Bipolar Disorder in Teens: Early Treatment Leads to Better Outcomes

Don’t you just hate it?

Hate the drudgery and pain of fighting an illness that doesn’t respond to treatment?

Granted, there are some illnesses that you can find remedies for, and recover.

Maybe a steroid injection, or an antibiotic, and you start noticing improvement in a couple of days.

But not all disorders are like that, unfortunately. You know what I’m talking about . . .

Sometimes It’s Hard to Get Better

Some are much harder to fight, more complicated to treat, and the prognosis is less predictable.

Like cancer, for instance. Or multiple sclerosis … or Lou Gehrig’s disease. Some respond better to treatment than others, and some illnesses make recovery almost impossible.

If you have bipolar disorder, you may have noticed that the longer you have it, the less you seem to improve.

The older you get … the longer you’ve been treated. And the more medications you’ve tried, the more the symptoms seem to get worse.

Now that’s not the case for everyone. Some people see a psychiatrist for the baffling mania they’ve experienced. They can get on a schedule, take their meds, follow their prescribed lifestyle plan, and they feel better and better.

But not all.

Some spend all their savings seeking treatment, following their doctor’s advice, getting help from family members to keep medications on schedule … And years go by without improvement. Symptoms swing more and more out of control. And work performance deteriorates, becoming almost impossible. Family relationships become more strained… if not broken.

Why is that?

Bipolar Disorder Can Become Treatment-Resistant Over Time

A certain group of psychologists and neuroscientists wanted to know the answer. So they pulled together a pile of 8 papers and 2 more meta-analyses, which involved 8942 patients.

If meta-analysis is a new term to you, here’s a short explanation. When researchers do a meta-analysis, they combine the information from a number of different studies to see what the consistent outcomes are — despite all of the differences across the studies.

So you can try to imagine how many studies had to be used, and how many different factors had to be analyzed, to learn about the experiences of these almost 9000 patients.

Five of the studies compared the first manic episode with those that followed. The others compared those with fewer episodes and those who had more of them. The result of all this . . . ?

Those who received psychotherapy and/or medications at the earliest stages of the illness had the best outcomes across the board. Best outcomes in terms of symptom severity, social function, relapse, remission, and employment.

The take home message is . . . the sooner you are treated after your first manic episode, the sooner you feel better, are able to manage your symptoms, and continue with a rewarding life.

On the other hand, the more you cycle, the further you advance into later stages of this illness, the less effective your therapy and medication treatment become. So … the more likely you are to experience more cycling and more impairment … and the less likely you are be able to function in a job or support yourself.

And there’s more . . .

Bipolar Disorder in Teens: Early Treatment Leads to Better Outcomes

Another study in Bethesda, Maryland, scrutinized patients at the date of entry into their network, the Bipolar Collaborative Network, to determine whether their date of entry was associated with early onset of the disease. They determined that those who entered the network at a younger age were more likely to have had an early onset of the disease as opposed to those who entered the network at an older age. And those who entered at an older age were less likely to have people with the disease in their family.

They also found that those who developed manic symptoms at younger ages were more likely to have parents or grandparents with bipolar disorder.

So, this all comes down to a major conclusion:

Since bipolar disorder needs to be identified, diagnosed, and treated quickly after onset, it’s important for family members to recognize the symptoms to help your loved one seek and receive treatment…as soon as possible.

To that end, here are some symptoms of mania to watch for:

There is almost nothing else in psychiatry which can develop so quickly and be so devastating. Manic symptoms, or mildly-manic symptoms, which we call hypomania, can dig you into a hole fast. So we teach our patients and their families to look for symptoms that occur at the same time that they are developing marked mood swings, or an elevated or irritable mood:

• episodes of high energy, excessive happiness, or irritability
• feelings of excessively high self-esteem, or super powers
• a diminished need for sleep … being able to go for days with little or not sleep
• increased talking at a fast rate of speed, with such pressure that you cannot be interrupted
• easily distracted from one subject to another
• fast stream of ideas and thoughts
• taking great risks time and again, such as substance abuse, unprotected sex, and reckless driving

In addition, there are depressive symptoms to watch for:

• low, depressed mood
• diminished enjoyment in favorite activities
• low energy level and fatigue
• major changes in sleep patterns … such as sleeping too much, or inability to fall asleep
• inability to concentrate
• feeling “bored”
• diminished appetite, loss of weight, or sudden weight gain
• complaints of stomach aches or headaches
• thoughts of death or suicide

Some of these symptoms can be also be seen in children or teens with other psychiatric disorders. But if the teen has a parent who has bipolar disorder, it’s critical to evaluate for that.

But know this: bipolar disorder isn’t easily diagnosed. It’s not uncommon for a child or teen with bipolar disorder to be diagnosed with major depression or other psychiatric disorders before the bipolarity can be identified. It’s a complex illness that requires scrutiny and observation over time. Basically, the sooner the diagnosis can be determined, the sooner effective treatment can be initiated.

By the same token, if you have bipolar disorder and were not treated early after your first manic episode, don’t despair.

At Innovative Psychiatry, we specialize in “difficult-to-treat” disorders and are committed to search for the most effective treatment to help you rediscover your best self.

Call us for an evaluation and let’s use the tools at our disposal to identify and find the most effective treatment for your specific needs.

Because we believe in helping you discover your best self,

Lori Calabrese, M.D.