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Thursday, July 31, 2014
Bipolar Disorder (Children and Adolescents)
Nonmedicative Treatment for Bipolar Disorder
Dear Doctor, My 8 year old son was diagnosed with bipolar disorder when he was three. We had tried medications to help his moods and rages. After some time we decided to not medicate him and try to help him handle, cope and work out his feelings. After 4 years of this I feel that he regresses more than progresses. He is enrolled in a special program at his school due to the limit of any facilities near us. My question is are there other alternatives that can be used in the treatment of bipolar disorder without the use of medications. I would really prefer not to go back to the medication route.
Thank you for your question re: a non-medication approach to bipolar disorder. Because bipolar disorder is a biopsychosocial disorder (i.e., it involves biological, psychological and social factors), its treatment also requires a biopsychosocial approach (medication, psychoeducation, therapy, school/community interventions). The most recent treatment guidelines for early-onset bipolar disorder (published in March 2005, by the American Academy of Child and Adolescent Psychiatry) suggest the use of medication as a first line of treatment, as have many publications before it. However, I do hear your concern about the use of medications. Although I don't know your son's medication history, I've found that some parents reject the medication approach because it has not been successful in the past or has led to more side-effects than positive responses. I've also found that if parents work closely and patiently with a child/adolescent psychiatrist who specializes in the treatment of childhood mood disorders, they can find an effective medication or, as is often the case, a combination of medications.
The majority of children with bipolar disorder also have other disorders, especially ADHD, which require medication. However, it is very important that the child's mood swings are stabilized before a stimulant or even an antidepressant is introduced because these two medications can lead to increased mania.
A conservative approach to medication is warranted with the psychiatrist starting "low and going slow," meaning that the psychiatrist starts a child on the lowest dose of medication and slowly increases the dose while tracking its effect on symptom reduction and side-effects.
I previously noted that a biopsychosocial approach should include psychoeducation, which involves parents and children obtaining knowledge/information about bipolar disorder to better understand and manage it. "Knowledge=Power." The more "knowledge" you and your child have about bipolar disorder, the more "power" you will have in managing it. To this end, I strongly recommend reading "How To Raise a Moody Child" by Mary Fristad, Ph.D. and Jill Goldberg-Arnold, Ph.D. This book will provide you with everything you need to know about mood disorders (bipolar and depressive disorders) in childhood and how to treat them with medication and non-medication approaches. Dr. Fristad has been conducting research on psychoeducational interventions (adjunctive to medication) for early-onset bipolar disorders for well over a decade and is one of the world's leading experts on this topic.
I hope this helps. My best wishes to you and your son in finding an effective approach to helping him cope with his challenges.
Nicholas Lofthouse, PhD
Clinical Assistant Professor of Psychiatry
College of Medicine
The Ohio State University