Thursday, August 18, 2011

Bipolar 1 Disorder

Last week we met with our psychiatrist and I shared with him our recent concern about my son’s silly behavior in the store and how it scared him. At the time, our doctor in his typical fashion, didn’t have much to say other than, “I don’t really know what’s going on,” then quickly went to his computer to organize our prescriptions.

Being the pesky mother bear I am, I emailed him asking for more clarification. I started with the following question:

“Does our son’s amazing response to Lithium, combined with his known symptoms, indicate what type of mood disorder he has? ”

Then I asked,

“Could his scary, uncontrollable, silly behavior in the store be a short episode hypomania?”

I was surprised to see that for the first time within our HMO, our psychiatrist had an opinion. He said that our son’s depression, episodes of increased energy and elated mood, episodic psychotic symptoms in a child who does not appear schizophrenic and family history suggest that much of his difficulty has been a manifestation of real bipolar 1 disorder.

He also mentioned that a person’s response to medication, including Lithium, does not prove or disprove a diagnosis. But he found our son’s response to Lithium to be very encouraging. Then followed up with, “too little is understood about real bipolar disorder in prepubertal children.”

So there you have it.

An official opinion.

This is not a diagnosis, but rather as our therapist calls it, “A working diagnosis.”

I believe this is the case because as our doctor mentioned, too little in known about children and real bipolar disorder. Don’t you find it funny that he used the word “real”.

So, you may wonder... how does this make me feel now that we have an official opinion?

First, it makes me very sad. This is not what I wish for my son and I still hope that he’s one of those kids who will overcome many of these childhood symptoms and only struggle with depression as an adult.

It makes me scared because I know how serious this road can be. I’m also aware that research shows that for those who develop bipolar disorder as a child, the disorder tends to be more severe as an adult. I know what challenges may lay ahead and it scares the crap out of me.

Then there’s the part of me that has known this all along, that has felt this was a possibility. I feel for the first time that the doctors may be recognizing what I’ve seen all along. After years of sharing all that I could, I feel like they’ve finally heard me and that they believe us and take us seriously.

Finally, hearing this opinion has given me hope that maybe we can give him the best outcome possible by treating the symptoms while he’s young, teaching him the importance of staying on his medication and giving him coping skills along the way. I’m also keeping in mind a piece of advice from Dr. Manpreet Singh from Stanford’s Pediatric Mood Disorders Clinic, “When it comes to symptoms in children, we can’t guarantee what’ll happen, we need to wait, watch and wonder. Don’t let your anxiety define your child’s outcome.”

In the end, my grief and fears are too much to think about, so for the moment, I’m holding on tight to the hope.


  1. Only time will tell the severity of his disorder. And also, in time he will learn to better handle his episodes and symptoms. Every year that passes will bring with it new coping strategies and understanding for coping with the illness so it is not all doom and gloom.

    Keep a positive perspective. I cling to my optimism like a life raft and it has helped me through some desperate times. :)

  2. Thanks In The Pink, that’s good advice!

  3. Dear Mama Bear:
    I felt the same way 7 years ago when my then 9 year old (early onset BPD) was so unstable! I was overwhelmed with the thought of what his life would look like. However, we finally did get him stable and he is now 16 and doing fantastic. In fact, we have decreased and discontinued many meds and he is better than ever. Will this be permanent? Who knows, but I do know that he has been stable for 7 years. You have hope and it is because you managed to get your son stable in a relatively (clinically speaking) short amount of time. The "Kindling Effect" has been thwarted. His brain will get to mature without being subject to the vast swings it experienced pre-lithium, thus it is just as likely you have prevented his illness from being so much worse as an adult. The studies you referenced were on people who didn't get treatment as children. Yours has!
    On another note, I told you earlier that my other 16 year would be starting lithium for treatment-resistant depression to augment the antidepressants that haven't worked for 6 years. My new doc told me we had an 80% chance of the lithium pulling him out of it - and IT HAS. I finally have my son back! He is delightful and funny again. We are all learning to live with the new dynamic his recovery is having on the whole family. Thank you so much for sharing your journey. We'll get there - you do have hope. I think once your son has had more stable days than those he experienced unstable, you will start to see the future as being much brighter.

  4. Boxturtle-Your story is so encouraging--7 years of stability, that is fantastic!! You bring up a good point about the “kindling effect” being stopped by the Lithium. I sometimes have wondered about the research that shows that the kids who looked bipolar as a child, but after treatment, eventually only had depression as an adult, if they did indeed have bipolar. Doctors claim that the kids that outgrew their bipolar symptoms proved that they did not have bipolar. Is it possible that these kids did, but because of early treatment and the child's brain being protected against the ”kindling effect” and the brains ability to repair itself through development that the disorder is stopped in it's tracks and instead able to overcome the disorder, maybe only having depression as an adult? Just a thought...

  5. Mama, he is way too young to get so gloomy over this. It will all be fine. The more it scares you the more it will scare your son and that will be counterproductive. Anxiety is transferred from parent to child. Keep positive and know that he has something that can be managed with meds. Things could be a lot worse.

  6. I love the quote at the end of your post. I need to remember that. I too worry about my children's futures and how this will all play out when they are grown. So we continue to muddle through, doing the best we can and praying that our guidance, vigilance and therapies will help in the end.

  7. I agree, remember the quote. There is so much that even the "experts" just don't know--and even when we do know a lot about something, it is still impossible to predict the future. (now if I could only listen to my own advice!)

  8. i was reading your posts about your ordeal sorry to hear all that ,as iam very familiar with bipolar disorder ,but there is another condition very similar to bipolar that is borderline personality disorder,especialy in kids can be very similar and hard to diagnose.Lets forget about labels but do the best for your kids .

  9. I was a Bipolar child before they thought it was possible to be Bipolar as a child. I empathize with you and your son. I've had BPD 1 for at least 23 years, though I remember having mood issues and being suicidal before that. Every cycle, I still learn something new.

    It sounds strange, but I would recommend martial arts and meditation practices as a way to help your son. Sports are a good physical vent for the energy, but the discipline required for martial arts is a little more stabilizing. Keeping the body strong and responsive seems to help reduce the overall levels of anxiety by reducing the fear of being able to fight off the innumerable threats you perceive when that side of the brain switches on. The meditative breathing and mindfulness of energy flow helps you step outside the inner storm and find peace once in a while.

    It's not perfect, and often it is a daily struggle to maintain a semblance of sanity, but it helps to make routines for structure and stability for those times you feel lost. And it also helps you figure out constructive ways to use the geysers of energy that erupt from time to time.

    I wish your son the peace he so desperately wants to feel.

    1. Thanks for the advice, I too see value in martial arts, but honestly, other than the cost of it, I’ve always been a little nervous of pursuing it since I was afraid it would only make him more dangerous in a rage.

      I hope to take him to yoga sometime to help with the calming techniques!

    2. Hi, I have BPD for 26 years, and am still wondering what is the cause of the disease. I am taking mood stabilizer and practising yoga to maintain my mental peace. Glad to find someone here who can share the experience.