David Miklowitz's blog

Bipolar disorder and school problems in a 21 year old

Hi Dr. Dave,
My daughter is suffering from Bipolar disorder since 2007. She is 21 yrs. old has been on several meds. since then, is taking tegretol, zyprexa, seroquel right now.Always C/O thoughts, mostly euphoric, and lack of focus, concectration.Always has to break the semester and take medical leave in order to finish the course. Do you have any suggestions or references. Thanks.


Sorry for the delay in responding.  First, I would suggest getting a second opinion on her medication regimen.  She's taking two atypical antipsychotics (Zyprexa and Seroquel) which can have a lot of side effects (weight gain, fatigue). She's also taking a relatively old-line anticonvulsant (Tegretol).  There may be good reasons for this regimen, of course, but you might get a reevaluation by a psychiatrist who specializes in mood disorders, if she's not already seeing one. 

Preschool kids with bipolar disorder

A reader asked:

"My son was diagnosed with BP when he was 4 and is now five.  The doctor keeps prescribing risperidol which has helped the sillies but not the irratablilty and anger.  I am thinking we should be doing something else."


Dr. Dave:

Unfortunately, medications used to treat bipolar disorder are not yet FDA approved for 5-year-old children. Your child psychiatrist should have an open discussion with you about the risks and benefits of each medication for your child.  The following are some general principles for treating bipolar disorder in kids- these may or may not apply to your child.

First, diagnosing bipolar disorder in young children is very difficult. Silliness and irritability in young children can have many causes, so the first thing to consider is whether the diagnosis is accurate. You may want to get a second opinion on your child's diagnosis.

Groups for bipolar kids

A reader asked:


Do you know of any structured groups for children with bipolar disorder in the Los Angeles area?

Dr. Dave's reply:

There aren't many, I'm afraid.  Look at the website for the Depressive and Bipolar Support Alliance (www.dbsalliance.org) or the National Alliance on Mental Illness (www.nami.org). You can also search the www.bpkids.org site for support group listings.  Consider groups that focus on broader topics (for example, dialectical behavior therapy for teens with depression) rather than strictly bipolar disorder. Good luck!




Distinguishing Bipolar from ADHD

A reader asked:

What is the best method for distinguishing a non-extreme case of bipolar disorder from ADHD? My 12 year old daughter is diagnosed as ADHD, and is on Adderall which is somewhat helpfull. We have a maternal family history of bipolar II (mom) and I (grandmom). My daughter is displaying some bipolar symptoms, but nothing extreme. Our phsychiatrist is considering bipolar in addition to or instead of ADHD. He is considering adding Lamictal to Adderal or replacing Adderall with Lamictal, and suggested that her response to therapy may be the tie breaker in her diagnosis. Is this the best approach?

Dr. Dave:

Borderline personality and bipolar disorder

A reader asked:

"My 15-year-old daughter has signs of borderline personality disorder. I've heard that some people think this is related to bipolar. What do you think? And is BPD something you address at your clinic? Thanks."

Dr. Dave:

Borderline personality disorder is usually not diagnosed until adulthood.  Be wary of any diagnoses of borderline personality disorder among adolescents. Although teens may show behaviors that are similar to adults with borderline personality (e.g., inexplicable rages, self-cutting, jumping from one relationship to another, intolerance of being alone), often this is because there are underlying mood disorders (depression, bipolar disorder, dysthymia) that lead to these behaviors.  You'd want to make sure any underlying mood problems are treated before settling on the borderline diagnosis.

Diagnosis of 13-year old

A reader asked:

Our 13-year old daughter has signs of a mood disorder -- persistent anger, oppositionality, impulse control -- along with NLD and executive functioning problems, but her therapist does not believe she is bipolar because she is not hypersexualized.  When she was willing to take medication, Abilify seemed to help.  Given that there seems to be no consensus about the parameters of adolescent bi-polar disorder, I'm concerned that the therapist is giving that diagnosis short shrift.  Is she?

Dear reader,

Approaching teens about mood disorder

A reader asked:

how should i approach my daughter about the idea of mood disorder? i am not 100 percent sure if shes bipolar or if its teenage hormones? I want to research it with her but not sure how to start. any suggestions? symptons we see as a family is irregular sleep patterns, social problems, recklessness, spending problems, unrealistic ideas about most all decisions, lack of self-esteem. any help you can give would be great! thanks


Clinicians in Reno, Nevada

A reader asked:

I am trying to locate clinicians in the Reno area who are trained in FFT.
Also, need a psychiatrist (who is accepting patients) specializing in adolescent BD, familiar with current research on related psychopharmacology issues.
Patient is 16 yr. old female recently discharged from inpatient unit with provisional dx of
BD II. No luck tracking down good local resources so far. Ryst and Strange at U NV are not accepting new patients. Family can easily travel to Sacramento, or beyond if necessary. Would appreciate any leads you might offer. Thanks, Pam