Sarah McQuilkin says she knew something was wrong with her adopted daughter when she was 2. Now, at 7, Sarita says, "Mommy, the world will be better off without me."
A suicidal child sounds impossible, but for kids with bipolar disorder, it's a grim reality. "One out of five bipolars will commit suicide," says Karen Swartz, a psychiatrist and director of the Johns Hopkins Mood Disorders Center in Baltimore.
"Without treatment, I see my daughter as killing herself," says a weeping McQuilkin, 60.
Parents slather sunblock on their kids, hold them tight when they get flu shots, give them medicine when they're sick. Should mental illness be treated with drugs, too? As more kids are diagnosed with bipolar disorder at earlier ages, parents wonder whether drugs such as Depakote and lithium are really the answer -- and how they might affect their child's growth and development.
Treating a child with heavy medication has far-reaching implications, and it's not always clear at a young age whether a child's outbursts are early signs of bipolar disease.
"Doctors have to be able to make as accurate a diagnosis as possible," says Gabrielle Carlson, professor of psychiatry and pediatrics at Stony Brook (N.Y.) University School of Medicine. "Bipolar is a life-long disease, and you don't want to diagnose it too early and be wrong, or miss something and be too late."
One early sign of bipolar disorder in children is lashing out, but not every child who lashes out is bipolar. On Dec. 1, after 10 years of debate, psychiatrists approved updates to their diagnostic manual of mental illnesses, including the addition of Disruptive Mood Dysregulation Disorder, describing children who have outbursts three or more times a week.
The new term aims to address concerns about overdiagnosis and overmedication of bipolar disorder in children and gives psychiatrists a way to differentiate between bipolar and other explosive outbursts.
"I understand the reason why a parent would be afraid to medicate their child. There are often serious and unknown side effects to consider," says psychiatrist Janet Wozniak of Harvard Medical School. "But parents also need to consider that there may be a downside to not medicating and missing an opportunity to interrupt the course of a serious illness."
Bipolar disease is a severe mood disorder bookended by both mania and depression, known to emerge in adolescence and early adulthood. About 2% of children and teens have been diagnosed. But a study published last week in Archives of Pediatrics and Adolescent Medicine found that just 14% of teens with any mental disorder are on medication.
"If someone has epilepsy or asthma, there's no question as to whether to treat with medication, no matter how young," says Robert Post, a professor of psychiatry at George Washington University School of Medicine in Washington, D.C. "But for a child with bipolar disease, there's a trepidation to treat with medicine. It's a potentially lethal disease, and the medicine that balances the risks is often overlooked."
According to the National Institute of Mental Health, 5.7 million people struggle with bipolar disorder; studies have found that 50% start showing signs before age 19. But many lead fully functional lives.
Just as doctors routinely use a combination of therapies to treat AIDS or cancer, mental health professionals say a combination of medications and one-on-one therapy works best in bipolar disorder but often isn't used, "either because those services aren't available or people don't know about them," says Post.
Without treatment, kids can have a hard time focusing in school and are more prone to outbursts. According to the National Alliance on Mental Illness (NAMI), half of students with mental illness ages 14 and older drop out of high school. "The illness in a child can severely impair a child's ability to socialize and get through school," says Post.
As with any drugs, medications for bipolar disorder have side effects. They vary from grogginess, weight gain and polycystic ovary syndrome to tardive dyskinesia, in which the tongue thrusts out uncontrollably.
Bipolar disorder also may show up differently in children than it does in adults. Kids generally suffer from rapid cycling, swerving from mania to depression in a matter of hours. In adults and teens, it can be months or even years between episodes.
"The reason we have emotions is a way to organize our bodies to react to the environment appropriately," says Ellen Leibenluft, chief of bipolar spectrum disorders at the National Institute of Mental Health. "Bipolar disorder happens when that circuitry goes awry."
What if a diagnosis is wrong? The incorrect medication can trigger bipolar disorder, too, according to Ken Duckworth, medical director of the National Alliance on Mental Illness. ADHD and bipolar disorder in the manic state look very similar, but medication for ADHD can trigger mania in a bipolar person.
So what can parents do to help spare their children from suffering? The best medicine for kids is a strong support system of family, teachers and doctors, say experts.
McQuilkin, who knew Sarita had a family history of bipolar disorder when she adopted the child, says she's kept a journal "documenting all of my daughter's behavior -- the rages, the depression, everything.
"We, as parents, have to be our kids' biggest advocates. We know them best."
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