A Variant of Bipolar Disorder?

The letter from Dr. John Sobor in the May 6 issue was like a breath of fresh air. I too feel compelled to respond to the subject of bipolar disorder in children and to the study by Dr. Barbara Geller, “Two-Year Prospective Follow-Up of Children With a Prepubertal and Early Adolescent Bipolar Disorder Phenotype,” which was reported in the June 21 issue.

I have great respect for researchers and their efforts to expand our knowledge of psychiatry. Similarly, I respect the lessons derived from clinical experience. Over the course of nearly 30 years of clinical practice, I have evaluated and treated many children and adolescents like those now labeled “bipolar” by some psychiatrists. These children do not have bipolar disorder as it has been defined traditionally. They seem to have a disorder that does not fit into our existing diagnostic categories. Why, then, are we willing to treat them with medications that have serious side effects and do not improve their condition?

In my experience, behavioral interventions, appropriate environmental support, and, when clearly indicated, medication to treat specific symptoms have been the keys to improvement for many of these children.

I should hope that as physicians we would not label children as young as 7 years old (sometimes even younger) with a serious, chronic mental health disorder when alternative explanations may well exist. Let us offer families hope, when we can, that their children may improve.