Pediatric Bipolar Disorder/Manic Depression

What is manic depression?

Manic depression, also known as bipolar disorder, is classified as a type of affective disorder (also called mood disorder) that goes beyond the day's ordinary ups and downs, and is becoming a serious medical condition and important health concern in this country. Manic depression is characterized by periodic episodes of extreme elation, happiness, elevated mood, or irritability (also called mania) countered by periodic, classic major depressive symptoms.

Who is affected by manic depression?

Manic depression affects more than 2.3 million American adults, 18 years of age and older, each year. And, 20 percent to 30 percent of adult bipolar patients report having their first manic episode before the age of 20. When symptoms are present before the age of 12, they are often confused with attention-deficit/hyperactivity disorder (ADHD) - a syndrome that is usually characterized by serious and persistent difficulties resulting in inattentiveness or distractibility, impulsivity, and hyperactivity.

Affecting males and females equally (although females are more likely to experience more depressive and less manic symptoms), manic depression often begins in adolescence or early adulthood. Manic depression is beginning to be better recognized in young children, although its diagnosis still may be difficult.

Manic depression is likely to occur in families and, in some cases, is believed to be hereditary. A family history of substance abuse also increases the risk of developing manic depression. Researchers are still seeking to identify a gene (or genes) that may be responsible for this disorder.

What are the symptoms of manic depression?

The following are the most common symptoms of manic depression. Each individual, however, may experience symptoms differently.

Depressive symptoms may include:

  • persistent feelings of sadness
  • feeling hopeless or helpless
  • having low self-esteem
  • feeling inadequate
  • excessive guilt
  • feelings of wanting to die
  • loss of interest in usual activities or activities once enjoyed
  • difficulty with relationships
  • sleep disturbances (i.e., insomnia, hypersomnia)
  • changes in appetite or weight
  • decreased energy
  • difficulty concentrating
  • a decrease in the ability to make decisions
  • suicidal thoughts or attempts
  • frequent physical complaints, such as headache, stomach ache, fatigue
  • running away or threats of running away from home
  • hypersensitivity to failure or rejection
  • irritability, hostility, aggression

Manic symptoms may include:

  • overly inflated self-esteem
  • decreased need for rest and sleep
  • increased distractibility and irritability
  • excessive involvement in pleasurable or high-risk activities that may result in painful consequences; this may include provocative, aggressive, destructive, or anti-social behavior such as sexual promiscuity, reckless driving, reckless spending, abuse of alcohol or drugs).
  • increased talkativeness (may include increase in rate of speech, changes topics quickly, cannot be interrupted)
  • excessive high or euphoric feelings
  • severe mood changes including unusually happy or silly, or unusually angry, agitated, or aggressive
  • increased sex drive
  • increased energy level
  • uncharacteristically poor judgment

Some teenagers in a manic phase experience psychotic symptoms, including hallucinations and/or delusions.

For a diagnosis of manic depression to be made, an individual must exhibit both depressive and manic symptoms to a varying degree, depending on the severity of the disorder. The symptoms of manic depression, especially in a teenager, may resemble other problems such as drug abuse, attention-deficit/hyperactivity disorder, or delinquency. Always consult your child's physician for a diagnosis.

Treatment for Manic Depression

Specific treatment for manic depression will be determined by your child's physician based on:

  • your child's age, overall health, and medical history
  • extent of your child's symptoms
  • your child's tolerance for specific medications or therapies
  • expectations for the course of the condition
  • your opinion or preference

Mood disorders, including manic depression, often can be effectively treated. Treatment always should be based on a comprehensive evaluation of the child and family. Treatment may include one, or more, of the following:

  • medication ( mood-stabilizing medications such as lithium, valproic acid or carbamazepine, or antidepressants)
  • psychotherapy (most often cognitive-behavioral, supportive, psychoeducational, or interpersonal therapy)
  • family therapy
  • consultation with the child's school

Parents play a vital supportive role in the treatment process.

Recognizing the varied and extreme mood swings associated with manic depression is crucial in obtaining effective treatment, and avoiding the potentially painful consequences of the reckless, manic behavior.

In most cases, long term, preventive treatment is necessary to stabilize the mood swings associated with manic depression.

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"We cannot thank Children's National enough for diagnosing and treating Jamie. Yes, it was hard to swallow that our child had a mental illness, but we finally had a diagnosis with which to work from. "

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