Bipolar Disorder Treatment for Children Gets Impressive Results
Bipolar disorder treatment for children often is not effective, and this is also true for the various subtypes (phenotypes) of the condition. But recent research efforts have shown that use of a drug known mainly as an anesthetic has provided impressive results when used by children with a certain phenotype of bipolar disorder.
Bipolar disorder affects adults and children
Bipolar disorder (also referred to as manic-depressive disorder) affects approximately 5.7 million adults in the United States. Although the average age of onset is 25 years old, younger people can develop the disease as well.
The Depression and Bipolar Support Alliance reports that bipolar disorder is more likely to affect children whose parents suffer with the condition. Presence of bipolar disorder in one parent increases the risk to each child by 15 to 30 percent. More than one million children and adolescents who have depression in the United States may actually have early onset of bipolar disorder.
Symptoms of bipolar disorder among young people tend to differ from those in adults. Children and adolescents are more likely to display aggression, irritability, sleep problems, and destructive outbursts when in the manic stage than are adults. During the depressive stage, young people usually have more physical complaints than do adults, such as headache and fatigue, and also to be extremely sensitive to failure or rejection and suffer feelings of worthlessness.
Fear of harm phenotype
Psychiatrist Demitri Papolos, director of research at the Juvenile Bipolar Research Foundation and a researcher at the Albert Einstein College of Medicine, has published a study (see below) and also was recently interviewed by NPR concerning the use of a new way to treat children with a subtype of bipolar disorder that he calls “fear of harm.”
Although there is still much controversy among mental health professionals about the presence of bipolar disorder in children and adolescents and the existence of a fear of harm phenotype, Papolos believes there are hundreds of thousands of such individuals.
In the NPR interview, Papolos discussed how he treated a young man, George McCann, who has suffered with bipolar disorder since he was very young. Specifically, McCann has a form of fear of harm phenotype, and he can become very aggressive, particularly if he feels threatened, although his actions are not premeditated.
Papolos reported how McCann responded to treatment with ketamine, a drug used mainly as an anesthetic. However, it has been shown to have rapid antidepressive qualities when given intravenously to adults with treatment-resistant depression.
For McCann, once he got over his extreme fear of trying the drug, use of an intranasal form of ketamine, taken every three days, has dramatically improved his life. Papolos has treated about 60 other young people with ketamine, and only two have not had extraordinary responses.
Bipolar disorder study
Results of a new study by Papolos and his team appearing in the May 2013 issue of the Journal of Affective Disorder reported on 12 young people (10 males, 2 females) ages 6 to 19 years who had fear of harm-phenotype bipolar disorder. None of the young people had responded to prior treatment with the typical drug options, including antipsychotics, mood stabilizers, and benzodiazepines.
One to two weeks before and after treatment with intranasal ketamine, the participants were evaluated for symptoms. Use of ketamine results in “substantial reduction” in mania, fear of harm, and aggressive behavior. Overall, significant improvements were noted in anxiety and behavioral symptoms, insomnia and other sleep problems, mood, and attention.
Much still is not understood about bipolar disorder among young people, and especially about the fear of harm phenotype. However, the results of the work by Papolos and the use of ketamine as a bipolar disorder treatment offer hope and may open new doors to therapeutic possibilities.
Depression and Bipolar Support Alliance
Papolos DF et al. Clinical experience using intranasal ketamine in the treatment of pediatric bipolar disorder/fear of harm phenotype. Journal of Affective Disorders 2013 May; 147(1-3): 431-36