Sufferers of bipolar disorder veer from periods of frenzied activity and euphoria to bouts of intense depression, two extremes often interspersed with brief runs of emotional calm.
The disorder affects roughly 1 in 100 adults, but almost no data exist for its prevalence among kids and teenagers. Now, a rare long-term study of school-age children diagnosed with bipolar disorder is showing that the condition strikes young people with particular ferocity.
Compared with adults, children in the investigation responded poorly to medicines and psychotherapy, say psychiatrist Barbara Geller of Washington University School of Medicine in St. Louis and her colleagues. After 2 years of treatment, bipolar symptoms cleared up in only 26 of 89 kids, the researchers report in the June American Journal of Psychiatry. The rest of the youngsters never responded to treatment or improved only for a few months before relapsing. A greater proportion–but still a minority–of adults with bipolar disorder benefits from treatment.
Geller’s group recruited children, ages 7 to 16, who were being treated for bipolar disorder by pediatricians or psychiatrists. The participating youngsters included only those who had feelings of euphoria or grandiose self-importance while manic, a symptom of bipolar disorder but not of attention-deficit hyperactivity disorder.
In the study, experimenters interviewed children and their mothers every 6 months. The researchers found that youngsters living with both parents recovered more often than did those in other household arrangements. Children also showed greater improvement if they maintained warm relations with their mothers.
Although nearly half the kids received lithium or an anticonvulsant drug to quell manic symptoms, their bipolar condition subsided no more often than that of their unmedicated peers. There was no evidence either for efficacy of other psychiatric drugs or individual, group, or family therapy.
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The sobering treatment assessment needs to be confirmed in more-diverse groups of children, comments psychiatrist Fred R. Volkmar of Yale University. Still, “the important possibility that children [with bipolar disorder] are less responsive than adults are to mood-stabilizing drugs cannot be ruled out,” he says.
Other research, published in the same issue of American Journal of Psychiatry, links early-onset bipolar disorder to disturbed electrical activity in the brain. A team led by psychologist Anita Miller of the University of Pittsburgh compared brain waves in 55 young adults who had suffered from severe depression during childhood and 55 others who had not.
Whether or not they were currently depressed, young women who had experienced childhood depression exhibited unusually high right-brain activity. In contrast, excess left-brain activity characterized young men who had had childhood depression. This sex difference was most striking for participants who had also been diagnosed with bipolar disorder since childhood. While intriguing, the scientists say they don’t yet know what underlying brain mechanisms might orchestrate this sex difference.