Treatment Options
The treatment of dysthymia is much like that used to treat depression. Because of the chemical imbalances that are part of bipolar disorder, its treatment almost always includes medication. For those parents who are hesitant about giving their children drugs to reduce symptoms, please think twice. This is not a disorder that will go away on its own.
While other treatments will help your child cope with this disorder, medication directly attacks the chemical root of bipolar disorder and provides an opportunity for symptom stability. There are a number of mood-stabilizing drugs that attack mania.
Medications
There are four common drugs used to treat mania: Depakote (divalproex sodium), Tegretol (carbamazepine), lithium, and Trileptal (oxcarbazepine). You've probably heard of the first two if you know anyone who is being treated for a seizure disorder. Depakote is currently the preferred drug if your child has what was previously referred to as rapid cycling, or the scary mixed episode.
Alert!
Although commonly used, the mood stabilizers Depakote and Tegretol should not be prescribed haphazardly to children and adolescents because they have not received FDA approval for use with children who have bipolar disorder. Lithium has only been FDA-approved for children over the age of twelve. Make sure your physician is using caution in prescribing these drugs for your child.
Lithium scares parents because it continues to have a stigma of being used on really crazy people. On some level, you are right to be concerned if your child is being prescribed this drug. While it does attack the depressive and manic symptoms of bipolar disorder, it requires very careful monitoring. Lithium levels are monitored by blood tests because it has been known to cause kidney and thyroid problems. This drug is prescribed based on a child's weight and blood lithium levels, so you can see why frequent visits to your child's doctor are important.
Side Effects
Of course, there are side effects to all of these medications. Depakote can cause drowsiness, stomach problems, weight gain, dizziness, and some problems in liver functioning although rare, and even thinning hair. Tegretol may cause difficulties such as drowsiness and dizziness, stomach problems, headaches, problems with vision, and fluctuations in liver functioning, and lowered white-blood cell counts. Lithium's side effects might include frequent urination and dry mouth, weight gain, tremors, stomach problems, and muscle weakness. Kidney and thyroid problems are also on the side effect list.
Essential
Lithium acts a lot like salt. Just like salt, lithium can make you quite thirsty. You can avoid dry mouth syndrome by keeping a bottle of water, a roll of mints, or gum handy. Reducing this side effect will continue to help your child cooperate with her medication regimen.
There are other less commonly used medications that can be helpful in stabilizing the symptoms of bipolar disorder: Neurontin (gabapentin), Lamictal (lamotrigine), and Topamax (topiramate). If these are mentioned by your child's physician, get the complete lowdown on these medications and their possible side effects before giving your approval.
With regard to the treatment of bipolar disorder, how do you decide whether to give a drug to your child considering that there
“I'm Not Taking That!”
You also need to consider whether the side effects are interfering with your child's willingness to take the medication. A teen will often refuse to take medication because he doesn't want there to be anything wrong with him. For him, having to take a drug means he's “crazy.”
If he's had mania before, he will remember feeling as if he can do anything and conquer the world! This is powerful, so it's quite understandable that he won't want to take a medication that will take that away from him.
For example, many girls who are taking these medications and gaining weight become frustrated quickly. They feel fat and ugly, and quickly become disenchanted with taking medication. If this is the case, communicate this with your doctor. It's important to be sympathetic to your child's concerns to increase cooperation.
Medication Is Not a Cure-All
There are other ways to manage dysthymia and bipolar disorder in conjunction with medication. Not every symptom will be alleviated or erased by medication. Frequently, a child has learned maladaptive ways of coping to modulate his symptoms. Psychotherapy can be useful here to educate not only the child but also the parents about dysthymia and bipolar disorder. The more you and your child know, the easier it will be to keep his symptoms under control and prevent them from causing significant problems with day-to-day functioning.
When is psychiatric hospitalization necessary for my child?
When nothing seems to be working and your child's symptoms are putting her at increased risk for harm, hospitalization may be the answer. There your physician can try new treatments while protecting your child from any harm.
There are support groups available to children who have bipolar disorder and depression and to families who have had one of its members diagnosed with bipolar disorder and depression. You can always find helpful information about dysthymia, depression, and bipolar disorder on the shelves of a bookstore or online. Often, your physician will have material available in his office that will be informative.
The diagnosis and treatment of dysthymia and bipolar disorder is complex. No single treatment is going to work on every child. That is why keeping track of your child's specific symptoms and behaviors is critical. Educating yourself is a powerful way to get control over what is happening to your child and find the best treatment options available.
