Dr. Gupta answers your questions on bipolar disorder

Parents looking for answers can come to the Child and Adolescent Bipolar Foundation website at http://www.bpkids.org for more information on bipolar and other mental health issues in children.

I am 52, and believe me or not, I have lived with most of these symptoms all my life. School was impossible, obesity comes and goes, alcohol and drugs also came into play for temporary relief (4 years sober). It does not surprise that your new drug has weight gain issues.
Endorphins need to be studied further! In my battles, I believe I need to create those positve effects on my brain, and do it in a healthy way. The only healthy way I have found is by strenuous excercize.
Your comments would be greatly appreciated.
Thank You

The ADHD and Bipolar "confusion" is really frustrating. It seems that oftentimes (even in adults) bipolar is simply assumed to be ADHD. The two conditions are very different.. ADHD people can't focus on a specific task for too long, while Bipolar people CAN focus, but frequently the subject of the focus is problematic (as with grandiose thoughts, risk-seeking behavior and other manic symptoms.)

I really wish the public were better educated. More significantly, I wish teachers and school counselors were better informed. Often a teacher's recommendation leads a parent to seek ADHD treatment. When parents go to the doctor, they "lead" the doctor towards an ADHD diagnosis, based on the teacher's ill-informed observations. Giving a stimulant like Rytalin to a bipolar person in a manic episode can be very dangerous and counter productive. But ADHD is a "popular" diagnosis, so many people simply assume that classic mania is really symptomatic of ADHD.

I would like to know why pharmaceuticals seem to be the only route that medical doctors use to treat bi-polar disorder. i've been bi-polar since i was a teenager and only found a doctor 8 years ago that finally diagnosed me correctly. i've been through every drug in the book and fish oil has been extremely beneficial to me....and i might add that it was after much research on my own that i discovered using it with my meds enabled me to cut my meds in half. i'm constantly searching for other natural sources of medications other than "synthetic" ones because i believe that our bodies are made to heal themselves if put in an environment to do so...it's a shame that our healthcare system only looks for ways to medicate with pharmaceuticals instead of finding ways to naturally heal our bodies. then, our kids wouldn't have to be on these powerful medications to begin with.

Why do parents need their children diagnosed at all costs? here in Italy the family is more careful BEFORE being out of control and BEFORE being prescribed chemicals. HOW? SPORT, HEALTHY LIFESTYLE, LOTS OF SLEEP time, RELAXING WEEKENDS with family....Don't you think as a doctor, these would be much more efficient ways, by preventing pathology, than curing with chemicals that are inevitably killers?!

The FDA panel voted 8-1 that Geodon is safe for children and adolescents with bipolar disorder, though nine panelists abstained, complaining of incomplete data from the company.
This is an excerpt from the AP version of the FDA approval of antipsychotics for 10-17 year olds. I do not understand how it gets approved with so many abstentions. I also hope that psychiatrist, counselors and doctors listen carefully to these children if they put them on antipsychotics. At age 38, I gained 30 pounds in 22 days. Because the initial weight gain was so drastic I asked to be taken off the medicine at two weeks, and none of the doctors listened. This was not the only adverse side effect from medication.
If Bipolar is left untreated because the medicine does not work, will it progress to schizoaffective disorder or schizophrenia?

thanks so much for posting on this controversial, and extremely pertinent topic. but i must say, my brother was diagnosed as being "bipolar" in his mid-20's after a series of other "misdiagnoses" (schizophrenia and major depression are two that i know of). he was prescribed Zyprexa after the initial diagnosis of bipolar, and seemingly immediately packed on the pounds. he went up and down several times, in dangerously rapid succession (sometimes over the course of a month, dropping or gaining ten pounds). he's now on abilify and no longer seems to be having these ricochet-like weight problems (he's heavier than he was before any medication, but it's at a manageable plateau). aside from this, he also seemed to have the beginnings of tardive diskinesia. he had involuntary toungue movements (tongue moved in and out of his mouth, as though he were panting) and hand movements (general shaking movement), that truly worried us all in the family. this was not my brother.

i decided to become a psychology major when i started college in order to find out more about the illness (among other personal reasons), and i must say that with diagnoses of the different types of depression being so dependent on arbitrary time-frames (6-months of experiencing very specific symptoms in order to be diagnosed with "major depression") and symptom indicators (not to mention the individual opinion of the therapist/psychiatrist, who will inevitably have their own prejudices in practice), it is disgusting to me how far these diagnoses can reach, even to children whose behavior could simply be indicative of the general course of development (general hyperactivity, disobedience). parents really need to take responsibility here, and not just spend their (i'm sure) abundant funds on visits to a psychiatrists prescribing such medications, which have relatively unclear mechanisms within the brain and with such widespread neurotransmitters as serotonin and dopamine, that don't just make your children "hyper", but are responsible for so many other vital functions, like inducing the feeling of satiation ("fullness" after eating) or pleasure in activities that we are supposed to take pleasure in, which these drugs seriously mask. i saw it in my brother on zyprexa. his daily expression was completely flat. it was like he had no other reason to get out of bed in the morning than to eat. this is such a shame.

Dr. Gupta,

I would like to thank you for covering this story. Bipolar Disorder is hardly covered in the news. It's important that readers understand that this is a real disorder, a disease of the mind, if you will, and it needs to be handled delicately. I think you did a great job of telling us the facts and answering some of our questions.

I look forward to your future blogs.

Thanks again,
Cristina C. Fender

ive just joined. is there a problem with seroquel and kids?

My grandaughter has radical behavior one minute she can be so nice the next minute she can be so mean with her words . with a split second her mood can change and you wonder what happend. She tips chairs over, slams doors, and has a very hard time calming down. she can be nice for a week and on a dime switch she remines me of Dr. jeckel and Mr. hide. What should i do.

I had big time heart rate issues on geodon. One night it got up to high, my heart- I didn't think I was going to make it.

Last Sept. I was denied health care insurance by a major provider because I had been treated for the last five years for depression. I was told I had to remove myself from all medications for one year in order to re-apply. A physician suggested to me on a personal note that this could be considered illegal, especially in a day and age when millions of people are being treated with anti-depressants. This person suggested that perhaps I should explore the laws further.

Other than the depression, I was and remain in perfect health. Can I be denied health care insurance for any reason? Is there somewhere to pursue the matter without going through legal channels? I wonder if drug companies would appreciate my being shunned by this insurance company because I was taking their medications.

Desperate to seek healthcare, I have removed myself from all medications for the last nine months and continue to do well. Just curious about your thoughts.

Thank you.

Having changed careers nine years ago from that of a nurse in psychiatry (25 years) to a teacher of emotionally impaired students, I have been apalled by the lack of knowledge and poor connection with mental health resources that exist in the public school system (at least in my state, my area). I think articles like this are important if we are ever to enable students like mine to reach their true potential.

Thanks for the enlighting info on bipolar disorder. My son and I have traveled the often difficult road of dealing with bipolar for the last 18 years. He originally was dx with adhd–but stimulants increased his manic swings and after going to many doctors and reading up on it he did get diagnosed and had been on lithium along with risperdal and other "cocktails."

The discouraging issue in all of this is that many doctors are reluctant to diagnosis a child with bipolar early on–my son was at the age of 5 but because my husand (now ex) wouldn't accept it we went on for awhile before he finally saw reality. I have had to deal with both my son and my ex as they both have the disease.

I also am a special ed teacher and see everyday the denial and the heartache of having a child with does not receive the treatment that is needed for a successful and happy life. I just keeping working with the parents and hope they see the light at the end of the tunnel.

On a sad note, by son has recently decided that he doesn't need his meds and since he is an adult and not living with me I have no recourse. I feel defeated and cheated that he has choosen this path for himself.

Please make every effort to seek out those who can truly give you the help you need–go to a doctor who specializes in the disorder and above don't give up hope. I still am.

PS The "Bipolar Child" is an excelllent book and resource.

When is society (Dr., politicians, etc) going to realize advertising drugs on TV is only feeding the need for these drugs to some of the public.

Advertising gives some people ideas that they "need" the drugs. Advertising only feeds the "physic" of some people particularly the older generation.

If we would take all the drug advertising off television it would cut down on the cost of health care immensly!.

As a previous health professional and having a mother who would feed into this system very well I know it is true!

Dr. Gupta & Team.

At age 47, I was diagnosed with Bipolar II and ADHD. It took 3 tough years to get the diagnosis and medication right. A patient counselor did not let me give up and even more did not dismiss me and the ebb & flow of depression and the different mania with Bipolar II which has been with me since college. Although the medicine has leveled out my life and my head. Similar to the post above, only strenuous exercise makes me feel like a healthy person.

For over 23 yrs I was in and out of many mental hospitals, required to take multipal and powerful anti-psychotic, etc. drugs as the diagnosis evolved through paranoid schitzophrenic on to manic-depressive and then finally pre-frontal petit-mal seizures, miltipal psychiatrists.

Very disruptive to my career, family and life. ...at times I was considered sucidal and a danger to self and others...and I was. Very very expensive also. In 1993 I decided to take the chance of stopping all perscribed medication...I lived in my van in a parking lot next to the beach for over seven months and went through my very difficult withdrawal. My doctor warned me of the danger and it was in fact very dangerous. I smoked all the marijuana I needed. I have never been hospitilized since, nor have I required any drugs other then marijuana and two glasses of red wine after work and before dinner. No more hospitals, no more psychiatrists.
I still use marijuana, am 72 years old, retired from work, and run three miles every other day......totally free of any so-called mental illness's, the endless depressions, the limitless anger, and the horrible effects of all the psychotropic drugs. I grieve so deeply for all those people locked forever in mental hospitals being forced fed those ever evolving manufactured drug chemicals....
Dr. Lester Greenspoon MD has done much research on the effects of cannabis on mental illness. I do not know him personally but he is certinally worth interviewing for the AC360 report on the effectiveness of marijuana.
I have also had eight major surgeries and use marijuana for pain control...many times I left the hospital sent home with a major bottle of Vicodan and never take one.....marijuana and a glass of wine work better....non-addicting, no side effects, no problems.
The positive effects of marijuana should not be overlooked nor underestimated.....maybe the biggest thing we shoud fear from cannibas is that it causes stress release laughter sometimes, and
is a soothing balm for pained emotions.....I thank God for cannabis and my brain receptors every day.... a very valid path out of very real mental hell....
Thank you Dr. Gupta for your comments on CNN, and for the opportunity here to share personal experience regarding the usefullness of medical cannabis for various forms of mental illness.

Since there has been "No" biological defect found for any mental illness by any neurological study and there is "no test" for chemical imbalance, then psychiatry must be limited in the ancillary tests of medicine like an EKG, EEG, blood work or other tests in the diagnoses of a patient. They aren't needed.

I assume (based on that knowledge above) that the psychiatric diagnosis can only be made on the basis of behavior and hearsay.

My question is: Is it safe to take any mind drugs based on hearsay and behavior which could be influenced by the age, dietary habit or physical illness of the person?

June 20/09

I saw a TV program called MENTAL this past week regarding the treatment etc. of an 8 yr. old Bipolar patient. I was intrigued because I too was 8 years old when Bipolar came into my life. I am 56 and Manic-Depression) the first name for Bipolar Disorder was virtually unknown and at least 50% of the patients committed suicide because of the psychic pain. My father was one of those.

I can tell you that I would have appreciated being diagnosed earlier and that scientists then and now need to find alternative medications without the terrible side-effects that accompany the ones we have now. Brain research is expanding and since almost all of my extended family members have some form of mental illness and since we all took part in a study for the (then) Canadian mental health facility which took blood samples from us all and were only able to identify the gene that causes Bipolar/Unipolar. That was in 1985.

Unfortunately, Pet Scans, MRI scans and CAT Scans are not used enough to let familes such as ours receive the benefit of knowing positively whether or not we have each inherited or just what form of mental illness each of us have inherited.

I truly hope this blog will spur medicos and scientists alike to find a real cure for Bipolar, Unipolar and Schizophrenia in the near future before it goes to our grandchildren – the next generation. My mother and father though deceased would truly appreciate the efforts.

At the very least, an increase in truly better psychotropic medications and better therapies – all with positive not negative side-effects.

God bless you all, Take care.

wow! reading over the comments left, some people are very aware of what bipolar is. a condition that cannot be "fixed" by proper diet and exercise. it is sad that such ignorance is still out there about mental illness. I agree that the side effects for these drugs are horrible and I wish more progress could be made in finding drugs that would be helpful and not so dangerous. Many of us who are parents of bipolar children do not rush right out to get our child medicated. After trying talk therapy and other alternative methods, medication was the last resort. Sometimes you just have to face the diagnosis and deal with it. There is life after bipolar if you educate yourself.

My daughter was diagnosed with bipolar 7 years ago. In looking back, I think that she exhibited signs of the disease at the age of 5.

Although she went to a treatment facility at the age of 15, she still wasn't properly diagnosed. I went through some really rough times with her until, at the age of 23, she said she just couldn't go on like that anymore and was suicidal. At that time she was diagnosed with Bipolar II, which mainly exhibits with severe depression. But even with the medications, it took her another 4 years before she was ready to take control of her disease and stop letting it control her.

My daughter still lives with me and is attending school to become a hair designer. But her life is still like a rollercoaster, and as a parent, I take all the rides with her.

About 3 years ago, I decided to get involved in something and it came to me that maybe I could help other family members dealing with what I have been. I joined the local chapter of the National Alliance for Mental Illness (NAMI) and have since become trained to facilitate a Family Support Group. It has given me a great deal of satisfaction to be able to help others and help myself too. I have learned a lot about mental illness and have learned to understand more about my daughter and myself. I would recommend NAMI to both consumers (the label placed on people with mental illness) and family and friends of people with mental illness.

Mental illness is devastating for all concerned. But knowledge is definitely power!

Not all Bipolar patients need drug therapy.There are 2 types ,BiPolar I and Bipolar 2.The latter can be called Pepsi lite and seldom requires drug therapy.Also one should read the article "Selling of Biploar Mania" in PLOS journal.In the same journal one can find the article on"Serotoni and Depression- Disconnect between literature and advertisement.Both give a different view.
One child age less that 5 years was treated at at an Ivory tower of research with disastrous consequences.

Seroquel saved my son. My son was diagnosed with severe generalized anxiety disorder with somatization disorder. For the first 4 years of his life he spent much time with pediatric gastrointerologists trying to determine what was wrong with him. His symptoms were diarrhea, occasional vomiting, stomach aches, severe nausea and he was underweight because he could not eat. By 5 years old they determined that it was a psychiatric problem. From 5 yrs old to 13 yrs old he went to many, many psychiatrists who just treated his daily (sometimes for hours) panic attacks and nausea with prozac and anti-nausea medication. Nothing worked. He had daily panic attacks and continued to be sickly. At 11 yrs old, he began feinting, hallucinating, having psudo-seizures, loss of sight, loss of hearing severe panic attacks and he talked often about he just did not want to live anymore if it meant living like that. At the same time, he maintained an A-B average in school. He was finally hospitalized because he could not go more than a couple of hours without a panic attack, he was 57 lbs at 13 yrs old and he was feinting numerous times a day and he could not go to school anymore. They took him off of prozac and put him on Syroquel 9 months ago. He has had only 3 panic attacks since then and that is because he forgot to take a pill. All his physical symptoms are gone. He has lived a life he and I never thought possible. He was in the talent show riding his unicycle, he was in the school play and he was gone to the movies numerous times since he could never have before without having an attack from the noise. He has only gained 20lbs, which has brought him up to a normal weight. We don't know what will happen during puberty, but if he had only this time to live a 'normal' life, at least he has had this and I am thankful!

I'm 20 years old, and I wasn't diagnosed with ADHD and Bipolar Disorder until October 2008. I always knew there was something "different" about the way that I functioned in social situations and the way that I managed my mood. I have the inattentive form of ADHD, rather than the hyperactive or mixed form, so I was never a hyper child. Instead, I was quiet and cooperative. Combined with the Bipolar Disorder, my quiet nature made my mood swings less noticeable, especially since I experience hypomania or mixed episodes instead of full mania. The truth is, the two disorders can exist together and, as me and other family members of mine have experienced, ADHD can be masked by other mood disorders, like major depression or bipolar disorder. My father was diagnosed with depression when he was my age and has had trouble managing it his entire life. He seemed to be entirely unresponsive to most medications. Recently, his doctor began treating him with an antidepressant in combination with Aderall and, after treating his undiagnosed ADHD AND depression, his symptoms seem to finally be under control. My sister had the same experience, until she was diagnosed and treated for ADHD, her depression was unrelenting. If ADHD is present with another mood disorder, symptoms will probably persist until BOTH disorders are treated. It's extrememly difficult to distinguish ADHD from other mood disorders. My biggest issue was that I had developed ways to compensate over the years for my forgetfulness and inability to concentrate associated with my ADHD. I'm still trying to find the right balance of medications to treat both disorders effectively, but it would be even more difficult if my psychiatrist hadn't made that distinction. It's easier if you have a family history of ADHD and mood disorders, although my sister was the first person in my family to be correctly diagnosed with the two. This was what prompted my doctor to start asking questions. College would be significantly harder for me if I was only being treated for one or the other. No one should jump to conclusions about their own mental status or diagnosis and they should always be honest with their doctors. Going to proper doctor is also important, a psychiatrist, rather than a primary care physician, should always be consulted. Also, if symptoms persist after trying multiple medications and combinations of medications, don't be afraid to question your doctor's diagnosis or get a second opinion. Mental disorders are the most difficult to diagnose and diagnosing them incorrectly can make them even harder and more frustrating to manage.

dr. gupta. my apologies for wrting in the this space but it was all i knew to do in order to ask questions regarding my weight. but i am writing in addtion to to the bi-polar information . I was wrongly diagnosed for many years as a schizophrenic and took 2000 mg of thorazine daily– not sure how much mellaril and ellavil. i also spent many months at a time hospitalized for about 14 years. had at least 100 ect treatments as well over that period of time. I also gained weight so fast that i had really deep stretch marks–yet did not realize i was gaining weight of couse. (too drugged i guess). this started around 1973. i was last hospitalized in 1984 . Once i was rediagnosed/i was what they termed back then..manic depressive. i have had my bi-polar disorder under control using Tegretol .(i here toyou can be helped and very well tpsas
p[s I was started on lithium-the big thing back then–and then added the tegretol. soon after found the tegretol was what was working. so for the last 25 years i am totally functioning–have my life back–and yet now and since then of course, i have dealt with an extreme weight prob. brought on by the meds. it was like my metabolism stopped. i fear diabetes /heart attack or stroke. i hate this and yet there is nothing i can do. i would not take one million dollars to stop taking the tegretol. i saved my life–with the help of some eager residents at the hospital that knew a challenge when they saw one. i was quite lucky. i do not want to die after all the fight i put into getting healthy mentally, i do not want diabetes,. and i do not want any of the illnesses that come with being overweight. no one seems to know what to telll me to do.,i wrote you when u were doing that study but it seemed so focused on kids. here i am at 58 feeling like i may not make it to 60. i have had alot of other things going against me with the weight including falls and now i am in a real pickle. i i need advice andyet i can not figure what to ask first. i fight to stay mentally healthy and have a strong survivor instinct but i have to tell you this weight thing is way over my head. it is so out of control that i am not sure what to do. i do know your interest lies with probs with kids. i am only asking is there any hekp /advice you can give me as i have not got just 60 pounds to lose now, i now need to lose over 100. i see this as getting worse. as a adult i feel i am left by the wayside or am falling through the cracks - i understand we much protect children's health, but as an adult i have done all that every dr, ever asked of me for years. now i need help to lose the weight.–but more than just a diet plan. this is so out of control..and without me eating tons of food byw–that i have no clue that anything can be done now. eating the right foods ecercses, m

My son who is 10 years old now was diagnosed with ADHD and Bipolar disease 2 1/2 years ago. His cocktail is 40 mg of Focalin XR, 400 mg of Seroquel and 500mg of Depakote ER per day. His dr also prescribed 30mg of Ritlin per day on top of this. I left out the Ritalin dosing since he is not in school right now and am now questioning if the other three medications are over medicating him. I wish I could find a reputable dr for my son in the city I live in for a very needed second opinion. My insurance only covers one mental health center and now am forced to pay out of pocket to find someone that can help him.

I have to say that I was also one of those who was misdiagnosed for many years and it took me three years to find the right medication. I have had 2 breakthroughs since then and have had to add an additional medication in order to maintain some sense of sanity.

The weight gain from the Seroquel is now at 50 lbs. I am not happy about that but I have to think of it this way, I can be fat and happy or skinny and suicidal. I prefer the former.

My 12 year old daughter was finally diagnosed after six years. She has been on so many meds that always caused side effects, mostly weight gain and not evening out her mood. Most recently we took her off seroquel because it stopped being effective and caused nonstop eating and weight gain as a result. She is now on lamictal and is doing great. Lost the weight and is very stable.

I've suffered from bipolar disorder since the 7th grade and now at 22, I thank God every day my doctor had no problem prescribing me the medication despite my age. What many people don't understand is that bipolar is one of those disorders that is caused only be chemical imbalances in the body. Although childhood trauma or loss can make the symptoms worse, the typical manic depressive will require medicine for their entire lifetime. It's not a doctor's opinion, it's a FACT.

As for some of you who say that fitness, vitamins, and diet is all the help you need: More power to you. I went off the medicine my Freshman year in high school and tried to survive with that being my only treatment. 7 months later they put me back on because I'd become completely obsessed with being fit to the point of bulimia!

I've accepted the fact that I will take medication for a long time, possibly a lifetime. and I'm ok with that.