Expert: Joyce A. Anthony - 12/1/2009

Question
I have two sons namely Hemant aged 22 years and younger one Roshan aged 15 years.

Hemant  joined engineering at the age of 18 years but after completing 5 semesters (at 21 years) out of a total of 8 semesters he was diagnosed with Bipolar Disorder and had to take break in his studies and when he went back for studies he complaints of his inability to concentrate on to his studies. As of now he is left with 3 semesters and struggling to complete his engineering

Initially he was prescribed with 500 mg of Depakote per day and later on increased to 1000 mg once daily and presently continuing on that. In addition to improve his concentration and sleeping pattern he has been prescribed Attentrol 25 (Atomoxetine Hydrochloride Capsules) once a day and Risnia MD 3 mg (Risperidone0 once a day. Lately he seems to be improving.

As if his problem was not enough we are now facing another problem and that is regarding my younger son Roshan..

In the last about 18 months since Hemant’s bipolar disorder was discovered, for about 12 months (during break from studies) Hemant  stayed with us in spells.  And during this period Hemant was teasing Roshan most of the times.

The teasing by Hemant to Roshan was normally in the form of occasional mild beating, forcing him to play TV games, which Roshan did not like, sometimes damaging or threatening to damage his possessions etc.

In nut shell we can say that for quite some time Roshan remained under a sort of fear from Hemant.

At this point of time Roshan is showing following symptoms:

•   Openly defies us most of the times;
•   Does not like us and our behavior;
•   Complaints that we did not save him when he was being mistreated by Hemant - his brother;
•   Al most total loss of appetite and complains of weakness as well;
•   Loss of interest in most of the things;
•   Has become careless in most things including studies;
•   Avoids going to school though generally good in his studies;
•   Does not take part in extracurricular activities in school;
•   Avoids meeting people;
•   Prefers to stay alone in the house;
•   Avoids brushing his teeth;
•   Towards the evenings sometimes he becomes more withdrawn and tense;
•   When we ask if there is some problem, he says yes but does not reveal anything. Says he would sort out the things himself;
•   His face seems to be in tension most of the times though earlier he was not like this;
•   Has become very thin, compared with his built up earlier but his height is just normal (167 cm) and weight  about 52 kg;
•   Most of these changes seems to be more pronounced in the last 5 – 6  months; and
•   For the last about one or two years he occasionally complaints pain in his stomach that is relived only after he vomits.

But when we ask Roshan whether he is affected by Hemant he never accepts that.

When we ask him as to what is happening to him, he says only he knows what he is undergoing. He also says that there is something that is bothering him but is not prepared to reveal. We have not succeeded in getting this thing out of him.

As per you what could be the reason. We are also getting affected by all this that is happening to both of my sons.

Do you think that Hemant’s behavior made any effect on Roshan as mentioned above?

We seek your help and guidance to bring him (Roshan) back on tracks preferably without or least medication.

As Roshan is too young we wish to avoid giving him allopathic medicines right at this age as we did for Hemant and would prefer some alternative line of medication.

The specific questions in respect of Roshan are as follows:

•   What can we do to get him back to normal?
•   Can it develop in to Bipolar Disorder at a later date as it happened in case of Hemant?
•   Should we go for medication?
•   Is homeopathy or herbal medication available/effective for such problems and if yes where to find it.
•   Do such cases get cured?
•   How long it could take to bring him back to normal?

Also, any advice for Hemant at this stage?


Answer
Hello MK:

First, Hemant is at a very difficult age.  At fifteen, he is neither a child nor a man.  It sounds to me like it could be caused by several different things, so you will need to work at finding the cause.  

First, get a medical doctor to do a thorough physical exam of Hemant to make sure he is developing correctly and there is no medical problem.  This is always the first step, as medical problems can exhibit themselves in many ways.

If he is found to be okay physically, I would make an appointment with a psychologist.  This would only be for evaluation.  He may be suffering from depression.  It could also be something as simple as puberty is confusing him and he doesn't feel comfortable discussing the changes.  A psychologist may help him come to terms with that, as well as give him a "safe" place to express his concerns.

If it is found he is suffering from depression, there are alternatives to medication that can be tried before medication.  The psychologist could help with finding a support group or other activities to help him get through it.  If medication is needed, it is possible that he would only need it a short time--but it is better to see if there are other choices first.  

I would not try any non-traditional medications, such as herbal remedies, on him at his age.  He is still growing and there has not been enough testing to see the long-term effects of such treatments on a young mind and body.  You could add a daily multi-vitamin that contains the "B" vitamins to his diet.  That would help his body deal with stress better.

Bipolar disorder is a "family" one.  That means that every member of the family is touched and changed in some way when one member has bipolar disorder.  Siblings often feel neglected because so much time and energy is needed to deal with the one with bipolar.Maybe your son feels you already have enough to deal with so he is afraid to put more pressure on you.

Set aside time for just you and Hemant.  Play a game, take a walk, or do something else that is just for you two and also gives you a chance to talk if he chooses to open up.  Try to do this at least once a week.  Don't pressure him to talk, but let him know you are there and willing to listen should he choose to open up.  Come right out and tell him you are there==then let him decide when he will talk.  

Fifteen is a difficult age in the best of conditions.  Having a brother with bipolar disorder makes it more difficult.  Follow the above steps and you will make things a lot easier on both your son and yourself.  As long as he knows you love him and will be there for him, he'll come to you in his own time.
                              Joyce A. Anthony