Bipolar Depression

Hi all,

I am a new member and have a few questions that I hope you can help with. My family is in the process of adopting a 4 year-old who has been diagnosed with BP. He is currently on 20mg of Zyprexa/day along with Risperdal (dosage unsure). Am I wrong in thinking that this is an extremely high dosage for such a little guy? He exhibits elevated levels of stress and anxiety after each dose and maintains very dark circles under his eyes. We assume these are due to the levels of meds he is getting. We are in contact with his neurologist concerning these issues. Wondered if anyone else had a little one with these same symptoms and any advice? We are also concerned about the ability to confidently diagnose such a young child with BP? Most of his issues seem to be behavioral (quite typical for a toddler) rather than medical/neurological, any advice will be greatly appreciated.

Thanks

Hi, Scott. It's not my place to second-guess the boy's pdoc, as every individual and every situation is unique. But you are entitled to ask very hard questions and demand satisfactory answers from the boy's psychiatrist. And if you are not satisfied to fire the shrink.

As a general rule, 20 mg of Zyprexa is very high, even for an adult. And two drugs of the Zyprexa class is very unusual. Both Zyprexa and Risperdal are what they call atypical antipsychotics. These are extremely powerful meds and can have very pronounced side effects. And kids are often more prone to side effects than adults.

There may be a valid reason for the double-dosing, but if the pdoc fails to provide you with one then get another opinion.

When someone is diagnosed this early, it is called early-onset bipolor disorder. The experts regard this as far more severe than the adult variety. Untreated, these kids tend to cycle extremely rapidly, their manias can rage out of control for hours on end, their sleep is messed up, and they can be extremely grandiose.

Believe me, their behavior is not usual four-year-old behavior. This is why meds treatment tends to be a no-brainer. But it needs to be smart meds treatment.

You talk about adoption. I don't know the kid's circumstances. But perhaps in a foster setting, he hasn't received the medical and psychiatric treatment he deserves. Institutional abuse and neglect is fairly common in foster settings. Maybe the home he was in erred on the side of over-sedating him so he wouldn't wouldn't disturb the other kids (or his caretakers). But this is only a wild guess.

Certainly a loving home environment will remove a lot of the stresses that feed his illness, but he will probably still need the meds. If the boy had cancer, you would take him to a pediatric oncologist. For similar reasons, a child and adolescent psychiatrist is the specialist for your boy. If one is unavailable, then a psychiatrist with experience and some extra training in working with kids.

Please be assured your boy has every chance of enjoying childhood and of growing up to have a rich and happy and productive life.

Must-read book: The Bipolar Child by Demitri and Janice Papolos.

Also check out this article:
http://www.mcmanweb.com/article-30.htm

John,

Thanks for the welcome insight and advice. We have since made an appointment with a pediatric psychiatrist (specializing in behavioral issues) to try to help determine the extent of "environmental" influences on his often extreme outbursts. A little background, he is still living at home with his biological family. Conditions there are uncertain. My wife and I both feel that the extreme hyperactivity levels we see are more indicative of ADHD than Bipolar, but we are waiting for a more extensive clinical evaluation prior to making any plan of action to help this wonderful child.

Hi, Scott

The experts are pretty much agreed on two things:
1)ADD/ADHD and early onset bipolar on the surface appear very similar.
2)Most bipolar kids also have ADD/ADHD

Dr Papolos advises when in doubt to treat for bipolar first, as the ADD/ADHD meds can exacerbate BP symptoms, in particular may cause kids to flip into mania.

Grandiosity and risk-taking are two of the main distinguishing features, but this requires expert evaluation. Hope you had a nice holidays -