Q:  1) Is having bi-polar a lifetime illness.  If a young child age 9 is diagnosed with this disorder will he ever out grow it or is he doomed to having to take medication for life.

      2) How can ones environment improve the effects of the disorder


Dear Ms. W. --

First of all, it would be important to recognize that sometimes this diagnosis is not correct. Especially at your son's age, it should be regarded as a "working diagnosis", open to revision as one observes his continuing course and response to treatment. On the other hand, if you have a history of bipolar disorder in your family, or if there are other reasons to strongly suspect that this diagnosis is correct, then we move on to your next question: can a person "grow out of it"?

Bipolar disorder, as an illness, has an astounding number of variations in the way that it presents itself. It can escalate very rapidly into a very severe condition, but on other occasions, it can look severe at the beginning and then go for years without recurrence. And then, of course, there is the very common version in which people have depression but do not have anything that looks like "mania" come and gone this way for years with very little reason to suspect "bipolar disorder". In other words, it is almost impossible to predict at the very beginning what this illness is going to look like over time.

To address your question, in some respects what we would really want to know is whether there are cases where people have a clear-cut episode of bipolar disorder, and then go on for decades without having another one, such that we might think they "grew out of it". I once heard a specialist from Harvard, Dr. Mauricio Tohen, say in a presentation that as many as 10% of people who have a manic episode will never have another one. At the time of this presentation, he was regarded as one of the world's experts on the long-term course of bipolar disorder. However, on a least one occasion since then, I have rooted around in the research literature on the subject and have never been able to find a reference for his comment, so can not hand it to you with certainty, or the proper reference you would want to have for such a statement. On the other hand, I think we can interpret his remark as indicating that at least in some cases, people do indeed seem to "grow out of it".

On the other hand, it is also clear that "growing out of it" is not common, and that the very large majority of patients with this illness have to contend with it for decades, probably in most cases, for their entire lives at some level (although there is some reason to suspect that in later life, symptoms can diminish on their own, perhaps in association with diminishing dopamine levels, a natural course for everyone, but which may make the manic-side symptoms less severe in some people). Your challenge, as a mother, will be to maintain a combination of hope and realism. This can be a great challenge indeed. Organizations like the National Alliance for the Mentally Ill (www.nami.org) have been formed in part for just this purpose. Another group which might be worth looking into is the depression and bipolar support alliance (www.dbsa.org). And in particular, for a mother of a young fellow like yours, although unlike these others it requires a modest registration fee to become involved, I would recommend the group called the Child and Adolescent Bipolar Foundation (www.bpkids.org). Much of their website is available for free; check it out.

Finally, as regards how one's environment can improve the course of illness over time: this is a fairly big question. I would strongly recommend here are the book by David Miklowitz entitled "The Bipolar Disorder Survival Guide", which includes a guide for how families can help. Look in particular at the information on maintaining a regular schedule of sleep. I will add my own two cents on that: read my essay about Bipolar Disorder: Light and Darkness -- Treatment Implications.

Dr. Phelps

Published September, 2007