The long, wild ride of bipolar disorder

Children who grow up with the psychiatric ailment known as bipolar disorder rarely grow out of it. Almost half of youngsters who suffered from bipolar’s severe, rapid-fire mood swings at around age 11 displayed much of the same emotional volatility at ages 18 to 20, even if the condition had improved for a while during their teens, according to the first long-term study of children diagnosed with the disorder.

Bipolar disorder took off with a vengeance in these kids. Initial episodes, often periods of frequent, dramatic mood swings, lasted for up to three years. Second episodes lasted for slightly more than one year, while third episodes continued for roughly 10 months.

During these periods, youngsters can veer back and forth several times a day between a manic sense of euphoria and a serious, even suicidal depression, say psychiatrist Barbara Geller of WashingtonUniversity in St. Louis and her colleagues. Manic euphoria typically includes grandiose delusions or hallucinations.

The study also suggests that a harsh set of symptoms that emerge by middle school and continue to at least the cusp of adulthood supports the classification of childhood bipolar disorder as a psychiatric ailment, the scientists conclude in the October Archives of General Psychiatry. Evidence of skyrocketing diagnoses of childhood bipolar disorder from 1994 to 2003 has fueled debate over whether the condition actually exists (SN: 9/8/07, p. 150).

“This is a landmark longitudinal study that provides the first strong evidence for continuity between childhood and late adolescent/early adulthood bipolar disorder,” remarks ColumbiaUniversity psychiatrist Mark Olfson, who directed the investigation of rising numbers of children diagnosed with bipolar disorder.

Geller’s team tracked children who had initially experienced at least two weeks of manic elation or grandiosity. Many children get diagnosed with bipolar disorder after enduring only one week of mania, Olfson notes. “It is not clear whether the ominous outcomes reported here extend to the larger population of children who meet psychiatric criteria for mania,” he says. Diagnosis hinges on the presence of mania since depression by itself might not qualify as bipolar disorder.

Children in the new study also came from predominantly white, financially stable families. Researchers have yet to examine the long-term course of bipolar disorder in children from other ethnic and economic backgrounds.

Geller’s team monitored 108 children who were brought to psychiatric or pediatric clinics between 1995 and 1998 in the throes of their first episode of mania. Researchers diagnosed bipolar disorder after interviewing mothers, presumed primary caregivers, about their children and after interviewing the children. A majority of children also received diagnoses of attention-deficit hyperactivity disorder and one of several behavioral disturbances.

Youngsters received a variety of medications and psychological treatments from their local clinicians.

During eight years after the initial bipolar diagnosis, the researchers interviewed children and their mothers on nine occasions. By the study’s end, 54, or half, of the youngsters were older than 18 years, with an average age of 20.

Over the course of the eight-year follow-up, bipolar symptoms largely disappeared for at least two months in 101 of 108 children. But 74 of those who recovered then experienced new episodes of mania.

Adult relapses into mania occurred most frequently in children who had antagonistic or distant relationships with their mothers during the study. This pattern held after the scientists accounted for cases of bipolar disorder and other mental ailments in children’s families.

Of the 54 patients tracked to age 18 or older, 24 of them — or 44 percent — still, as adults, experienced manic episodes. That frequency is 13 to 44 times higher than estimates of mania’s prevalence in the general population of U.S. adults.

One-third of patients age 18 or older also abused alcohol and drugs. Geller’s group will present details on drug abuse among these individuals in a future publication.

During manic episodes, kids at all ages typically spent the vast majority of each day swinging back and forth between several hours of mania and periods of depression. In such cases, “a euphoric child can very quickly become seriously depressed and suicidal,” Geller says.

Geller’s findings feed into a growing awareness that serious mental illnesses such as bipolar disorder develop throughout childhood, even if critical neural and emotional changes aren’t obvious at first, comments psychiatrist Ellen Leibenluft of the National Institute of Mental Health in Bethesda, Md.