By 2020, more than 11 million cancer survivors will be 65 years old or older, representing a 42% increase in just 10 years, according to projections from the National Cancer Institute (NCI).

Largely because older cancer patients and survivors tend to have other health problems, the challenges of caring for them will increase with their numbers, says Julia H. Rowland, PhD, who directs the NCI’s Office of Cancer Survivorship.

In a study published in the October issue of Cancer Epidemiology, Biomarkers & Prevention, Rowland and colleagues characterized older cancer survivors as “overlooked, understudied, underserved, and vulnerable.”

“We will see a wave of older adults with cancer or with a history of cancer as baby boomers grow older,” she tells WebMD. “The good news is that cancer is no longer a death sentence. It is a disease that can be cured and people often live for many decades after treatment. But we have a lot to do to prepare for the unique challenges that older cancer patients and survivors present.”

A Patient’s Perspective

Oncology nurse Lillie Shockney, RN, knows all too well the challenges facing the health care system and older cancer patients and long-term survivors.

A two-time breast cancer survivor, Shockney directs the Johns Hopkins Breast Center and is a long-time advocate for patients with the disease.

Her first breast cancer was diagnosed 19 years ago when she was in her mid-30s. She was treated for a second, unrelated cancer in her other breast two and a half years later.

“I understand the issue from both sides. I have been living and breathing it for many years,” Shockney tells WebMD.

She says one big concern is that there will be a major shortage of oncologists in years to come as medical students choose more lucrative specialties.

By one estimate, there will be a need for about 3,800 more oncologists in the U.S. than will be practicing within a decade.

“We will have a lot more people to take care of, with far fewer oncologists to take care of them,” she says.

Increase in Cancer Survivors

In the four decades since President Nixon declared a “war on cancer” while signing the National Cancer Act, the number of cancer survivors in the U.S. has increased about fourfold, from 3 million to 12 million.

The newly reported projections were made by analyzing data from the NCI’s Surveillance, Epidemiology and End Results (SEER) registry, which tracks cancer incidence and survival in the U.S.

The analysis revealed that:

• Close to 60% of cancer survivors in the U.S. are aged 65 or older, and this figure is projected to rise by 3% by 2020.
• The vast majority of people over the age of 65 with a cancer history will be free of cancer, but most will have other health conditions that may be complicated by past cancer treatments.

Shockney says general practitioners, nurse practitioners, and other health care professionals will increasingly be called on to treat noncancer-related conditions in older cancer survivors.

“In the past, oncology specialists have followed cancer survivors for the rest of their lives, but that is not going to be possible in the future,” she says. “There is an urgent need to include cancer survivorship care into medical school and residency programs for primary care doctors.”

“No matter who you are, no amount of information ensures prevention,” Jenkins says. “It’s almost hard to find somebody who hasn’t had a family member or friend with breast cancer.”

Jenkins, 40, has had both. Her grandmother, Patsy Roth, now in her 80s, was initially diagnosed at age 42 and underwent a double mastectomy. (Today, Roth’s cancer is slow-growing and she is otherwise healthy.) And in mid-June, Jenkins’ close friend, trailblazing film producer and Stand Up To Cancer co-founder Laura Ziskin, died from breast cancer at age 61. Five allowed Jenkins to positively channel emotions about losing Ziskin, she says.

Lifetime’s “Five” Project

Jenkins joins the project’s other directors (and Hollywood A-listers), Jennifer Aniston, Alicia Keys, Demi Moore, and Penelope Spheeris, who each made a film based on a story arc developed by Marta Kauffman, co-creator of the hit TV sitcom Friends, which co-starred Aniston. Jenkins is best known for her 2003 independent crime drama, Monster, which led to an Oscar for best actress for its star, Charlize Theron.

Collectively, Five explores breast cancer’s effects on relationships and women’s perceptions of the disease, which is the second most common cancer among U.S. women after skin cancer. According to the National Breast Cancer Foundation, some 200,000 new cases are diagnosed annually, and 40,000 women die of the disease every year.

Each 20-minute film follows its title character — Charlotte, Cheyanne, Lili, Mia, and Pearl — from diagnosis through various stages of treatment and coping. Pearl, played by actor Jeanne Tripplehorn, is the chronological link: She loses her mother to breast cancer in the first film, then grows up to become an oncologist who treats the other four lead characters, then faces breast cancer herself.

Five’s rich cast also includes Rosario Dawson, Bob Newhart, and real survivors. Jenkins wants the film to inspire through its characters, to entertain without forcing the educational component. “It was so intriguing to look at breast cancer like this, with humor and drama, not in a heavy-handed way yet encompassing the full spectrum of emotions with different points of view.”

High-dose supplements increased vitamin D levels to normal in most patients studied, but it is too soon to know if supplementation improved their outlook, says researcher Thomas Churilla, MS, a third-year medical student at Commonwealth Medical College in Scranton, Penn.

The findings were presented here at the annual meeting of the American Society for Radiation Oncology (ASTRO).

Vitamin D and Cancer Risk

Vitamin D is found in some foods, especially fatty fish, milk, and fortified cereals. Vitamin D is also obtained by exposure to sunlight.

Some studies have suggested a link between low vitamin D levels and cancer risk and progression, but others have not. None has proven cause and effect.

Research in the laboratory suggests that vitamin D has anti-tumor properties, regulating genes involved in the multiplication and spread of cancer cells, Churilla tells WebMD.

For the study, the researchers collected blood samples from 160 men and women with cancer and measured their levels of vitamin D. The five most common diagnoses were breast, prostate, lung, thyroid, and colorectal cancers.

Among people in the study, 42% had vitamin D insufficiency, defined as levels between 20 and 30 nanograms per milliliter (ng/mL) of blood. An additional 32% had vitamin D deficiency, with levels less than 20 ng/mL.

Vitamin D Levels and Stage III Cancer

The average level of vitamin D was about 24 ng/mL. People with levels below 24 ng/mL were nearly three times more likely to have stage III cancer than those with higher vitamin D levels.

Criteria for different stages differ by type of cancer. But in general, stage III indicates more extensive disease than lower stages: larger tumor size and/or spread of the cancer beyond the organ in which it first developed to nearby lymph nodes and/or adjacent organs.

There was no association between low vitamin D levels and even more advanced, stage IV cancers that have spread throughout the body, however. Churilla says that could be because patients with stage IV cancers may have already been seen by a variety of doctors who treated them for vitamin D deficiency.

Vitamin D Supplementation

As a second part of the study, the researchers treated patients with low vitamin D levels with 50,000 international units (IU) of vitamin D a week for eight weeks. The recommended dietary allowance of vitamin D for most people is 600 IU a day, but much higher doses are often needed for the short-term treatment of vitamin D deficiency. This type of treatment should only be done under a doctor’s supervision.

The average vitamin D levels of the supplemented patients rose to about 35 ng/mL — in the normal range.

Now the patients have to be followed for months and years to see if vitamin D supplements appeared to reduce the chance of cancer spread and extend lives, Churilla says.

Phillip Devlin, MD, a radiation oncologist at Harvard Medical School, tells WebMD that such a study does not show cause and effect, only an association between low vitamin D levels and stage III cancer.

Churilla agrees. It could be that people with stage III cancer are more likely to have low vitamin D levels because they are sicker and don’t eat as well or get out in the sun as much as people with less advanced cancer, he says.

Devlin says the study generates interesting ideas that need to be tested in larger, longer studies.

“We do not recommend vitamin D supplementation for cancer patients at this point,” he says.

These findings were presented at a medical conference. They should be considered preliminary as they have not yet undergone the “peer review” process, in which outside experts scrutinize the data prior to publication in a medical journal.

In 2001, the drug received FDA approval as a treatment for schizophrenia. It’s a member of the class of drugs known as atypical antipsychotics.

Other drugs of this class — notably Zyprexa and Risperdal — are often used to help control the manic phases of bipolar disorder. Many patients taking these drugs have unwanted weight gain. Geodon does not appear to affect patients’ weight, according to bipolar disorder treatment expert Paul E. Keck, MD, professor of psychiatry and pharmacology at the University of Cincinnati.

“Many bipolar medications cause substantial weight gain, making it challenging to treat patients for this serious and often disabling condition,” Keck says in a Pfizer news release. “Managing the symptoms of this disorder is the primary objective of treatment. Finding an agent that is acceptable to patients is also a key element to successful treatment. Geodon has now been proven to rapidly control the symptoms of acute mania and has not been associated with significant weight gain.”

Geodon does have side effects, however. The one of most concern is increased risk of abnormal heart rhythm. People with a specific heart-rhythm problem called long QT syndrome, people who’ve had a recent heart attack, and people with severe heart failure should not take Geodon.

Bipolar disorder is also known as manic-depressive illness. It’s characterized by profound mood swings between periods of depression and periods of mania. During manic episodes, a person may feel very irritable, or may feel excessively happy and bursting with energy.

The initial treatment for bipolar disorder is lithium, which reduces the high risk of suicide associated with this lifelong psychiatric illness. However, psychiatrists usually use atypical antipsychotics for control of manic episodes in patients with bipolar disorder.

The FDA had previously approved Zyprexa to treat acute episodes of mania associated with bipolar disorder. Now the drug is approved to delay relapse into either mania or depression in patients with bipolar disorder.

“Bipolar disorder is a serious condition that can be difficult to treat. For those who achieve stability on existing medications, relapse of symptoms is all too common,” says Frederick K. Goodwin, MD, director, Center on Neuroscience, Medical Progress, and Society, at the George Washington University Medical Center, Washington, D.C., says in a news release.

Bipolar disorder — previously called “manic-depressive” disease — affects 2.5 million Americans and is a mental illness that causes people to have severe high and low moods. People with bipolar disorder have mood swings from feeling overly happy and joyful (or irritable), to feeling very sad (or overly happy). According to the National Institute of Mental Health, nearly one in every five people with the illness ends their life by suicide. In between episodes of mood swings, a person may experience normal moods.

The word “manic” describes the periods when the person feels overly excited and confident. These feelings can quickly turn to confusion, irritability, anger, and even rage. The word “depressive” describes the periods when the person feels very sad or depressed. Because the symptoms are similar, sometimes people with bipolar depression are incorrectly diagnosed as having major depression.

Zyprexa is the first medication approved to treat both acute mania and delay relapse of symptoms associated with bipolar disorder since lithium was approved in 1974. Zyprexa is also one of the ingredients in the drug Symbyax — as well as one in the antidepressant Prozac — which was recently approved to treat bipolar depression.

The FDA approved Zyprexa for long-term treatment of bipolar disorder based on a study that showed patients taking Zyprexa went significantly longer without relapse than patients taking placebo. An attack of mania occurred in 16% of Zyprexa-treated patients compared with 41% of placebo patients. In addition, depression relapse occurred in 35% of Zyprexa patients compared with 48% of patients taking placebo.

In the study, significant side effects for Zyprexa patients were weight gain, fatigue, and restlessness.

High blood sugar — even associated with coma or death — has been linked to medications such as Zyprexa. All patients taking these drugs should be routinely checked for symptoms of high blood sugar. People with diabetes should be monitored regularly for worsening of blood sugar control.

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But most Americans — 78% — don’t know even the basics about bipolar disorder, according to a new survey.

“The impact of untreated bipolar disorder on a person’s life is huge,” says Richard C. Birkel, PhD, in a news release. Birkel is executive director of The Nation’s Voice on Mental Illness, which commissioned the study along with Abbott Laboratories.

The telephone survey of 1,004 Americans — including 275 college students — was released today.

“Overall, Americans do not perceive mental illness to be as serious as other major diseases facing people in this country,” the report states.

Other findings:

• Forty-eight percent of the nation can identify schizophrenia as a mental illness, where as only 22% of people surveyed identified bipolar as a mental illness.
• Seventy-eight percent failed to name bipolar disorder and could not associate it with any of the risks, such as substance abuse and suicide.
• Almost four out of 10 (38%) people could not think of a single symptom associated with bipolar disorder.
• On a 100-point scale, where 100 is most serious, the nation as a whole rates mental illness as a 67 in terms of seriousness compared with other illnesses; 35- to 54-year-old women rate it slightly more serious than the rest of the nation.
• People over age 55 are least aware of bipolar disorder.

Bipolar disorder is caused by imbalances in brain chemicals and affects more than 2 million Americans. Though each case is different, the disorder usually involves periods of mania, followed by depression, with normal moods in between — hence, the name manic depression.

The mood swings can last for hours, days, weeks, even months.

Though there is no cure for bipolar disorder, it is a treatable and manageable illness, experts say. Medication is an essential part of treatment, to stabilize mood swings. With a therapist’s help, people can understand their illness better and develop skills to cope with stresses that trigger mood swings.

Because doctors don’t always understand bipolar disorder/manic depression, many people don’t get the right treatment.

In a study that included more than 20,000 bipolar disorder patients, those taking the drug Depakote had a suicide rate almost three times higher than those taking lithium. The findings are reported in the Sept. 17 issue of TheJournal of the American Medical Association.

After adjusting for other factors that could play a role in suicide, such as other medical or psychiatric conditions, the researchers also found that the risk of suicide attempts resulting in hospitalization was 70% higher for patients taking Depakote.

All but Abandoned

Lead researcher Frederick K. Goodwin, MD, says the findings should serve as a wake-up call to many psychiatrists who have all but abandoned lithium for bipolar disorder in favor of newer medications, which are heavily marketed by their manufacturers. He adds that this is especially true of younger doctors, who are often not taught about lithium in medical school.

“Lithium is the number one mood stabilizer in every country except America,” he tells WebMD. “If it is really better for some patients, then we really should be rethinking this rush away from it. At the very least we need to make sure that nobody gets out of residency in this country without knowing how to use it.”

Roughly 1.5% of the U.S. population suffers from bipolar disorder, which was once known as manic depression. Characterized by extreme mood swings with episodes of severe depression, people with bipolar disorder are 10 to 20 times more likely to commit suicide than the general population.

The introduction of lithium in the 1970s revolutionized the treatment of bipolar disorder and gave psychiatrists their first effective drug for preventing suicide, Goodwin says. Due to their ability to help stabilize mood, Depakote and several other antiseizure drugs have been used since the mid-1990s to treat patients with bipolar disorder.

This study is the first to compare lithium to Depakote for the prevention of suicide. The 20,000-plus patients with diagnoses of bipolar disorder were followed over the course of the seven-year study.

After adjusting for other suicide risk factors, the researchers concluded that the risk of suicide and suicide attempts was 1.5 to 3 times greater during treatment with Depakote than with lithium. The findings bolster those of a European study concluding that lithium is better for suicide prevention than another antiseizure drug used to treat bipolar disorder, known as Tegretol.

Antiseizure Drugs Better for Some

Though he says that lithium is underused in the treatment of bipolar disorder, Goodwin says the antiseizure drugs, either alone or in combination with lithium, represent a better choice for many patients. Patients who are sicker, he says, and those who also have substance abuse problems tend to respond better to the newer drugs.

In an editorial accompanying the study, Ross J. Baldessarini, MD, and Leonardo Tondo, MD, of Harvard Medical School write that preventing suicides among patients with bipolar disorder and other mental illnesses has been too long neglected as a sign of treatment success. The two recently published a review showing that untreated bipolar patients were almost nine times more likely to commit suicide than patients taking lithium long term.

“Not until this year has the FDA approved any treatment to prevent suicidal behavior — with the recent approval of [Clozaril] for such purposes among patients with schizophrenia or schizoaffective disorder,” the two write. “This approval was supported by a prospective randomized study showing about 32% lower risk of non-lethal suicidal behaviors … Hopefully, such renewed interest in the potentially treatment-modifiable lethality of major mental disorders will be sustained and increasingly successful.”

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Robbins had reportedly been hospitalized and placed on suicide watch shortly after he was suspended from playing this year’s Super Bowl against the Tampa Bay Buccaneers. In the hours leading up to the big game in late January, there were accounts of the 29-year-old going on a drinking binge, missing crucial team meetings, and being disoriented and utterly depressed.

Spector, 62, supposedly resisted arrest in early February, minutes after police found the bloodied body of B-movie actress Lana Clarkson in the foyer of his Los Angeles mansion. The record producer, responsible for more than a dozen Top 40 Hits in the 1960′s (“Be My Baby,” “You’ve Lost That Lovin’ Feelin’”), was accused of shooting Clarkson in the face and faces first-degree murder charges.

Although Spector has been notorious for his drunkenness and violent behavior over the decades, Rolling Stone reports that in the months before the murder, colleagues had found him sober, pleasant, and productive.

In the Raiders camp, some teammates publicly criticized Robbins for bailing out on the team in the Super Bowl, where Raiders lost to the Bucs 48-21. Despite the center’s record of missed games and unexplained absences, guard Frank Middleton says he and many fellow players never knew Robbins as a depressed guy.

What happened to Robbins and Spector, and how did people working closely with them miss what was really going on? Psychiatric experts say a number of factors contribute to society’s misconceptions about bipolar disorder and make treatment of it all the more difficult.

The Anatomy of Inner Turmoil

According to the American Psychiatric Association (APA), people with bipolar disorder, commonly known as manic depression, usually suffer extreme mood swings, cycling from mania to depression.

In the manic phase, they usually feel invincible, euphoric, hyperactive, and very productive. This could lead to excessively risky behavior, grand delusions, uncontrollable thoughts and actions, irritability, rage, and insomnia. In the depressed phase, they can experience intense sadness, despair, fatigue, insomnia, difficulty concentrating, changes in appetite, and constant thoughts of suicide.

Robbins once described his problem as ‘a battle within your head.’ Spector explained his as ‘devils inside that fight me.’ These are two examples of the emotional challenges affecting the lives of millions of people. The Depression and Bipolar Support Alliance (DBSA) reports that 2.5 million adult Americans suffer from the chronic disease; other countries reportedly have similar rates.

The good news is that effective treatments exist for manic depression, including medication, counseling, and sometimes a mix of both. The bad news is that many people don’t take this life-altering remedy because they are either in denial about their illness, think nothing can help them, or they’re misdiagnosed — usually with depression. It is also common for those who are on drugs to relapse because they stop taking their prescription, often because they think they’re getting better.

The stigma attached to psychiatric illness doesn’t help either. Many people think only violent and insane-acting individuals could possibly have a mental disorder. Though it is true that mania could cause someone to become more aggressive and do illegal things, most of the time, people with serious psychiatric problems end up to be victims of crime.

“They are not as good at defending themselves because they tend to be loners, and vulnerable,” says Robert Hirschfeld, MD, chairman of the department of psychiatry and behavioral sciences at the University of Texas Medical Branch in Galveston. He says many tend not to know what manic depressives go through unless they experience the disorder themselves, or know someone close to them who is suffering.

Otherwise, most people think sufferers can ‘pull it together,’ when that’s not usually the case, says David Dunner, MD, director of the Center for Anxiety and Depression at the University of Washington in Seattle. He explains that mental illness isn’t usually viewed in the same vein as the flu, pneumonia, heart disease, or broken bones. Yet, he says, “The same kinds of physical things are wrong when someone has depression or a manic episode.”

Medical experts aren’t yet certain of the exact cause of bipolar disorder, but a biological cause is the prime suspect since it seems to run in families. APA figures indicate that 80% to 90% of individuals with manic depression have a relative with either depression or bipolar disorder, a rate 10 to 20 times higher than in the general population.

A person’s environment can also contribute to the disease, says Hirschfeld, pointing to both early and current experiences as possible factors.

Silent Suffering, Public Misunderstanding

Spector and Robbins’ woes with manic depression may both have played out on the national stage, but based on reactions of shock to their plight, it seems their recent emotional anguish went relatively unnoticed or were ignored until it was too late.

The same thing can happen to ordinary citizens, testifies Dan Gunter, who has endured bipolar disorder for nearly a decade. The Opelika, Ala., resident says before he was accurately diagnosed with the illness, he cycled from mania to depression to the point that he hurt many people close to him and quit a good-paying healthcare job.

When he first sought help, doctors thought he had depression and prescribed him antidepressants. The drugs, he said, made his manic episodes worse.

Once the bipolar disorder was correctly identified and he was able to take the right medication, however, Gunter says his life improved dramatically. Now he not only works as an announcer for a group of radio stations, he has started his own coaching business — helping other people with manic depression.

Although he considers the damage to his marriage irreparable, Gunter says his new life under treatment has helped him cope with many emotional difficulties.He considers himself fortunate that many of his family and friends have been understanding about his disease.

Gunter worries about the people who do not receive appropriate treatment, pointing to DBSA figures that say roughly seven in 10 consumers are misdiagnosed by doctors at least once. Also, more than a third (35%) of the misdiagnosed suffer for more than 10 years before they are accurately diagnosed with bipolar disorder.

The problem, Gunter says, is that most people will only report some symptoms, and many physicians don’t take the time to do a comprehensive evaluation. “So bipolar disorder is very often misdiagnosed as depression, as schizophrenia, and other disorders,” he says.

An estimated 3 million Americans suffer from bipolar disorder, previously known as manic depression. The mental illness causes a person to go through cycles of mania (“high” mood) and depression, mixed with periods of normal mood.

One study shows that the drug Zyprexa is even more effective than lithium, the current mood-stabilizing drug of choice, for helping people with bipolar disorder stay in remission and prevent relapses into mania. A second study shows that adding the drug Seroquel to mood stabilizers can better treat and resolve manic episodes.

Both studies were presented this week at the Third European Stanley Foundation Conference on Bipolar Disorder in Freiburg, Germany.

In the first, year-long study, researchers found that bipolar patients treated with Zyprexa relapsed into mania only half as often as those who took lithium (14% vs. 28%). Zyprexa also seemed to keep people out of the hospital compared with lithium.

Both treatments fared equally well in preventing relapses into depression.

Study researcher Frederick Goodwin, MD, director of the Center on Neuroscience, Medical Progress and Society at George Washington University, and colleagues say the findings are significant because lithium has been the gold standard in the treatment of bipolar disorder for decades. But lithium requires blood monitoring for adverse reactions, which can create problems with getting people to stay on the drug.

The researchers also found that people on Zyprexa were less likely to discontinue their medication than those on lithium.

The second study shows that the combination of the drug Seroquel and a mood stabilizer, such as lithium, is more effective than lithium alone in treating bipolar mania.

Researchers at Harvard Medical School in Boston gave 105 adults with bipolar disorder who were suffering a manic episode either 21 days of Seroquel or a placebo in addition to a mood stabilizer.

By the end of the study, those who received both drugs had a significantly greater improvement in manic symptoms. In addition, more patients in the Seroquel group experienced a complete resolution of their manic episode than those who received only mood stabilizers.

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Lederman and her husband took their son to the hospital, where he was admitted for a three-day evaluation. At the end of the three days, he had been diagnosed with bipolar disorder.

From that day forward, the Lederman family’s life changed. And even though their son’s condition is now stable, it requires “constant vigilance,” says Lederman, author of the forthcoming book, Swing Shift: The Ups & Downs of Parenting a Bipolar Child.

Previously known as manic-depression, bipolar disorder is a mood disorder marked by extreme changes in mood, energy levels, and behavior. Although symptoms typically emerge in adolescence or adulthood, they can be seen in children as young as 7 or 8, says Robert Kowatch, MD, professor of psychiatry and pediatrics at Cincinnati Children’s Hospital Medical Center.

Until recently, young people were rarely diagnosed with this disorder. Yet up to one-third of the 3.4 million children and adolescents with depression in the U.S. may actually be experiencing the early onset of bipolar disorder, according to the American Academy of Child and Adolescent Psychiatry.

Bipolar disorder begins with either manic or depressive symptoms. Like children with depression, children with bipolar disorder are likely to have a family history of the illness — as was the case with Judith Lederman’s son. Her husband’s father also suffered from the condition.

The National Mental Health Association lists the following signs and symptoms and recommends that you seek medical help if you see a child struggling with any combination of these symptoms for more than two weeks.

Manic Symptoms

• Severe changes in mood — from unusually happy or silly to irritable, angry, or aggressive.
• Unrealistic highs in self-esteem. May feel indestructible or believe they can fly, for example.
• Great increase in energy level. Can go without sleep for days without being tired.
• Excessive involvement in multiple projects and activities. May move from one thing to the next and become easily distracted.
• Increase in talking. Talks too much, too fast, changes topics too quickly, and cannot be interrupted. This may be accompanied by racing thoughts or feeling pressured to keep talking.
• Risk-taking behavior such as abusing drugs and alcohol, attempting daredevil stunts, being sexually active, or having unprotected sex.

Depressive Symptoms

• Frequent sadness or crying.
• Withdrawal from friends and activities.
• Decreased energy level, lack of enthusiasm, or motivation.
• Feelings of worthlessness or excessive guilt.
• Extreme sensitivity to rejection or failure.
• Major changes in habits such as oversleeping or overeating.
• Frequent physical complaints such as headaches and stomachaches.
• Recurring thoughts of death, suicide, or self-destructive behavior.

Many of these symptoms can be indicative of conditions other than bipolar disorder, but it’s important to have the child evaluated to reach the right diagnosis, says Tim Lesaka, MD, child psychiatrist with The Staunton Clinic in suburban Pittsburgh. Many cases previously thought to be attention deficit hyperactive disorder (ADHD) may, in fact, be bipolar disorder, he says.

“With kids with bipolar disorder, it’s a matter of extremes,” says Lesaka. “With an ADHD kid, there’s a five-minute tantrum and then an apology. With the bipolar child, it can be eight hours of rage with no apology. There is an explosiveness … followed by a super-depression.”

Treatment for bipolar disorder — in kids as well as in adults — usually consists of a combination of medications that may include one or more of the following: mood stabilizer, antipsychotic drug, antidepressant, or antiseizure drug. Medication does work, Kowatch says, but there’s always the problem of getting kids to stay with the program. “It’s a real pain for them,” he says. “The drugs have side effects … but the alternative is to wind up in the hospital.”

Researchers at Ohio State University are looking into other treatment options in two new studies, one funded by the National Institute of Mental Health and the other by the Ohio Department of Mental Health.

The researchers are studying a promising new treatment called psychoeducation that they believe can help children with early-onset bipolar disorder and their families.

Though there have been a few studies evaluating medication in children, none has examined psychosocial treatments, says Mary Fristad, PhD, leader of the studies and a professor of psychiatry and psychology at Ohio State.

“Medications are vital for helping children with bipolar disorder, but they can’t do everything,” says Fristad.

“If you have your first mood disorder as an adult, you have already learned a lot of coping skills that can help you, such as how to hold a conversation and how to treat friends,” says Fristad. “But when you get a mood disorder as a child, you often have never had a chance to develop these interpersonal skills. We help kids ‘catch up’ with these skills, which in turn helps them manage their symptoms.”

While acknowledging that bipolar disorder in children does indeed exist, Barry Cohn Markell, PsyD, a licensed clinical psychologist in Park Ridge, Ill., adds a note of restraint. “It’s talked about more, but it’s still very rare.” (According to Kowatch of Cincinnati Children’s Hospital Medical Center, approximately 1% of children in the general population suffer from bipolar disorder.)

Cohn Markell is concerned that an inaccurate diagnosis of bipolar disorder can “label” a kid for life. “Many of the symptoms that are listed for bipolar disorder can be caused by other things from abuse and neglect to physical illnesses such as epilepsy, encephalitis, brain tumor, or head injury.”

When parents bring a child with severe mood swings to him, Cohn Markell learns about the child’s environment — by observing the child himself and/or by giving the parents and teachers an observational scale (“If the behavior isn’t the same at home and at school, then something else might be going on,” he says). He also takes a history to determine how long the symptoms have been present and refers the child to a pediatrician to rule out physical illness.

If a child is diagnosed with bipolar disorder, says Cohn Markell, he recommends counseling, special classes or schools, and support services for the child and family.

Judith Lederman agrees. “There’s so much to know and so much to deal with,” she says. But it’s important to know that you’re not alone. There is support out there. But you have to seek it out.”