Early Onset Bipolar Disorder: A Case Study
Tara Skye Goldin, ND
Early onset bipolar disorder is being diagnosed at an alarming rate.
When I first started out in practice nearly 20 years ago, the thinking was that bipolar disorder was a disease that had its typical onset in late adolescence and early adulthood like many other mental illnesses, such as schizophrenia. Lately the frequency of seeing a diagnosed Bipolar 1 or Bipolar 2 school-aged or younger child seems to have increased exponentially. Whether this is due to changed diagnostic criteria, lifestyle, nutritional or environmental influences, or the consequences of our mobile anonymous society where we can mate without knowledge of psychological genetic background, or a combination of the above, has yet to be determined.
Is it the diagnosis du jour? What does it mean to us as NDs and homeopaths?
Throughout my career I have successfully treated many people who have had this diagnosis. Most often I have used a combination of classical homeopathy, nutrition, and supplementation with B vitamins and fish oils. I have in recent years educated myself more on allopathic treatments for this illness due to the high rate of morbidity (20% of untreated cases end in suicide) and the sheer volume I currently see in practice that may be taking their psychotropic medications concurrently with homeopathic or naturopathic protocols.
Symptoms of Early Onset Bipolar Disorder
- seeming lack of need for sleep. Infant always seems “wired” and alert.
- inconsolable tantrums.
Toddlers and preschool aged
- prolonged tantrums.
- verbally precocious, early speech, highly intelligent.
- highly energetic, never seem to get tired – 2 speeds, wired and asleep.
- Overly attached to mother. Extreme separation anxiety.
- Mood swings that may go along with the prolonged tantrums.
May be misdiagnosed as ADHD due to high energy and difficulty focusing. In these children none of the medications typically prescribed for ADHD are helpful in improving focus. The stimulants as well as many antidepressants may and often do exacerbate symptoms.
- preoccupation with gore, violent video games. More nightmares.
- severe mood swings may continue.
- violent rages.
- learning disorders.
- may have associated oppositional defiant behavior.
I chose this case from my files since it is a case that I have been following for over 5 years. This child has responded exceptionally well to homeopathy and diet changes alone and is not currently medicated with pharmaceuticals. I started seeing K. when she was 11 years old and she is now 16 and quite stable.
K. was diagnosed with bipolar disorder at age 5 after seeing numerous specialists. She had seen an audiologist, occupational therapist, nutritionist, psychologist, and finally a psychiatrist. Her evaluations began at age 3. She was born from a normal pregnancy but seemed inconsolable as a child. She began to get periodic UTIs (urinary tract infections) at the age of 6 weeks. She was diagnosed with kidney/bladder reflux and she underwent surgery at age 20 months. Prior to the surgery she had had 10 or 12 UTIs. There have been no problems with infections since the surgery. She has 3 fully formed kidneys that are completely functioning.
At age 34-35 months she was diagnosed with sensory integration disorder (another diagnosis du jour in my opinion) and received occupational therapy for about 1 year for that, tantrums, mood swings, and an apparent lack of need for sleep.
At age 5 she was seen by two separate pediatric psychiatrists. After some experimentation she was placed on divalproex, lithium and risperidone. Her mother gave her kava concurrently and she seemed to stabilize for a time.
At age 7 due to FDA warnings about kava her parents discontinued it. Without the kava she became unstable again. The psychiatrist wanted to add 2 more meds and that’s when the parents decided to try a more natural approach. She saw an ND in the Denver area and was fairly stable on Crocus sativa. The family moved out of state for a few years and the ND they were seeing in Denver stopped practicing. While they were out of state their new homeopath was unable to find the simillimum and she was unstable during that period. Upon their return to Denver, they were referred to me for my homeopathy expertise.
The mother writes “K. without remedies is overly sensitive to life. She cries too easily, she laughs too quickly and too loud, she doesn’t have regard for personal space, is narcissistic, and quick to mouth off to people. She doesn’t keep her hands to herself. She won’t accept blame or responsibility and she generally struggles to get through her day. She rubs people the wrong way. She is also very hyper and high strung– she moves constantly. She has a hard time falling asleep. She has many nightmares.
“She teases and aggressively jokes with her younger sister. She has trouble making friends with other girls. We homeschool her now. Other girls find her needy and annoying. She would like nothing more than to have a best friend but the other girls withdraw from her and she gets bullied and picked on.”
The incident that caused her mother to call me was a raging incident in which she slammed the door to her room so hard that she broke her arm. It often takes her hurting herself to stop a raging episode. Her mother remembers:
”This was one of numerous, huge blows… throwing stuff at us, endless screaming, she would burst blood vessels near her eyes from the screaming, throwing her body around, and she was so violent with the door that she did break her arm… other tantrums when she was younger would usually end after she a) screamed and cried herself out, or b) hurt herself (I remember she was kicking a closet metal door (those bifold) with both feet and just freaking out – she ended up getting one foot in the door and kicked with the other foot and the metal door sliced her toe pretty good – that ended that tantrum. I think she did the closet door thing when she was about 7 or 8.”
After 2 other remedies that did not seem to affect the case (Lachesis and Veratrum album), I prescribed Hyoscyamus LM4 in a daily dose after the mother reported she had an increase in masturbation. I like to use LM dosing in these cases since I find there are less aggravations and less chance of antidoting. I slowly move up 2 levels in potency when the remedy appears to stop working or the case plateaus. The dosing I use (from Jeremy Sherr) is 1 drop in 4 oz purified water, succuss the glass 5-10 times and have the patient take 1 Tbs QD.
After she started taking Hyos. her mother reports that “K. is as good as K. gets.” She has more appropriate responses, no more fits or crying episodes, and the masturbation has diminished. She is starting to make friends. We continued the Hyos. Over a 2-year period we were up to Hyos. LM18.
At this point the remedy picture begins to change. K. is now 13 and while she is not raging as much, she is exhibiting hysterical sadness and fear. Her mother describes an “intense neediness.” She is seeing a counselor and she continues homeschooling. During that time the whole family also went gluten and dairy free due to other health problems in the family. (An aside: Her mother noticed that the potencies were lasting longer as a result and we did not need to move up as frequently.) She is also showing intense remorse and embarrassment for those times when she does act out.
At this time I changed the remedy to Hydrophobinum (Lyssin or Rabies nosode) LM4. The fears and the neediness diminished. She has been on Hydrophobinum for over 3 years now and is currently taking Hydrophobinum LM42 daily. While I have not seen K. in a long time, her mother reports that she is doing well. She now goes to a regular high school, has friends, has a steady boyfriend, gets good grades, is involved in theater and drama, and has a part-time job. Most poignantly, here are her mother’s own words to describe K. now:
“I actually have no doubt that she’d have been inpatient by now. Her behavior had gotten so bad by the age of 5 (tearing out her own hair, sleeping only 6 hours a night, scratching her arms till they bled, wild and massive mood swings, no natural fear of any kind) that we had no choice for our sanity and hers but to try meds. When the psychiatrist wanted to put her on 5 meds, we said ‘no’. I told him we were going to try homeopathy for 6 months to see if we could help her (we had nowhere to go but up). I asked him, “How many patients do you lose to natural medicine?” He said, “None. They all come back. You’ll be back.” Well, that was Jan of 2001 and it’s now March of 2010 so I’m pretty sure we won’t be back.
“Without homeopathy, I shudder to think of where she’d be. It’s still work to keep her balanced and it’s not always easy, but her life (and ours) is a dramatic departure from where we were heading.”
Tara Skye Goldin, ND is a naturopathic doctor practicing in Boulder, Colo. She is a 1990 graduate of Bastyr University, and has studied homeopathy in depth with Louis Klein, RsHom; Jeremy Scherr, RsHom; and Andrew Lange, ND, all to whom she is eternally grateful for their broad knowledge base and genius. Her practice focuses on homeopathy, botanical medicine, nutrition, women’s health and pediatrics, as well as mood disorders. When she is not working, she enjoys spending time with her family, hiking and nordic skiing in Colorado, practicing Ashtanga Yoga and choral singing.
Desktop Guide to Keynotes and Confirmatory Symptoms. Morrison R. Grass Valley, CA: Hahnemann Clinic Publishing; 1993.
The Bipolar Child: The Definitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder. 3rd Edition. Papolos D, Papolos J. New York, NY: Broadway Books; 2006.