Long Delays to First Treatment Are Crippling Many with Bipolar Disorder: What You Can Do

December 26, 2012 · Posted in Course of Illness, Risk Factors 

child with mental illness

An article published by N. Drancourt et al. in the journal Acta Psychiatra Scandinavica this year examined the duration of the period between a first mood episode and treatment with a mood stabilizer among 501 patients with bipolar disorder. The time between a first episode of depression, mania, or hypomania and first treatment averaged 9.7 years. The authors conclude that more screening, better recognition of the early stages of the illness, and greater awareness are needed to decrease this long delay.

Editor’s Note: The article by Dancourt et al. replicates earlier findings of an average treatment delay of 10 years among bipolar patients from the treatment network in which this editor (Robert Post) is an investigator (formerly the Stanley Foundation Bipolar Network, now called the Bipolar Collaborative Network). The duration of the untreated interval (DUP) for patients with bipolar disorder is unacceptably long and carries a heavy price.

Those with the earliest age of onset experience the longest delay to first treatment. Early onset is associated with poor outcome compared to adult onset bipolar disorder, and the duration of time untreated adds a separate, independent risk of a worse outcome in adulthood, especially more frequent and severe depression, more episodes, and less time well.

What patients and doctors can do to shorten this interval to first treatment: Know the risk factors for early onset bipolar disorder so you can seek evaluation and advise treatment as appropriate.

Bipolar illness often runs in families (although half the time it occurs in those without a positive family history of bipolar disorder).

Know your parental risk factors:

One or both parents with a bipolar disorder, especially if their illness is poorly controlled, they have made suicide attempts in the past, or they have substance abuse problems. These are risk factors that a child will develop early-onset bipolar disorder.

Risk factors in children include:

Stress or adversity at a young age; other child psychiatric diagnoses, such as an anxiety disorder, ADHD, oppositional defiant disorder, or depression; early symptoms short of a diagnosis of bipolar disorder, which might include periods of elation or euphoria out of context with events, sleep irregularities (especially short sleep time without apparent fatigue), and very rapid and distinct changes in mood.


A bipolar diagnosis is likely in a child with ADHD who is suicidal, homicidal, hallucinating, delusional, or overtly hypersexual.

If a child is symptomatic and one or more of the above factors are present, the family should obtain a consultation with a doctor who specializes in child psychiatry. If that physician is not helpful, seek another opinion.
If your child’s mood deteriorates, chart their mood on a daily basis and bring the mood chart to the child’s physician. (We offer various mood charting calendars on our website www.bipolarnews.org. The Monthly Mood Chart Personal Calendar is the most comprehensive.) Also chart progress in order to have detailed information about which treatments are successful and whether side effects occur.

In a child who has a parent with bipolar illness and is symptomatic, Family Focused Therapy (FFT) can help moderate or prevent early symptoms of bipolar disorder. FFT was pioneered by David Miklowitz and involves education about the illness and its treatment, symptom recognition, and enhancing family communication and support.

Know that stigma may be involved in the diagnostic process and be persistent. Most parents are scrupulous about applying sunscreen to their kids when the risks of skin cancer are low and occur decades in the future. Be equally scrupulous about childhood psychiatric problems, which can have dramatic and more immediate adverse effects.

In this editor’s 35 years at the National Institute of Mental Health, he saw patients with the most difficult to treat illnesses, many of whom might have had a much easier course if they had received earlier and more consistent treatment. His many years in the field of treatment and research in the mood disorders has taught him that changes in public health attitudes do not come easily, and thus he suggests that patients and their families become proactive in educating themselves about psychiatric illness and seeking timely and appropriate intervention for their children with mood and behavioral problems.


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