My son was diagnosed with bipolar disorder in the 5th grade. He is now about to turn 21. He cuts and he cannot hold a job or finish a class at the local community college.
His bipolar disorder seems to be more depression-based than manic, or maybe the lithium and Abilify he takes helps the mania but doesn’t treat the depression.
Are there any medications recently developed which can help the depression? I know there is a study underway looking at this problem, but I can’t find out much about it. Sam took the initial test and they said that he qualified, but is no longer interested in participating in the research.
I also know that lithium has long-term effects on the kidneys and this concerns me.
Do you have any suggestions as to resources I can tap to help Sam? His doctor doesn’t really seem to care about looking at alternatives. He hasn’t actually attempted suicide yet, so the doctor seems happy with the status quo. I think we can do better, but don’t know where to turn.
Any suggestions you have would be helpful.
Dr. Fink answers…
This email raises a number of questions that are common to many families I have worked with over the years:
- This young man’s diagnosis of bipolar disorder was made over 10 years ago, during a time when there was a lot of over-diagnosis of bipolar disorder in children. As Gwen indicates, her son seems to be showing more depression than mania.Studies are now indicating that many children with mood regulation problems – severe rages and chronically irritable mood – are more likely to be diagnosed with depression and/or anxiety as adults, than bipolar disorder.Since I don’t know the details, I can’t comment on this case in particular, but given the complexities of this diagnosis in children and the debates about it, a family in this situation may want to consider a completely fresh evaluation to carefully review the diagnosis and treatment plan.
- The National Institute of Mental Health (NIMH) could be an extremely valuable resource. Many of the best studies about childhood bipolar disorder are being done there. Dr. Ellen Liebenluft is one of the most respected researchers in the field, and her group may be doing studies that could be appropriate in this situation.But even if there isn’t a study that this young man or other young people would fit into, (or if the young person has no interest in participating in the research as Gwen indicates in her letter) I would encourage families to at least seek out a second opinion from a psychiatrist who is well versed in this area – a child psychiatrist who also works with young adults would be most helpful I think.
- Treating depression in bipolar disorder is often the most difficult and challenging component of the disorder – and choosing medications to try can be very tricky. Some of the choices may change if the diagnosis changes and certainly, even if he truly has bipolar, treatment of the depressive symptoms is going to be an important conversation, since he seems to be having trouble functioning because of these symptoms.There are a variety of options – I cannot comment in particular because I haven’t done an evaluation of this young man – but I encourage patients and families to seek out a different perspective if they feel the current doctor is not attending to important symptoms.
- Gwen doesn’t mention if her son is in therapy – but this is also going to be a crucial part of long term treatment/management of the kinds of difficulties he is living with. In particular, if he is self harming, connecting with a therapist or group who are specialty trained in Dialectical Behavioral Therapy (DBT) may be valuable.This is a skills-based model, a subtype of Cognitive Behavioral Therapy (CBT), and has an excellent track record of helping people with long-term difficulties regulate mood and behavior. Getting a young person to engage in treatment may be difficult, but it is certainly an option to explore.
- Families benefit from support from other families living with these issues. NAMI is a terrific organization that provides information, networking, training, and family-to-family emotional support that is incredibly helpful to those living with or caring for people with mental illness. I strongly encourage families to look into this or other support organizations as part of managing mood disorders for the long term.
Photo by Alexander Konovalenko, available under a Creative Commons attribution license.