BI POLAR DISORDER

Hi,

I am a concerned father.  My 4 1/2 year old son was "diagnosed" with bi-polar disorder and has been on lithium and risperdal since 9/2000.  He is up to 900mg of lithium daily.  We recently contacted his psychiatrist because he seems to be getting worse.  We've been through several similar cycles and each time the lithium level was increased.  We also see a woman who is a "play therapist".  My concern is that my son always seems to be sick, with either a respiratory infection or a never-ending cough.  I wonder if the medications have anything to do with it. Also, I have noticed increased signs of sensitivity in his psyche. He is very sensitive to his brothers (he is a triplet). He teases but can't be teased.  He craves one on one attention.  He is very defiant and fresh.  He is very cranky in the morning.  I could go on and on. I am just worried about him and pray that he can somehow outgrow this bi-polar disorder.  I don't want him on lithium all is life.  I worry about the side effects.  I worry about him killing himself one day or refusing to take his medication.  I realize that I have not really asked any questions. I just wanted to vent.  He's can be such a sweet little boy and it kills me to see him in one of his cycles.  He is destroying any chance for peace in our house and my wife is a wreck because he preys on her.  

Thank you for your time.

[Kevin Kennedy, Ph.D.]

Dear Marc M.,

The diagnosis of Bipolar D/O, or any Mood D/O for that matter, in such a young child is a somewhat controversial subject. However, it is clear that some very young children do display such conditions, and if the diagnosis is correct the need for medications (antidepressants, mood stabilizers, anti-psychotic agents) will likely persist because Mood D/O's are biologically-based conditions.

Because the stakes are high, and the ramifications of taking mood stabilizing drugs and anti-psychotic drugs are significant, it would make sense to arrange a second opinion.

If there is a family history of Mood D/O, and particularly Bipolar D/O, your son's vulnerability certainly increases. At his age, while therapy for him can be useful, you will achieve the most mileage from the medications and from a systematic plan for behavior management within the home.