A reader asked: "If a 9 year old only exhibits more of the depressed mood part of cycle (symptoms of irritability especially among peers, crying outbursts, isolating) has a family history of bi-polar from mother's side 2 individuals, would an evaluation/intake still be warranted by your program? When do manic episodes typically begin in children?"
Yes, most definitely, an evaluation would be warranted. Children who have bipolar parents or extended relatives and are showing symptoms of mood instability are considered to be at risk for developing bipolar disorder, even if they don't have it yet. We treat such children in our clinic, although the treatment is likely to be different than we would do with children or adolescents with established bipolar disorder. For example, we may decide following our evaluation that the child can benefit from a simplified medication regimen, or that his or her mood can be stabilized with lower dosages; or we may emphasize therapy and stress management to a greater extent.
Manic episodes can occur at almost any age, and have been recorded as young as age 4 or 5, but the average age at onset is believed to be about 18. However, that is just an average- there are as many youths who have manic episodes before 18 as after it.