Children and adolescents can develop bipolar disorder especially if one or both parents have the disorder. Unlike adults with bipolar disorder, whose episodes tend to be clearly defined, children often have fast mood swings between depression and mania several times a day. Children with mania are likely to be irritable and prone to tantrums. Bipolar disorder in children can be hard to diagnose. For example, while irritability and aggressiveness can indicate bipolar disorder, they also can be indicate attention deficit hyperactivity disorder, conduct disorder, oppositional defiant disorder, or schizophrenia. Alcohol and drug abuse may, in children, be a symptom of bipolar disorder.
Because bipolar disorder runs in families, researchers have been searching, unsuccessfully thus far, for specific genes. Genes, if found, however cannot explain bipolar disorder. Thus studies of identical twins, who share the same genes, indicate that genes and other factors play a role in bipolar disorder. If bipolar disorder were caused entirely by genes, then the identical twin of someone with the disorder would always develop the disorder. However, this is not the case.
Brain-imaging studies are helping researches learn what goes wrong in bipolar disorder. New imaging techniques allow researchers to take pictures of the living brain, to examine its structure and activity, without the need for invasive procedures. The techniques include magnetic resonance imaging (MRI), positron emission tomography (PET), and functional magnetic resonance imaging (fMRI). These studies suggest that the brains of people with bipolar disorder differ from the brains of others. The significance of these differences is not yet known.
Drugs called "mood stabilizers" usually are prescribed to help control bipolar disorder. Several types of mood stabilizers are available. In general, people with bipolar disorder continue treatment with mood stabilizers for years. Other drugs are added when necessary, typically for shorter periods, to treat episodes of mania or depression that break through the mood stabilizer.
Lithium, the first mood-stabilizer is effective in controlling mania and preventing the recurrence of both manic and depression. Anticonvulsant drugs such as valproate (Depakote®) or carbamazepine (Tegretol®), also have mood-stabilizing effects and may be used for difficult-to-treat bipolar episodes.
Newer anticonvulsant drugs including lamotrigine (Lamictal®), gabapentin (Neurontin®), and topiramate (Topamax®), are being studied to determine how well they work in stabilizing moods. Anticonvulsant drugs can be combined with lithium, or with each other, for maximum effect. It has been shown that people with bipolar disorder are at risk of switching into mania or hypomania, or of developing rapid cycling, during treatment with antidepressant drugs. . Therefore, "mood-stabilizing" drugs generally are required, alone or in combination with antidepressants, to protect people with bipolar disorder from cycling. Lithium and valproate are the most commonly used mood-stabilizing drugs today. .
Atypical antipsychotic drugs including clozapine (Clozaril®), olanzapine (Zyprexa®), risperidone (Risperdal®), quetiapine (Seroquel®), and ziprasidone (Geodon®), are being studied as possible treatments for bipolar disorder. Evidence suggests clozapine may be helpful as a mood stabilizer for people who do not respond to lithium or anticonvulsants. Other research has supported the efficacy of olanzapine for acute mania, an indication that has recently received FDA approval. Olanzapine may also help relieve psychotic depression. It is of note that olanzapine, more than most antipsychotic drugs can cause or bring-out parkinson symptoms.
If insomnia is a problem, a high-potency benzodiazepine drugs such as clonazepam (Klonopin®) or lorazepam (Ativan®) may helpf to promote better sleep. However, since these drugs may be habit-forming, they are prescribed on a short-term basis. Other types of sedatives, such as zolpidem (Ambien®), are sometimes used instead.
People with bipolar disorder often have an abnormal thyroid. Because too much or too little thyroid hormone alone can lead to mood and energy changes, it is important that thyroid levels are monitored by a physician. People with rapid cycling tend to have thyroid problems and may need to take thyroid pills in addition to their bipolar disorder drugs. Also, lithium may lower thyroid levels in some people, resulting in the need for thyroid supplementation.
Alcohol and drug abuse are common in people with bipolar disorder. Research suggests that many factors contribute to substance abuse problems, including self-medication of symptoms. Treatment for co-occurring substance abuse, when present, is an important part of the overall treatment plan. Anxiety disorders, such as post-traumatic stress disorder and obsessive-compulsive disorder, also may be common in people with bipolar disorder. Co-occurring anxiety disorders may respond to the treatments used for bipolar disorder, or they may require separate treatment.

In addition to the mood cycling, the levels of the adrenal hormone cortisol cycle. This suggests that cycling of adrenal hormones may play a role in the highs and lows of bipolar disorder. It’s less clear they play a role in the “ons” and “offs” of PD people. In addition to the mood cycling, the levels of growth hormone, secreted by the pituitary gland, cycle. This suggests that cycling of growth hormone may play a role in the highs and lows of bipolar disorder. Such cycling of growth hormone, but not adrenal cortical steroids, occurs in some PD people with “ons” and “offs.”


The above indicates that in bipolar disorder, certain hormones cycle and are synchronized with the person’s mood. Whether the cycling hormones precipitate or cause the mood changes or merely accompany the mood changes is not known. The likelihood is the cycling moods and hormonal changes are part of an as yet not understood cycling mechanism in the brain.
Fame, Creativity, Bipolar Disorder
History has a place for the "mad genius" who in a euphoric fervor, conceives revolutionary ideas, incomprehensible except to him, but invaluable to society. Is this link between creativity and mental illness coincidence, or are the two related? If related, does heightened creative behavior alter the brain's chemistry such that one becomes more prone to bipolar disorder? Does bipolar disorder alter the chemistry of the brain so that creative behavior can be expressed? Noting the list of famous, creative, people who developed Parkinson disease, Dr Lieberman commented that there may be a relationship between the two. The relationship between fame, creativity and bipolar disorder is more striking. It’s of note that of the famous people with bipolar disorder only one had PD.

A 1949 study of 113 German artists, writers, and composers was one of the first to examine the relationship of fame, creativity, and bipolar disorder. Although two-thirds of the 113 artists, writers, composers were considered normal, there were more suicides and "neurotic" individuals in the artistic group than could be expected in the general population. Similar studies support the disproportionate occurrence of bipolar disorder, in artistic and creative people. When comparing individuals in the arts with those in other professions ( businessmen, scientists, and public officials), the artistic group showed two to three times the rate of bipolar disorder, suicide attempts, and substance abuse.
The abvoe studies support the existence of a link between bipolar disorder and creativity. The existence of such a link suggests to some, that a third factor, yet unidentified, may account for the link. It’s postulated that an overactivity of the cingulate gyrus, the brain between the cortex, the thinking part of the brain, and the thalamus, the part of the brain that receives information, may be over-active, resulting in unusual links between incoming information, memory, and thinking. This may result in odder or more unusual associations, expressed as creative thought. People with bipolar disorder are more emotional, resulting in greater sensitivity and acuteness. This, coupled with a lack of inhibition due to an altered prefrontal cortex may result in more unconventional forms of expressions. People with bipolar disorder are more open to experimentation and risk-taking.