By Dr Roger Paterson, Psychiatrist
Bipolar disorder (previously known as Manic-Depressive Disorder) is being diagnosed at an
increasing rate in children and teenagers. Some experts estimate that an additional one million
children in the USA may suffer from the early stages of Bipolar Disorder. It is unclear whether there is
a real increase in the disorder, or doctors are just getting better at diagnosing the illness.
Childhood Bipolar Disorder may have fooled doctors in the past because it does not always have the
usual features seen in adults of several week cycles of either depression or mania, with variable
intervening periods of normality, all over several years. The depression can be very severe with a
sense of hopelessness, loss of enjoyment and thoughts of suicide. The flip side, mania, can also be
very severe with grandiosity, recklessness, overspending and occasionally losing touch with reality.
With children, things are not nearly so clear. They may have an adult pattern but more often seem to
have much more rapid cycles, flitting back and forth over days, even several times a day. They are
often irritable in the mornings, (“feeling like an angry bee buzzing around the room ready to sting
some body”), sluggish to get going but by midday seem to have improved. Later in the afternoon they
can become wild, strangely happy, even aggressive. This hyped up state can last long into the
evening/night, leading to settling problems.
There is even some question that toddlers and infants may have some cyclical mood problems, where
difficulties in soothing, fidgetiness and rapid mood changes can be seen.
Now why is this interesting to ADHD sufferers?
Well, it may be very likely that the episodes of hyperactivity (as seen in mania) may well be diagnosed
as the hyperactive part of ADHD. Doctors are now relatively relaxed about diagnosing ADHD, but find
it much more difficult to apply a label of Bipolar Disorder to children. Hence, they may reach for antiADHD medication which may well make Bipolar Disorder worse. Some estimates in the US suggest
that up to 15% of children thought to have ADHD may actually be bipolar.
This could explain why some children diagnosed with ADHD are not responsive to stimulant
medication and may well be better on anti-Bipolar Disorder medication.
Medications used in Bipolar Disorder include lithium and anti-epilepsy drugs (the most common in use
in WA being Tegretol and Epilim). Other drugs that have sometimes been used to stabilize mood
include antidepressants (but beware the risk of precipitating a manic episode) or major tranquilisers
(such as Olanzapine/'Zyprexa', Risperidone/'Risperdal' and Quetiapine/'Seroquel').
Some children do not have severe bipolar disorder, but mild/moderate mood swings (sometimes
called cyclothymia). These children may also respond to anti-Bipolar Disorder medication.
To further increase the confusion, it is possible that ADHD and mood swings co-exist, and so some
children may be prescribed both stimulant medication and mood stabilisers. Very often, use of
medication in this area is done as a trial, with regular feedback from the patient and their family to the
doctor being necessary in order to fine-tune the treatment. In the future, clinical experience and
research will help doctors work out just how common Bipolar Disorder is in children and teenagers,
and where the overlap with ADHD lies. For the moment, the important message is that Bipolar
Disorder in children and teenagers has probably been under diagnosed in the past and that it should
be thought about in a situation where children display rapid and/or sustained mood shifts for no
obvious reason, and when concentration problems do not seem to be an issue.
Reviewed 2012