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Bipolar Disorder (Children and Adolescents)

Finding A Good Specialists for Mood Disorders

10/06/2004

Question:

My 19 year old daughter was diagnosed as being bipolar 4 years ago. She was put on lithium and depakote, which she took for 5 days. Here is the problem: We went to the local mental health center where a counselor talked to her for about 1/2 hour and then talked to me for about 15 minutes(mother). The counselor declared that she thought my daughter was bipolar and set up an appointment with a doctor the following week. We went into our appointment where he reached for her file, examined it for a couple of minutes and then asked if he had ever seen her before. Then, he asked if she was using drugs, alcohol, or was sexually promiscuous. She wasn`t, so then he said she was bipolar and prescribed the aforementioned medication. He then said that he would see her in 1 month. All of this in less than 10 minutes. After 5 days, we had had enough. With the quick slapstick diagnosis, it just didn`t justify the extreme drugs. For those 5 days, she could hardly stay awake and she developed ticks and also spasms in her limbs. She had been taking various forms of ADHD medication since 5th grade. We also tried prozac for 3 months and just recently tried zoloft for 1 month. The zoloft seemed to make her depression worse. In researching this bipolar condition, I found that she had most of the childhood symptons and if she truly is bipolar, most likely, has bipolar II, or rapid cycling. As she gets older, the symptoms seem to be getting worse. She has complained of racing thoughts, bright intense images, suicidal thoughts, and many more symptoms. This leads me to believe that she maybe is bipolar or at least has some sort of chemical imbalance. I have tried to work with our family doctor, but I know that she needs a specialist. Since I have already had one bad experience, I want to find someone that specifically deals with this type of problem. I have asked my family doctor for a referral, be he gave me the name of the lead mental health professional in our small town that I have not heard a lot of goods things about. Where do I find someone specializes in this, someone that can truly help her? I tried to see if I could get her into a clinical trial, but since she hasn`t been on any meds recently, she wasn`t eligible. Ironically, we have kept her off of meds so that she would be better suited for a trial.

Answer:

Thank you for contacting me about your daughter and your concerns regarding her diagnosis and medication. Because of the medication side-effects your daughter has been experiencing, I strongly urge her (or you, if she has given you her permission) to contact her psychiatrist ASAP and tell him about these difficulties. I also strongly encourage her (or you) to contact her psychiatrist and counselor to share your concerns about the assessment and diagnosis. Diagnosing bipolar disorder can be very difficulty and sometimes requires more than one assessment session. I'm not saying the diagnosis is incorrect or that a mental health professional cannot make such a diagnosis in one session, but if your daughter/you feel uncomfortable with the diagnosis, I strongly urge you to talk to the counselor about your concerns and ask him/her how she arrived at the diagnosis.

Hopefully the counselor will have conducted a comprehensive interview of all the "DSM-IV" psychiatric diagnosis. DSM-IV stands for the Diagnostic and Statistical Manual of Mental Disorder-Version 4, the so-called diagnostic "bible" of the mental health profession. Sometimes bipolar disorder can be mistaken for other problems (e.g., substance abuse, hormonal imbalance, personal stress, medical condition, adverse reaction to medications etc.,) so those need to be "ruled-out." A comprehensive assessment will also include a review of your daughter's developmental, social, medical, educational/occupational, and treatment history and a family history of psychiatric problems, as many psychiatric diagnoses tend to run in families.

If after raising these concerns with your daughter's counselor and psychiatrist you are still unsatisfied with the level of care you are receiving, communicate this to the professional and ask for a referral to another mental health professional specializing in mood disorders. Ethically they should help you with this referral if you are not happy with their services. You may also want to contact the following organization for referrals to mental health professionals who specialize in mood disorders in your area (you may have to travel though): Depression and Bipolar Support Alliance (DBSA).You can find a mental health professional at this  site called in the " Find a Mental Health Proffesional" topic.

I hope this response is helpful. Let me know, one way or the other. My best wishes to you and your daughter.

For more information:

Go to the Bipolar Disorder (Children and Adolescents) health topic, where you can:

Response by:

Nicholas   Lofthouse, PhD Nicholas Lofthouse, PhD
Clinical Assistant Professor of Psychiatry
College of Medicine
The Ohio State University