NEWSWEEK Cover: Growing Up Bipolar

Monday, May 19, 2008 General News
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NEW YORK, May 18 As Newsweek General Editor MaryCarmichael reports in the May 26 cover, "Growing Up Bipolar" (on newsstandsMonday, May 19), childhood bipolar disorder is hard to pin down. At least800,000 children in the U.S. have been diagnosed as bipolar, no doubt some ofthem wrongly. There are many drugs, but it's unclear how they work. Often theydon't work at all, and they may interfere with normal brain growth. There areno studies on their long-term effects in children. Yet untreated bipolardisorder can be disastrous; 10 percent of sufferers commit suicide.

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Parents must choose between two wrenching options: treat their childrenand risk a bad outcome, or don't treat and risk a worse one. No matter whatthey do, they are in for uncertainty and pain. Carmichael reports on thedilemma by telling the wrenching story of one family, Amy and Richie Blake andtheir 10-year-old son Max, who was diagnosed with bipolar disorder when he wastwo years old.

She reports that Max was seven the first time he tried to kill himself. Hewrote a four-page will bequeathing his toys to his friends and jumped out hisground-floor bedroom window, falling six feet into his backyard, bruised butin one piece. Children don't really know what death is, as the last page ofMax's will made clear: "If I'm still alive when I have grandchildren," itbegan. But they know what unhappiness is and what it means to suffer.

On a recent Monday afternoon, Max, now 10, was supposed to come home onthe schoolbus, but a counselor summoned his mother at 2:15. When Amy Blakearrived at school, her son gave her the note that had prompted the call. "DearMommy & Daddy," it read, "I am really feeling sad and depressed and lousyabout myself. I love you but I still feel like I want to kill myself. I amreally sad but I just want help to feel happy again. The reason I feel so badis because I can't sleep at night.

And dad yells at me to just sleep at night. But, I can't control it. It isnot me that does control it. I don't know what controls it, but it is not me.I really really need some help, love Max!!!!! I Love you Mommy I Love youDaddy."

At 10, Max Blake has been on 38 different psychoactive drugs, Carmichaelreports. The meds have serious side effects. They have made Max gain weight,and because he's still growing, they frequently need to be changed. The Blakesare aware that many people think their child -- any child -- should not be onso many drugs. They aren't always happy about it either. But to some degree,they have made their peace with medication.

"He's oppositional-defiant, he's dyslexic, he's ADHD, he's OCD," says Amy."Give me an initial and he has it." Bipolar children, especially thosediagnosed early, often have such a litany of disorders. The bipolar braintries to compensate for its weak prefrontal cortex by roping in other areas tohelp; these areas may now become dysfunctional, too. Child psychiatrists thusface an enormous practical challenge: they often can't treat one disorderwithout affecting another one. "It's like a balloon where you push on one sideand the other side pops out," says Janet Wozniak, the Massachusetts GeneralHospital psychiatrist who helped define childhood bipolar disorder. With kidslike Max, she adds, parents often have to settle for "just having one part ofthe symptoms reduced."

Max's life has improved in some ways since his early childhood. TheManville School, part of the Judge Baker Children's Center in Boston, hasgiven him a social life. Last year he won a "Welcome Wagon" award afterteachers noticed he was always the first to show new students around. When hisclassmates have outbursts of their own, he talks them down. "He'll say thatmaybe they need to take some space, take a deep breath, leave the classroom,"says his teacher, Julie Higgins.

He has n

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