I have a 4.5 y/o daughter who is incredibly bright and has numerous behavior issues.  I started seeing a CSW when she was 3, was referred onto a psychologist and then onto a psychiatrist, which we saw today.  The MD suspects that she has cyclothymia and is recommending that she take Zoloft.  I am against medications and I am very nervous about a DX with no real tangible evidence to support such a DX and recommendation of a psychotic med for an almost 5 y/o.  There are no long term studies that I am aware of that show outcome of medicating children vs. not medicating at such a young age.  What is your professional opinion on young children and cyclothymia?  Are there any methods to acurately determine a clear DX prior to medicating or is it just based on MD's opinion?  I don't want to medicate my child unless it is absolutely necessary and in her best interest.  I look forward to hearing from you.  

Thank you in advance for your assistance.

Dear Ms. C' -- 
Sorry to say I'm not enough of a specialist in this area; frankly, there are times I'm glad of that as I'd have a tough time knowing how to advise you, there is so little research to go on, as you point out.  Try www.bpkids.org if you haven't been there yet.  The issue of how to diagnose in adolescents, let alone kids, let alone infants, is very controversial  -- crucial, but very tricky, as some of what you can find on their site will show.   See also http://www.bipolarchild.com and their section on lots of useful books for parents. 

Dr. Phelps