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childhood depression

Bipolar Disorder and Adolescents

Symptoms of bipolar disorder in children and adolescents may look like other disorders

Traditionally bipolar disorder has been thought to first show in early adulthood – and more often in females.  Bipolar disorder was considered to be quite rare as few as 20 years ago, to be more exact. The first emergence came in the early 20s, mainly in females. But, our knowledge about bipolar disorder has grown rapidly in the last 20 years.

Instead of the single manic-depressive diagnosis – which included diagnostic criteria of both depressive periods, alternating with manic periods – described as “euphoria”?

Those who did not have clearly rhythmic, alternating periods of a “happy” and frantic manic phase with a classic depression period were mishandled, misdiagnosed, mistreated, or dismissed.

Bipolar ChildrenIn addition, it wasn’t really known that bipolar disorder could start in adolescence or even childhood, or that there are different types of bipolar disorder.  Today, it still isn’t “officially” recognized in the “psychiatric bible” – the Diagnostic Statistical Manual of Mental Disorders (DSM), but at least more practitioners do know that it exists.

Today, we don’t exactly know what causes bipolar disorder (only that there is a genetic link of some kind, and often some past trauma). But, we can at least identify adolescent and childhood bipolar illness.  We also recognize a variety of different types of bipolar disorder (Such as mixed manic episodes, rapid cyclers, people without a depressive phase, hypomania, dysphoria rather than euphoria and cyclothymia). We also have a “catch-all” type – Bipolar NOS or “not-otherwise-specified”.

Adolescent or childhood bipolar disorder is official known as: “early onset bipolar disorder”.  In fact, childhood bipolar disorder can be more serious than a similar disease in adults and may have slightly different symptoms.

Symptoms of bipolar illness in children can often be more severe, and the cycling period may be more frequent.  Children also have more mixed episodes.  Children also have slightly different symptoms – so even the depression phase of the cycle may not be obvious.

Pediatric patients (children and adolescents) with bipolar disorder may have:

Bipolar Disorder in Children•    Abrupt mood swings
•    Periods of hyperactivity followed by lethargy
•    Intense temper tantrums
•    Frustration
•    Defiant behavior
•    Chronic irritability

These symptoms have to appear in more than one setting (school and home) and cause “distress”.

The problem is that many of these symptoms may look like other disorders.  They might be disorders such as ADHD, childhood depression, anxiety disorder, obsessive compulsive disorder, conduct disorder, premenstrual syndrome, oppositional defiant disorder and others. The danger might come from a misdiagnosis and improper treatment.

Bipolar disorder is treated with anti-manic agents (lithium), anti-convulsants (Depakote, lamotrigine) or atypical antipsychotics (Abilify, Risperdal).  In many cases, anti-depressant won’t be needed.  Treatment for other disorders like ADHD or depression may make bipolar disorder worse. Childhood bipolar disorder is something that desperately needs treatment as the distress caused to the patient, and the family can predispose the youngster to

•    Drug or alcohol abuse
•    Stealing
•    Involvement with law enforcement
•    Poor social integration
•    Poor academic performance
•    Suicidal tendencies
•    Premature sexual behavior

The Balanced Mind has a good self-check list of symptoms that can help a parent or a teen decide if bipolar disorder might be an issue.  Self-testing is not always accurate and should be discussed with a doctor, (preferably with test results in hand).  Not all doctors accept pediatric bipolar disorder. Parents may have to seek advice from more than one mental health professional and be aware that insurance may not cover the illness.

Melissa Lind

Depression in Children

It may not seem possible, and most people don’t want to think about depression in children.

Different from developmental disorders such as ADHD or Autism Spectrum Disorders and different from mental disorders such as Schizophrenia, which have obvious symptoms, Depression can occur in children.

Childhood DepressionUp until about 20 years ago, depression in children wasn’t widely recognized.  It wasn’t that the depression didn’t exist; it was undoubtedly just that we didn’t know about it.  Two decades ago, even if the child was aware that “something” was wrong, the parents, teachers, and other adults were likely to dismiss it as a “stage” or “phase” that the child was going through.

There were several reasons for that way of thinking, such as:

  • A belief that children didn’t get depression – adolescents were dismissed as “moody,” younger children were dismissed as “difficult.”
  • Medication available for depression wasn’t appropriate for children due to severe side effects.  Newer antidepressants were not available until Prozac was approved in 1988 for adults.  These medications known as “serotonin specific reuptake inhibitors” (SSRIs) were not approved for children until 2002 and to date, only Prozac is recommended for depression in children though Zoloft and Luvox may be used for Obsessive Compulsive Disorder (OCD) in children.
  • The long-term effects of depression were not yet known.  Depression at any age can contribute to chronic diseases such as diabetes and heart disease.

Today, we recognize childhood depression.  About 11 percent of children have experienced at least one episode of childhood depression before the age of 18, according to the National Institute of Mental Health. Normal behavior can certainly vary from child to child and from age to age – as children are prone to “stages” that they will grow out of.  But if a child has an extended period of depression – it is something that should be properly addressed. Such serious issues should not be taken lightly.

Juveniles (those up to age 17) often have different symptoms of depression than those common in adults.  Children with depression may be excessively sad and lethargic, but depression may also show as:

  • Complaints of illness
  • Refusal to go to school
  • Clinging to a parent or caregiver
  • Excessive worrying
  • Sulking
  • Grouchiness
  • Anxiety
  • Acting out at school
  • Excessive negativeness
  • Feelings of being misunderstood

Depressed FeelingsThese symptoms are occasionally experienced by most children as they are growing up, but when symptoms persist for several months or interrupt normal activities and development, more investigation is needed.  One needs to find out what the cause may be.  If a child is being bullied – he or she may not want to go to school.  If a child complains of illness – it may truly be sick.  On the other hand if these events occur over and over, you need to discuss the problem with a doctor.  You may also need to see a child psychiatrist or psychologist.  In some cases, therapy may be warranted but in other cases, the child may benefit from medication suitable for depression.

In any event, you should not ignore symptoms of depression or any other mental illness signs – but investigate them.  It may be that your child is “going through a stage”, but it may be more serious.

Children complaining of illness may be depressed!