As a new feature of CNNhealth.com, our team of expert doctors will answer readers' questions. This week, Dr. Gupta answers multiple questions about bipolar disorder.
The Food and Drug Administration spent two days this week weighing whether three powerful drugs that treat bipolar disorder and schizophrenia should be prescribed for children. The drugs are called atypical antipsychotics. The panel specifically was looking at the risk, benefit ratio of Zyprexa, Seroquel and Geodon. These three drugs come fraught with controversy because the list of risks associated with them. Common side effects include weight gain, high blood pressure, type 2 diabetes and in some situations, sudden cardiac death. The weight gain is not small – in some cases, a teen can put on 40 pounds in a few months after starting the medications. They seem to interfere with part of the brain that corresponds to our ability to feel full.
Most doctors agree that the risks and side effects need to be weighed by doctor, patient and parent. Many experts CNN spoke to who see children with bipolar disorder and schizophrenia believe these drugs are safe and should be widely available for use when a child has a severe mental health problem.
I received hundreds of questions by e-mail and on twitter. Here are answers to a few of the most common ones.
From @cognimmune via Twitter.com:
"At what age can a child be diagnosed with bipolar disorder or schizophrenia?"
That is a really great question and one that experts don’t really have an exact answer to. According an expert in child psychiatrist at Seattle Children’s Hospital, Dr. Christopher Varley, diagnosing a child less than 10 years old is very unusual and difficult to do. Most diagnoses are made in the early teen years.
From @shampm via Twitter.com:
"My daughter is adopted and we are having a hard time getting diagnosed [with bipolar disorder]. What can we do?"
Diagnosing bipolar disorder can be tricky because many children, and adults, display different sets of symptoms. For instance, not everyone with bipolar disorder will have instant changes to mood or outbursts of anger. Although the main characteristic is a drastic change in mood/personality, one person with bipolar may experience manic depression for a long time, and others may have only short episodes. A person with bipolar disorder may also display changes in his or her sleep patterns, energy level and have difficulty making decisions.
From Tori in Florida:
"I suspect my 16-year-old daughter may suffer from bipolar disorder. How does one know whether to seek a psychologist or psychiatrist for treatment?"
This is a an important one, Tori. The biggest difference between the two professions is that psychiatrists prescribe medications and psychologists do not. Psychiatrists are medical doctors and widely viewed as the best people to treat bipolar disorder because most patients with bipolar disorder do require medication. Psychiatrists are well qualified to identify which drugs might work best for a specific patient. But a major part of any therapy for this disorder is considered psychotherapy. And that can be provided by psychologists and other mental health professionals as well. Talk therapy can help you develop coping mechanisms and may help you keep you on your medications. Bottom line? After diagnosis, you may find a combination of treatment from both beneficial.
From Jackie in Massachusetts:
"I heard many of antipsychotic drugs are being prescribed to kids for who aren’t even diagnosed with bipolar disorder? Is that true?"
Jackie, this is a question a lot of people have. What exactly are these drugs being prescribed for? A recent study published in the Ambulatory Pediatrics Journal looked at the trends in prescribing atypical antipsychotic medications. It found these drugs are prescribed only 37 percent of the time to treat bipolar and schizophrenia. What makes some critics cringe is that these powerful antipsychotics are being used almost one-third of the time to treat ADHD - which can often be treated with a less-potent drugs or behavioral therapy.
Here is the breakdown of how atypical antipsychotic drugs are prescribed:
– 37.1 percent bipolar disorder & schizophrenia
– 29 percent ADHD
– 13.8 percent nonpsychiatric diagnosis
– 7.5 percent autism
– 5 percent Tourette's syndrome
Source: Ambulatory Pediatrics Journal
From John in West Virginia:
“I’m having trouble researching ADHD and bipolar disorder. The two seem similar. What is the difference and is it possible to have both?"
John, to answer to the second part of your question, yes, it is possible to have both. But it can be really confusing. It's a clinical diagnosis, and sometimes some of the symptoms sort of overlap, things like inattention, hyperactivity, impulse disorder, those are all things that are associated with ADHD. But specifically with bipolar, you tend to get what are pretty dramatic mood swings so you can have intense euphoria sort of followed by manic depression. That's one of the big differences. What's particularly difficult to distinguish in kids is that sometimes a treatment can be very similar as well, so that may be some of the trouble, there. I’d say if you are looking for a cardinal symptom of bipolar, extreme mood swings would be the main difference.