Nassir Ghaemi M.D., M.P.H.

Mood Swings

Depression in Children: Proof of Bipolar Disorder

God and Nature follow the Constitution when deciding when illnesses can begin

Posted Nov 17, 2012

Apparently, many clinicians and professors of psychology and English and such have formed a large community of bipolar skeptics.  

Some of them even claim that bipolar disorder does NOT exist, EVER, in childhood.

It must be, therefore, that God, or Nature, decided to begin this illness only at the age that the US constitution decides is the right age at which we can allow a person to vote, or to kill another person in a war.

I didn’t know God and Nature decided to follow our voting and killing patterns.

But now that we have learned this important metaphysical fact, I still am bothered by some apparent scientific disproofs of the newly discovered Constitutional wisdom of the bipolar skeptics. I’ll mention the most important, in my view, and I will ask those who make this claim, such as my colleague on this Psychology Today website, to respond directly to it: 

Do the bipolar skeptics believe that depression happens in children?  Clinical depression, meeting standard adult definitions for depression: does that happen in children? Skeptics obviously don’t  think that mania happens in children. But my question is about depression: Does it happen?  I will be surprised if the bipolar skeptic will state that depression NEVER happens in kids either.  (In that case, childhood would be truly idyllic.) 

If we accept that depression happens in kids, here is my question: How do the bipolar skeptics respond to the proven research fact that somewhere between 25-50% of children with depression (preadolescent children included), when followed into young adulthood (about age 20), develop full-blown, clearly diagnosable adult episodes of mania or hypomania? (Sources here). The skeptics dont deny that mania or hypomania happen in adulthood, I presume. 

Well then, these depressed children later develop adult mania. What does this mean? Does it mean that they have “major depressive disorder” until age 20, at which point their disease magically changes to something completely different: bipolar disorder? Or is it rather the case that they have bipolar disorder from the very start, with the first episodes of their mood illness being depressive episodes,  and manic episodes beginning later?  This is a course of bipolar illness, depression preceding mania, that has been described for over a century.

It seems clear that bipolar disorder happens in children, because some (in fact many) depressed children have bipolar disorder, which declares itself clearly with mania as they get older into adolescence and young adulthood.  How is this explained away?

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About the Author

Nassir Ghaemi, M.D., M.P.H.,

is Professor of Psychiatry at Tufts University School of Medicine, and Director of the Mood Disorders Program at Tufts Medical Center in Boston.

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