Expert: Libby Bonner - 12/22/2006

Question
My 7year old son has been recently diagnosed w/bi-polar.  This is not surprising since this runs in my family.  I don't want to medicate him though.  I have noticed that the family members including myself that have taken meds for this disease affect our memory and clarity.  I have an uncle who before diagnosed was very smart and after meds he is hard to talk to.  He has memory loss and sometimes it seems like his IQ has dropped.  I believe this is the meds.  I graduated w/honors and scholarships, now I can not remember half the stuff I learned in school and feel like I just am not all there at times.  I don't want my son to have to go through this.  Is there a way to treat this w/out medication?

Answer
I have limited experience w/ mental illnesses in children.  Partly, this is because, as recently as 10-12 years ago, the belief was that children did not have mental illnesses.  And so my experience is limited to a few parents in the NAMI [www.nami.org] support group that I facilitate.

I have done a bit of readin online, however, since first getting your question and will use that, and the exerience described above, in answering.

First, I would direct you to two helpful sites:  www.bpkids.org and www.aacap.org   I believe both sites mention the possible consequences of under-treating or not treating bipolar disorder.

1.  I would want to make sure that the diagnosis was correct.  I would also want to know what behavioral methods, if any, are effective for children, used w/ or without meds.  In that regard, you may hit insurance issues; probably the majority of health insurance policies sharply limit mental illness treatment for Rx, hospitalization, and behavioral therapies.

2.  Certainly, psychiatric meds have side effects, or even just a daily draggy effect, but normally only w/ multiple meds and/or high doses and/or w/ the anti-psychotic meds.  Children would certainly be given very low doses and a minimum number of meds.   --- I have read, in many sources, that some of the effects that you ascribe to meds may be simply the long-term result of having a mental illness.  Most mental illnesses wax and wane, and w/ each episode of increased symptoms, the theory goes, some little bit of damage occurs in the brain.  Cumulatively, over time, you can see decreased memory and decreased cognitive ability.    

3.  I myself would definitely want a pubescent child started on meds.  The very worst consequences of untreated bipolar disorder [aside from alienating friends and family and causing chaos in his own and others' lives] are suicide, severe substance abuse [because patients who feel that bad, or that unlike others, will self-medicate w/ substances to feel better], and illegal behavior [often violent behavior] that can lead to incarceration.

4.  Whether medicated or not, your son surely qualifies as a special needs child for whatever programs and support that your school system offers.  You must become thoroughly acquainted w/ these, so that you can make choices [if you are in large system, perhaps] and so that you can hound the system to provide every single thing they are obliged to.

5.  The behavioral methods to which I referred to, above, used w/ adult patients, are called cognitive behavioral  therapy [and there is a newer name, but you can find it by searchign cognitive behavioral therapy.]  I don't know that this could be used successfully w/ such a young child, since it would require insight and self-awareness that a young child has not yet developed, I think.

However, certainly see what child psychologists have to offer.

5.  NAMI offers a series of free classes for parents of young children, taught by trained parents.  If you wanted to do only one thing prior to agreeing to medicine [or prior to deciding not to medicate], I would try to take these classes, called Visions for Tomorrow.  You would become part of a network of parents that might have continuing usefulness, you would learn some child management techniques, AND they would undoubtedly cover issues of diagnosis and treatment: whether or not to use meds, and when to start.  The instructors and/or parents will also probably have the names of best docs, best school systems, best non-med approaches [if any.]  Again, if it were me, I would go to any amount of trouble to take this class.   NOTE:  the starting dates for some Visions classes are listed at the nami.org website, but we have found it incomplete.  For a complete list of upcoming classes, contact the state NAMI office.

Hope you can go forward w/ this info to make whatever is the best choice for your child.  Another note, however:  a decision NOT to medicate, given your son's age, certainly needs to be reconsidered at least annually.

[I hope you report to your doctor that you feel like you are just "not all there at times."  If you haven't, please do.  Could be that a change of meds and/or dose/s could make an improvement.]

Best of luck, and thank you for writing.