Juvenile bipolar disorder: New study could be the key

Written by Jeannette Ross

The Wilton Bulletin

Saturday, 31 December 2011

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Juvenile bipolar disorder is not recognized in the Diagnostic and Statistical Manual of Mental Disorders, but parents of children who suffer from it know it is real.

Their children suffer from rapid and abrupt mood swings, extreme and protracted temper outbursts, and sometimes visual and auditory hallucinations. They are easily frustrated and, most tellingly, in the most severe cases, the children’s bodies cannot properly regulate their temperature. As Inger Sjogren said, “Any bipolar kid sleeps hot.”

Ms. Sjogren of Wilton is executive director of the Juvenile Bipolar Research Foundation (jbrf.org), which is based in Maplewood, N.J. The charitable organization supports research into this mental disorder.

Despite the often poor prognosis for these children — diagnosis is difficult, medications are expensive and often ineffective — she reports there may be some good news on the horizon in the form of a drug study and genetic research.

The Food and Drug Administration has given the foundation approval to undertake a study of the use of the drug ketamine in treating children with bipolar disorder who also have a biological marker associated with difficulty in regulating body temperature.

The double-blind study will involve 60 children between the ages of 6 and 12; 30 will get the drug and 30 will get a placebo over the course of 15 days. The drug will be given intranasally and the children will be monitored every day they receive the drug with physical and mental tests. Results should be apparent very quickly, Ms. Sjogren said.

It the results are as anticipated, the foundation would hope to have its study replicated by another scientific team, she said.

The study will be funded by supporters of the Juvenile Bipolar Research Foundation. It is the first placebo-controlled study to apply this novel treatment in this age group, Ms. Sjogren said. The children will be recruited primarily from the tri-state area. They must undergo certain tests by a pediatrician and must be free of certain pharmaceuticals, athough they may be on standard drugs for bipolar disorder such as lithium.

The study should get underway in a matter of months, she said. For information on participating, visit the foundation website.

This is an off-label use of ketamine, Ms. Sjogren said, which is more commonly prescribed as an anesthetic or as an analgesic for chronic pain syndromes. In the pilot study that has been conducted “it clearly works to relieve fear and aggression,” Ms. Sjogren said. (Ketamine may also produce hallucinations and a state of dissociation and thus has been used illicitly, sometimes referred to as Special K.)

Ketamine has been used in a few individual cases of juvenile bipolar disorder with encouraging results, Ms. Sjogren said. Its main effect is to lower body temperature.

The study is being spearheaded by Dr. Demitri Papolos, the foundation’s director of research, who has compiled profiles of 8,000 children suffering from juvenile bipolar disorder, which is also known as early-onset bipolar disorder. In his studies he has focused on the part of the brain that controls arousal, or the fight-or-flight instinct. Ketamine, Ms. Sjogren said, seems to have a calming effect.

Early onset bipolar disorder affects close to one million children in the U.S., according to the foundation. Bipolar disorder — also referred to as manic depression — was thought to be rare in children. It was often misdiagnosed as ADHD, oppositional defiant disorder, depression, as well as other disorders.

“In the past, this was viewed as a behavior issue,” Ms. Sjogren said. “But how many six-year-olds talk about killing themselves and how they are going to do it?” she said, referring to one child.

Genome study

The foundation also recently received funding to do a genome-sequencing study to look for a genetic mutation that would be involved with juvenile bipolar disorder. To do so, the foundation is searching for a family where the disorder has come down on only one side of the family.

“It is commonly accepted this is carried by at least several genes,” Ms. Sjogren said. “What’s not commonly accepted is when it is activated.”

“The sequencing study would be a huge breakthrough,” she said. “But we need to find the right family. We only have one shot at this.”

The study will be done at Albert Einstein Hospital under the direction of Dr. Herb Lachman, co-director of the Program in Behavioral Genetics.

“We need six affected individuals,” she said, “six people with bipolar disorder in the extended family, where the condition comes down only one side. This is turning out to be a tall order.”