that she has grown out of that relationship, we're looking for a new one. Our health insurance has been fabulous for inpatient charges and abysmal for outpatient coverage. There have been periods when our daughter was sick enough to be hospitalized, but we have avoided it through cobbling together an intensive daily outpatient visit with a collection of providers up to five times per week. This was wildly expensive, but luckily the need for this subsided and she settled down as the 'overlay of adolescence' passed. Many providers painted a view of a better future as our daughter developed more insights into her illness and stopped experiencing the hormonal changes of puberty.

It was difficult to know what, when and how much to tell our child's school administration. We moved our daughter from a large competitive school to a very small school whose faculty had experience with kids like our daughter. We credit that school with her eventual high school graduation after she'd discussed dropping out and getting a GED for several years.

Medications during the chaotic years included anti-depressants, mood stabilizers, anti-anxiety drugs, ADD drugs, drugs for sleep and anti-psychotic drugs. Some of the side effects have been serious and frightening. No combination of medication has been very effective for our daughter -- we are still searching. Throughout the ordeal, we have used talk therapy in conjunction with medications. We've found that this combination gets the best results in the medical literature.

The ideal basic treatment for bipolar disorder would include regular sleep habits, good diet and daily exercise, but our daughter cannot comply with this basic regimen. Either due to her illness or the side effects of her meds, her sleep is disturbed, her diet often geared to make her feel better and her exercise habits erratic. She often uses recreational drugs in an effort to self-medicate, and this almost certainly makes the treatment regimen less effective.

For us, family therapy has been critical in understanding how to deal with this tragic and disruptive force in our household. We had another child who was born deaf and had other disabilities since birth, so we're already a household with more challenges heaped on the marriage and family dynamics. Therapy for the other family members in addition to the bipolar child is probably what has allowed us to continue as an intact family.

We have learned to continue plodding ahead each day, trying to improve our daughter's health and hoping that maturity 'evens her out somewhat' -- as so many providers have predicted.