There is an alarming and growing trend in psychiatry to diagnose bipolar disorder in children. While the usual time of onset for a bipolar disorder is sometime in adolescence (see table under Bipolar Disorder), researchers are coming to the conclusion that the disorder can be present in children and cause disruption in the child’s life and the lives of those around them. They claim that rather than presenting with classic manic and depressive episodes, children are more likely to have rapidly cycling moods (within the day) and mixed states, in which they are irritable and aggressive. They feel there is a strong overlap, if not diagnostic confusion, with attention deficit hyperactivity disorder (ADD/ADHD). They further support their position, by reasoning that since 50-60% of the risk of bipolar disorder comes from genetics (40—50% from environmental factors), it is likely that some manifestation of the disorder is present from childhood. Of course, the next step in the logical progression is that medication is the appropriate course of action.
At The Center for Whole Psychiatry + Brain Recovery, we do not rule out the use of medication. However, before embarking on a course of medication, whose long term effects on the developing brain and body are completely unknown, we very thoroughly assess the various factors that can very easily impact and improve a child’s behavior and experience of him or herself. These factors include a thorough evaluation of eating habits and nutrition, nutritional deficiencies, unusual nutritional requirements (for example some children have a 5 fold increased need for zinc and other associated nutrients, as they have a condition called kryptopyrolluria), food sensitivities, inflammatory or infectious issues (e.g., asthma, eczema), digestive problems, toxic exposures (e.g., mercury) and even hormonal problems. In addition, a thorough evaluation for learning disabilities, or conversely unusually gifted abilities which are unused, and an assessment of the family dynamics and parental relationship are all in order. In the large majority of cases, this evaluation eliminates the need for medication.
As I write this I recall a cute, very bright 12-year-old boy who was brought to me by his parents for assaultive behavior—he would for no apparent reason, pull a knife out of a kitchen drawer and threaten his parents or siblings. He was hospitalized and I prevailed upon the staff to avoid medication (anti-psychotic medication) with success. On his release, he was tested for food allergies, and his diet corrected. The mold in his home was corrected. His parents entered couples counseling, and the father also corrected his diet (reducing his provocative aggressive behaviors). The child went into counseling and has since graduated college, made friends and found a career, never needing medication.
As I sit here updating this page of the website, I am now reflecting on a patient I’ve been treating for three years. She came to me at 14 years of age diagnosed with attention deficit disorder, and anxiety disorder, and a very unstable personality which would cause her to have emotional breakdowns in school and at home– and even with friends. Through a very thorough evaluation (including genetics), we were able to alleviate 90% of her difficulties with diet and a few supplements. It turned out that her genetics (SLC16-A1 and alpha ketoglutarate dehydrogenase gene variants affecting mitochondrial function specifically in the prefrontal cortex, as well as) made her exquisitely sensitive to high glycemic index meals which caused her emotional brain to become over activated and her thinking brain to go off-line. Thorough evaluation of diet, lifestyle, fundamental nutrients, inflammation and peer dynamics is just so important in young people, as more and more young people are being given medications that may have long-term effects which we do not know about. We do know in animals that early use of stimulants permanently changes the nervous system. The reliance on medication in our young people is, in my opinion unconscionable. It is a mindless, convenient, profitable experiment with no justification. Once again, I am not against medication, but it is being massively over prescribed.