Chat With Joseph Biederman, M.D.
The Balanced Mind Foundation Live Event Transcript

Did you miss our chat with Joseph Biederman, M.D? Read the transcript of this exciting and informative chat. The Balanced Mind Foundation will be hosting several more expert chats this Spring. Watch your email for more details. 

                            Biography

Dr. Biederman is Chief of the Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD at the Massachusetts General Hospital, and professor of psychiatry at the Harvard Medical School. He is Board Certified in General and Child Psychiatry and is also a member of the The Balanced Mind Foundation Professional Advisory Council. In 2000, Dr. Biederman pioneered and established a Stanley Foundation Center at the Massachusetts General Hospital dedicated to the treatment of pediatric bipolar disorder.
                                    

Nanci - The Balanced Mind Foundation   
Welcome, Dr. Biederman. We’re glad to have you join us - we have a full house this afternoon!

Dr. Joseph Biederman   
Glad to hear it.

Nanci - The Balanced Mind Foundation   
Would you like to start with questions or do you have any opening remarks?

Dr. Joseph Biederman   
Let's start with the questions.

Nanci - The Balanced Mind Foundation   
Great, here's the first one

Janet   
Is there any data on adults who have been diagnosed with juvenile bipolar? Do they end up looking like people with adult onset?

Dr. Joseph Biederman   
It is estimated that at least 60% of adults start their illness as children and adolescents. Follow up studies will more accurately be able to answer your question

batgirl   
Dr. Biederman, if the mood is not yet stabilized, what can be done if a child has a huge lack of focus?

Dr. Joseph Biederman   
Very often children with bipolar disorder have comorbid ADHD. If the mood is stabilized and symptoms of ADHD persist, a cautious introduction of medicines for ADHD may be considered.

Megan   
Is bipolar being over diagnosed and over prescribed? How do we as parents know the right diagnosis?

Dr. Joseph Biederman   
You need to work with a clinician that you trust.  

batgirl   
Dr. Biederman, are there good results with biofeedback and bp kids.

Dr. Joseph Biederman   
No  

Megan   
Can you separate the hormone factor, which seems to send teenagers into a tail spin, from BP symptoms?

Dr. Joseph Biederman   
All teenagers have hormonal issues. BP symptoms are in a totally different league.  

Nanci - The Balanced Mind Foundation   
Can you expand on that a little, Dr. Biederman, as far as how we distinguish between 'normal' adolescent behavior - moodiness, irritability, etc. and bipolar symptoms?

Dr. Joseph Biederman   
By the magnitude, severity and persistence of the abnormal mood.  

micki   
What drug combinations have you had success with in stabilizing manic type irritability for early adolescents?

Dr. Joseph Biederman   
There is no one effective combination. Medicines are combined to address different clinical problems afflicting individual patients.  

Jackie ~ WI aka mom2one   
Dr. Biederman, under what circumstances would you suggest using a cognitive enhancer.

Dr. Joseph Biederman   
The use of cognitive enhancers at this time is experimental and is used to try to improve executive function deficits. Their efficacy and safety are unknown  

juliefarmer   
What non-drug therapies have you found to be effective?

Dr. Joseph Biederman   
The cognitive behavioral approaches.  

Nanci - The Balanced Mind Foundation   
What are your thoughts on other interventions such as Omega 3 fatty acids, light therapy or dietary changes?

Dr. Joseph Biederman   
In our study, Omega 3 fatty acids were half as effective as Risperdal.  

Nanci - The Balanced Mind Foundation   
Have you had any experience with light therapy?

Dr. Joseph Biederman   
No.  

kathy   
How young is it realistic to be able to diagnose a child with bipolar disorder?

Dr. Joseph Biederman   
It depends on the expertise of the diagnostician. Although preschoolers represent a minority of our referrals, we diagnose BP disorder in preschoolers.  

ciao_bella   
What is your opinion of bipolar being viewed as a spectrum disorder? Would you agree or disagree with this perspective and why?

Dr. Joseph Biederman   
Although we reserve the diagnosis of bipolar disorder to the most severe cases, bipolar disorder like all psychiatric disorders occurs within a spectrum.  

Jodi

How effective is Clozaril in treating an adolescent with refractory mania?

Dr. Joseph Biederman   
Clozaril belongs to the class of atypical neuroleptics and atypical neuroleptics have been shown to be effective in treating mania.  

micki   
What do you recommend to deal with the horrific weight gain and cravings associated with many of the medications---which we have no alternatives but to use to try to stabilize our kids?

Dr. Joseph Biederman   
Unfortunately weight gain continues to be a serious problem without easy solutions. Since not all medicines have the same weight gain liability, one approach is to examine alternative treatments with less weight gain liability.

micki   
In your experience, does cognitive functioning in kids return to their premorbid states--once they are stabilized sufficiently?

Dr. Joseph Biederman   
For the most part, it should.  

Petra

My son has been stable for quite a while but is still aggressive and oppositional even on good days.  Is this normal or do we need to adjust his meds?

Dr. Joseph Biederman   
The medication may not be dosed adequately.  

Cheri   
How often is BP misdiagnosed as ADHD? Can ADHD have the sexual symptoms as BP?

Dr. Joseph Biederman   
There are no mood or sexual symptoms in the defining features of ADHD.  

Omom   
I've read a lot about gluten free diets, wheat free diets and dairy free diets and their impact on bp. Can you comment on their effectiveness or role in treatment?

Dr. Joseph Biederman   
There is no relationship documented with BP disorder.  

ciao_bella   
I am interested in what you know about sleep issues, especially when it's regarding a teen. Teens like to stay up ‘til all hours. How can this be distinguished from the sleep issues of those that have bp?

Dr. Joseph Biederman   
Mania associated insomnia is a very different problem than the tendency to stay late in normal adolescents.

momx3

Dr. Biederman, do you think it is possible for a child or adult with bipolar to be able to successfully be medication free for extended periods of time?

Dr. Joseph Biederman   
Not commonly. It all depends on the patient and the type of problems that afflict him or her.  

bmeyers   
Recently our daughter has had an increase in obsessive thoughts and repetitive speech. She has become fixated on pretty graphic violence to driving her teacher nuts at school, repeating the same off-topic thought. Is this common with BP symptoms or is this more OCD characteristics?

Dr. Joseph Biederman   
BP disorder and OCD can co-occur. I do not know what exactly is afflicting your child.  

joan   
I'm a volunteer on the The Balanced Mind Foundation education message board. A question I get a lot is "why should special accommodations be made at school for things like absences and missing homework"? The answer I give is that stress causes our kids to shut down. Do you have a better answer I can give?

Dr. Joseph Biederman   
There is no simple answer to your question. A child that is psychiatrically ill and unable to attend school may need a note from the treating clinician documenting the situation. Some school systems are willing to decrease the academic load of unstable children to facilitate their re entry into the school setting  

mom   
Have you ever diagnosed a child with bp disorder, when there was no one else in the family with the illness?

Dr. Joseph Biederman  
Absolutely. Family history is not required for diagnosis  

simplysan67

What type of therapy/interventions would you recommend for promiscuous teens with bipolar? It has been an active concern on the The Balanced Mind Foundation support groups for parents of teens.

Dr. Joseph Biederman   
Hyper sexuality is commonly part of the clinical picture. There is no unique treatment for this problem. It is hoped that with clinical stabilization, this problem should improve as well. Residential programs could offer containment in some cases.  

teddyone   
If hypothyroidism is caused by lithium usage and then the lithium is discontinued and the thyroid still shows being under active, could the thyroid be a cause of the mood disorder instead of it being BP?

Dr. Joseph Biederman   
Lithium associated thyroid problems are common and treatable; they should disappear with lithium discontinuation.  

sue01   
Is there a relationship between pediatric epilepsy and pediatric bipolar?

Dr. Joseph Biederman   
No  

Pam   
I know that the executive functioning of the brain does not totally mature until early adulthood, but when children with bipolar disorder have deficits does this mean they won't mature as others do or does it depend on the severity of the deficit?

Dr. Joseph Biederman   
Executive function deficits are deficits and not aspects of brain maturation.  

kathy   
My 3 year old son is a threat to others and himself. How do I, as a parent, know when hospitalization is necessary?

Dr. Joseph Biederman   
Dangerousness is a good criterion.  

Omom   
Lithium and Depakote -- why would one be prescribed over another? Are they very similar or quite different in what they treat?

Dr. Joseph Biederman   
Both are mood stabilizers.   

tulip   
Do all children with BP have periods of intense anger?

Dr. Joseph Biederman   
No  

batgirl   
Is there a specific ADHD medication that seems to cause the least amount of difficulty for kids whose moods have not yet been stabilized?

Dr. Joseph Biederman   
No; all are potentially destabilizing.  

Jay   
Is a significant cognitive decline typically associated with BP disorder, e.g., 5 grade levels? What about regression in maturity?

Dr. Joseph Biederman   
Not really  

tulip   
Can you discuss the latest research findings using neuroimaging with bipolar disorder?

Dr. Joseph Biederman   
Not in a chat room  

Nanci - The Balanced Mind Foundation   
Would you be able to talk about the role of neuroimaging as a diagnostic tool? This question frequently comes up with our members regarding the merits or limitations of CAT scans, MRIs and SPECT scans.

Dr. Joseph Biederman   
Neuroimaging technology is a research and NOT A DIAGNOSTIC TOOL!!!

Nanci - The Balanced Mind Foundation   
Can you expand on what role this technology plays in the research world?

Dr. Joseph Biederman   
In research studies we analyze group data and not individual findings; it does not work like a chest x-ray that can help with clinical diagnosis at the individual level.  

simplysan67   
What type of research regarding bipolar would you like to see happen next, or what needs further research? Are any focused primarily on therapy or alternative treatments?

Dr. Joseph Biederman   
Genetic and neuroimaging; longitudinal follow up and treatment studies.  

Megan   
How do you attribute the "popularity" of the BP diagnosis? Is it that education has caught up with the population? Where were BP kids before?

Dr. Joseph Biederman   
In my opinion it is largely due to the increasing number of scientific papers on the subject.  

Mitzi   
What do you recommend for treating bipolar depression? SSRI's run the risk of aggravating the BP and triggering mania. Is low dose Lithium an option? Or, what do you recommend?

Dr. Joseph Biederman   
Antidepressants are potentially destabilizing and should be used with great caution.  

Nanci - The Balanced Mind Foundation   
Do you have time for one more question?

Dr. Joseph Biederman   
Ok.

Omom   
For parents who have a child recently diagnosed with BP, could you recommend any books to help us get our arms around this, especially tips on behavior management instead of just medication.

Dr. Joseph Biederman   
Dr Wozniak just published a book for parents; there are several others as well. (Editors note:  Dr. Biederman is referring to “Is Your Child Bipolar? The Definitive Resource on How to Identify, Treat, and Thrive with a Bipolar Child” by Mary Ann McDonnell and Janet Wozniak, MD).

Nanci - The Balanced Mind Foundation  
I would like to thank Dr. Biederman for sharing his time and expertise. We covered a wide range of topics. We were delighted that you could join us this afternoon and thank you for all of your work to support pediatric bipolar disorder and our families

Dr. Joseph Biederman  
My pleasure.