Bipolar I Disorder has six different categories, including:

• Single Manic Episode
  No past episodes of Major Depression and the presence of only one Manic Episode
• Most Recent Episode Hypomanic
  Currently in a hypomanic episode, having had more than on manic episode or mixed episode, significantly distressed or impaired socially or occupationally
• Most Recent Episode Manic
  Current or most recent episode was Manic, and at least one major depression episode or mixed episode.
• Most Recent Episode Mixed
  Current or most recent episode was Major Depression and at least one Manic Episode
• Most Recent Episode Hypomanic
  Current or most recent episode was Hypomanic, at least one Manic episode or Mixed episode, and mood symptoms are significantly impairing social or occupational performance.
• Most Recent Episode Mixed
  The current or most recent episode was Major Depression and there has been at least one Manic Episode

Although rare in young children, bipolar disorder—also known as manic-depressive illness—can appear in both children and adolescents.37 Bipolar disorder, which involves unusual shifts in mood, energy, and functioning, may begin with either manic, depressive, or mixed manic and depressive symptoms. It is more likely to affect the children of parents who have the disorder. Twenty to 40 percent of adolescents with major depression develop bipolar disorder within 5 years after depression onset.4

Existing evidence indicates that bipolar disorder beginning in childhood or early adolescence may be a different, possibly more severe form of the illness than older adolescent- and adult-onset bipolar disorder.38 When the illness begins before or soon after puberty, it is often characterized by a continuous, rapid-cycling, irritable, and mixed symptom state that may co-occur with disruptive behavior disorders, particularly attention deficit hyperactivity disorder (ADHD) or conduct disorder (CD), or may have features of these disorders as initial symptoms. In contrast, later adolescent- or adult-onset bipolar disorder tends to begin suddenly, often with a classic manic episode, and to have a more episodic pattern with relatively stable periods between episodes. There is also less co-occurring ADHD or CD among those with later onset illness.

Bipolar Disorder: Manic Symptoms:
 

The essential treatment of bipolar disorder in adults involves the use of appropriate doses of mood stabilizing medications, typically lithium and/or valproate, which are often very effective for controlling mania and preventing recurrences of manic and depressive episodes. Treatment of children and adolescents diagnosed with bipolar disorder is based mainly on experience with adults, since as yet there is very limited data on the safety and efficacy of mood stabilizing medications in youth. Researchers currently are evaluating both pharmacological and psychosocial interventions for bipolar disorder in young people.

Bipolar Disorder: A Warning About Antidepressants and Psychostimulants

Using antidepressant medication to treat depression in a person who has bipolar disorder may induce manic symptoms if it is taken without a mood stabilizer, such as lithium or valproate. In addition, using psychostimulant medications to treat ADHD or ADHD-like symptoms in a child or adolescent with bipolar disorder may worsen manic symptoms. While it can be hard to determine which young patients will become manic, there is a greater likelihood among children and adolescents who have a family history of bipolar disorder. If manic symptoms develop or markedly worsen during antidepressant or stimulant use, a child psychiatrist should be consulted, and treatment for bipolar disorder should be considered. Physicians should be aware of the signs and symptoms of mania so that they can educate families on how to recognize these and report them immediately.

Valproate Use

According to studies conducted in Finland in patients with epilepsy, valproate may increase testosterone levels in teenage girls and produce polycystic ovary syndrome in women who began taking the medication before age 20. Increased testosterone can lead to polycystic ovary syndrome with irregular or absent menses, obesity, and abnormal growth of hair. Therefore, young female patients prescribed valproate should be monitored carefully.

 About the Author: Dr. Catherine Swanson Cain, PhD, LMFT provides counseling and therapy to families of young children with behavior problems or mental health disabilities. She also provides consultation and training to educators, child care providers, and professionals on a variety of behavioral health issues.