Diagnosing a child or adolescent with a mood disorder is tricky. For bipolar disorder, most youths do not clearly display symptoms as defined in the Diagnostic and Statistical Manual of Mental Disorders. They may show some symptoms, but not others and possibly not in a clear pattern. There is also the problem of labeling someone with a severe mental illness early in life. The burden of that stigma is heavy, and may prove detrimental if the diagnosis is incorrect. However, there are five signs research has found that may point to an early transition from depression to bipolar disorder.
Symptoms of bipolar disorder typically do not emerge until late adolescence or young adulthood. Even then, correct diagnosis takes an average of more than 10 years. Early treatment for bipolar disorder can improve the quality of life of the person not only at the time of treatment, but over a lifetime. This is why it’s important to begin treatment as early as possible. However, bipolar disorder often presents itself differently in minors than adults.
For example, if an adult is untreated, manic episodes can last three to six months. Patients receiving treatment can still experience hypomanic or manic episodes. Hypomanic episodes last up to four days and may be considered manic if the symptoms persist more than one week.
In children, episodes rarely last long enough to qualify as manic or even recognizably hypomanic. These periods are quick and do not generally express grandiosity that is a requirement in mania. Instead, the most prevalent symptom is irritability and heightened mood. These children or adolescents, if diagnosed, are generally given diagnoses of “bipolar disorder not-otherwise-specified” since they do not meet the qualifications of the adult version of the disorder.
Some who are at risk for the disorder will also show early signs of depression. Adults also tend to seek treatment first for depression, which is one reason monitoring depression in youths is important. Around 14-23% of those at risk go on to develop bipolar disorder compared to 0.7% that are considered not at risk.
One study, recently published in Schizophrenia Bulletin, monitored 50 adolescents with early-transition bipolar disorder and 50 healthy controls to determine the risk factors for depression transitioning into bipolar disorder. Jan Scott of the Institute of Neuroscience, Newcastle University and her research team found five risk factors that could identify youth at risk from transitioning from depression to bipolar disorder.
1 Subthreshold Mania
Manic episodes require three to four of the seven symptoms lasting more than one week:
-Less need for sleep
-Flight of ideas
-Increased goal-directed activity
-Excessive involvement in high-risk activities
In subthreshold mania, the person experiences fewer than the required symptoms and/or experiences the symptoms for a shorter time period.
Cyclothymia is similar to bipolar disorder in that there are periods of ups and downs in moods. There may be periods of elated or irritated mood and low periods that closely resemble depression. However, the criteria for the severity of bipolar disorder are not met.
3 Family history of bipolar disorder
Genetics is one of the three factors that are thought to lead to bipolar disorder along with chemical imbalance and environmental factors. The chances of developing bipolar disorder if a parent has it are 4-15%. That chance increases if both parents have the disorder.
4 Atypical depression
About 40% of people with depression experience atypical depression. This category of depression includes symptoms like weight gain instead of loss or sleeping more than 10 hours a day as compared to having trouble sleeping. More symptoms of atypical depression are longer periods of depression, high comorbidity of anxiety disorders, more frequent leaden paralysis and a higher risk of suicide.
5 Antidepressant-induced elation
One reason misdiagnosing bipolar disorder as depression is risky is that antidepressants can trigger mania in people with bipolar disorder. SSRI’s and the drug venlafaxine carry a 35% increased risk for subsequent bipolar disorder diagnosis.
Subthreshold mania and cyclothymia were found to be the highest risk factors associated with an early transition from depression to bipolar disorder in adolescents, so youths who show signs of these symptoms should be closely monitored for the potential of developing bipolar disorder. However, the decision to diagnose and medicate any patient, regardless of age, should be left up to a qualified mental health professional.
Image credit: Predi