Genetics & Bipolar Diagnosis
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Q:  Genetics & Bipolar Diagnosis

My 13-year old son has been seen by 2 psychiatrist.  The 1st doc says that he's bipolar.  The 2nd says he's not bipolar because there is no family history of depression or alcholol abuse.  My son's symptoms are irritability, depression and anxiety.  He becomes easily agitated and is thinned skinned.  He cannot complete schoolwork.  From reading your website, I believe he is bipolar.  Although there is no euphoric mania, his symptoms are consistent with depressed agitation.  Is it possible for him to be bipolar when there is not a glimmer of an affective mood disorder among his parents and grandparents?  I can see why these 2 docs have differring opinions. How much weight should we give to genetics?


Dear Ms. K' -- 
Good question (I wish I had a good answer).  I just read a child psychiatrist's report that in his opinion, the "Bipolar Spectrum Diagnostic Scale" works well in kids (but it has not been tested in that population to see how many it misclassifies).  

Since you've had these evaluations, you must be pretty worried about him.  Sounds like the key issue here might be the anxiety, since irritability is not very specific to any condition and common in adolescents anyway.  If that was pretty severe, and especially if the depression has been pretty severe (because that has more direct risk), then you're probably going to end up looking at medications.  You could try to stall for a while on that step and see how far you can get with a good psychotherapist, since therapy is know to be as effective as medications for both depression (at least mild to moderate; in adults) and anxiety.  

But in case it comes to choosing between an antidepressant, which is probably what would be suggested by the non-bipolar-diagnosis psychiatrists you see; and a mood stabilizer, which is what the bipolar-diagnosis psychiatrists would likely recommend; then you'll have yet another good question with no good answer:  how much risk does an antidepressant pose, compared to the risks posed by one of the mood stabilizers?  Tricky.  Obviously different for each mood stabilizer.  Controversy about how much risk antidepressants pose (e.g. the recent "ban" in Britain for antidepressants in kids). 

But as to your question, we could rephrase:  how often is it that I see an adult (since I don't see kids much) who clearly has bipolar disorder yet has no relatives with either mood or alcohol problems?  Answer: "not very often".  Sorry, I haven't been counting.  It's not so few that finding a "blank" family history would make me question an otherwise fairly certain diagnosis; and it's not so few that I can remember saying to myself "wow, check that out, clearly bipolar but no family history"; but it's not very common, as usually one finds something up the family tree.  As you can see though, words like "sometimes" and "usually" are not quantitative in the way you're (appropriately) looking for.   

Dr. Phelps

Published May, 2004


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