Ongoing challenges of treatment, and suggestions for clinicians.
A list of brand name medications and their generic equivalents.
Dr. Janet Wozniak is the Director of the Pediatric Bipolar Clinical and Research Program in Pediatric Psychopharmacology at Massachusetts General Hospital, and a member of The Balanced Mind Parent Network's Scientific Advisory Council. Dr. Wozniak's research focuses on the characteristics, longitudinal course and treatment of pediatric bipolar disorder.
How are bipolar disorder and anxiety issues connected? Which comes, first the chick or the egg?
Janet Wozniak MD
There is a strong bidirectional overlap between anxiety disorders and bipolar disorder. That is, in a sample of bipolar youth, at least half have significant anxiety of various forms, and in anxious children we see higher than expected rates of bipolar disorder; so we know that they 'travel together' but we do not understand the nature of the relationship. It may be likely the genes that are associated with bipolar also produce changes that bring anxiety.
Sometimes the child has anxiety first, sometimes mood first, and sometimes both come on together. A lot of kids start off with significant separation anxiety along with the moodiness of preschool age and then go on to have full-blown mania depression. We do not know the 'chicken and egg' part, but many parents feel that if their child’s anxiety is treated, the mood reactions would diminish. The problem with this approach is that the best medications for anxiety are the SSRI antidepressants, and these will make mania much, much worse!
So if both co-occur, our standard treatment approach is to use a mood stabilizer, anti-manic treatment then sequence in an anti-anxiety treatment. We tend to use benzodiazepines, BuSpar, or Neurontin for the anxiety, as these won't make mania worse.