Erin Jackson

Ms. Kucik
Independent Research GT
May 10, 2016

How to Improve a Childs Mood?

A ten-year-old boy wandered the street and his mother found him on the eight train in
New York twice in one year. Concerned, his mother took him to see a psychiatrist and he was
diagnosed with depression. The psychiatrist quickly chose to treat the boy with antidepressants,
but he did not get better. He kept going back and the psychiatrist eventually discovered the
young boy had bipolar disorder. After, he was given medicine an antipsychotic, but it took
multiple tries and a long time to find one that effectively treated his symptoms. Throughout this
time, his condition worsened and even with a diagnosis, he still had to cope with this difficult
illness without an adequate prescription. Luckily, the right medication was eventually found.
(Carey, 1) There are so many other stories like this boy and more work needs to be done to
improve medicine to help treat bipolar disorder. People who have this illness need to find the
right medicine to quickly treat their symptoms. Although bipolar disorder in children and
adolescents can be treated in a variety of ways, mood stabilizers seem to be most effective long
term treatment option. Psychiatrists should try to use mood stabilizers over antipsychotics and
antidepressants for the long term treatment of children adolescents with bipolar disorder.
Bipolar disorder is a mood disorder where people experience the extremes of mania and
depression. However, some children display symptoms as character traits rather than classic
episodes (Aryal et. al ). Bipolar disorder I is when people experience mania and depression.

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Bipolar II is when people have hypomanic and depressive episodes. Mania is when people feel
very high. They may go on shopping sprees with money they do not have and have racing
thoughts. They might do things that are out of character, like becoming promiscuous (Schwartz).
In extreme cases, people might experience psychosis meaning they lose touch with reality. Some
people experience hypomania, a less severe version of mania. It does not interfere with a
patients daily life. In fact, people may be more productive and friends find them fun to be
around.
On the other hand, people experience depression which is feeling very low. Symptoms
include a change in eating and sleeping habits, losing interest in activities they used to like,
feeling very sad and feeling hopeless. Patients may have suicidal thoughts. Some people may
have mixed episodes which means they have symptoms of both mania and depression at the
same time. These can be especially frustrating because people may have racing thoughts but they
are all negative. This can lead to patients feeling especially suicidal.
People with bipolar disorder need to be treated to live a healthy, happy life. However, this
can be more difficult when treating children and adolescents. Firstly, most of the information
psychiatrists use to treat their patients is from studies based on adults. Secondly, children handle
medications differently than adults and they may metabolize their medicines faster than adults
which changes the dosage (Schwartz). Children may also have different, more severe side
effects, meaning the negatives could be greater than the benefits. Additionally, ethics can change
and become more complicated when treating children because of the side effects associated with
children. Ethics is the moral responsibility to treat patients with medication that improve their
quality of life with the least severe side effects possible. When treating children, the different
nature of their bodies makes their cases more complicated.

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Knowing neurotransmitters and how they work is essential when treating bipolar
disorder. There are three main types that affect bipolar disorder, norepinephrine, serotonin and
dopamine. The excess of them leads to mania and the lack leads to depression (NIMH).
Norepinephrine, also called noradrenaline or simply adrenaline is a chemical associated with the
fight or flight response that is associated with the flight or fight response. (Rogers). People feel
adrenaline rushes when doing things, they seem a little dangerous for example like riding a roller
coaster. It makes people feel good. Having too little can lead to a depressed mood, but having too
much can lead to anxiety (Source). Serotonin is an essential hormone and is involved in many
different types of behaviors, such as emotional and motor (Frazer, Hensler, 1). The lack of it is
heavily associated with depression. It is essential for maintaining stable moods and energy. When
serotonin levels drop, some people become sleepy. (Frazer, Hensler, 1). This may be why some
people experience fatigue as a symptom of depression (source). Dopamine is known as the
reward chemical. It increases when the brain predicts a reward meaning it produces a good
feeling. For example when a basketball player scores a three pointer, their dopamine levels
increase and when they miss, then decrease. When a person constantly has low dopamine levels,
they do not feel as much pleasure. Increasing it to an efficient level can help a depressed person
feel happier. Finding the right balance of these hormones is essential to a persons emotional
wellbeing.
Bipolar disorder is treated through three main types of medications, the least effective
being antidepressants. Antidepressants are used to treat the depressive phase of bipolar disorder.
They work by increasing levels of certain neurotransmitters depending on the type of medication
used. There are three main categories of antidepressants, selective serotonin reuptake inhibitors
(SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs) and bupropion. SSRIs work by

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increasing serotonin levels and SNRIs increase both serotonin and norepinephrine levels
(NIMH). Bupropion is newer class of antidepressants and it works by increasing the amount of
norepinephrine and dopamine. (Stahl et. al., 159-162). All of these medications work by
inhibiting certain structures that contribute to regulating the transport of these hormones. These
all work by attaching or binding to cell membranes of the neurotransmitter. These transmitters
are responsible for removing the extra hormones from the synapses. When the medicine binds to
the cell membranes of the structures, they cannot remove the excess hormone, leading to the
increase of these hormones (Iversen).
Antidepressants do have some benefits as they can successfully treat the depressive
episode of bipolar disorder in some bipolar patients. They treat unipolar depression effectively
(NIMH). In three studies a fifty percent positive response rate was found in patients (Zhang et.
al., 1). Although it is not a popular treatment option in treating bipolar disorder, some patients do
find them effective. These drugs can increase serotonin, norepinephrine or dopamine levels when
they are low, making patients feel less hopeless and depressed.
However, antidepressants have far more drawbacks than benefits when it comes to
treating bipolar disorder. First they are not effective when used to treat bipolar depression. The
New England Journal of a medicine published a study which was part of the Systematic
Treatment Enhancement Program for Bipolar Disorder (STEP-BD). NIMH funded this clinical
trial to find ways to improve the treatment of bipolar disorder. In one part of their study, they
found a 24% effectiveness rate when used with mood stabilizers. The placebo had an
effectiveness rate of 27% (Labbe). This means that antidepressants do not work well. A medicine
is considered to work well when it is significantly more effective the placebo. Since the medicine

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was less effective than the placebo, it probably will not work in most patients. This means
patients will most likely have to take another medicine treat their symptoms.

Antidepressants have to be used in combination with other medications as they only treat
one extreme. They increase levels of dopamine, serotonin and norepinephrine. When treating
patients, the ideal option is to take as few medications as possible in combination with more
therapy (Wynn). It does not make sense to add a medication that is not likely to work.
Antidepressants can also induce mania in bipolar patients (Schwartz). Many people with
bipolar disorder were originally diagnosed with unipolar depression. Antidepressants were
associated with rapid cycling in these patients (Ghaemi et. al.) Antidepressants could cause an
excess of dopamine, norepinephrine or serotonin in the bodies of people who suffer from bipolar
disorder. leading to mania. The goal of treating patients is to cause a remission of symptoms as
soon as possible (Wynn) and the induction a mania prevents this.
Antidepressants have side effects like all other medications. They can cause an increase
in suicidal thoughts (Antidepressants NHS). Antidepressants have been found to make patients
have a harder time sleeping, and feeling more anxious than usual. Some patients may feel
nauseous, gain weight or have bowel issues (Source). Some patients have also reported having
headaches and becoming dizzy (Grohol). Side effects are generally fine if the benefits outweigh
them. However, antidepressants benefits do not outweigh the side effects as they do not have a
great effectiveness rate and can induce mania.
A more effective alternative to antidepressants is antipsychotics. They are used to treat
psychosis in people with bipolar disorder or schizophrenia. Psychiatrists have recently started to
use antipsychotics to treat acute mania in patients with bipolar I disorder. There are two main

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classes of antipsychotics, typical and atypical, the former meaning older and the latter being
newer (NIMH). These types of medicine work by promoting normal brain activity in people with
mental illnesses by decreasing certain hormones and increasing others, such as targeting
serotonin and dopamine receptors (Guzman). These are new medicines which can treat psychosis
and mania.
Antipsychotics are fast acting, quickly causing a remission of symptoms. Some
psychiatrists use antipsychotics when they need something to work quickly in young patients
(Schwartz). In many short term studies, they seem to be more effective than the mood stabilizers.
In a two-month study conducted by the U.S. National Institute of Mental Health, antipsychotics
had a significantly higher success rate. Risperidone, an atypical or a newer antipsychotic, had a
success rate of 68.5% in improving manic symptoms as compared to lithium, a mood stabilizer,
scoring 36.5% and divalproex sodium, an anticonvulsant mood stabilizer, only having a 24.7%
success rate (Labbe). They also had a lower discontinuation rate meaning more patients were
able to stay on the medicine because it effectively treated the patients symptoms (Labbe). They
can also help mood swings become less frequent and help episodes become less severe (Grohol).
The benefits of antipsychotics are far greater than those of antidepressants.
While the benefits of the antipsychotics may outweigh antidepressants, they also have
side effects and drawbacks to them. They may cause severe metabolic side effects in children and
adolescents. In the previously mentioned study, conducted by the U.S. National Institute of
Mental Health, they found a weight gain of up to eight pounds as compared to close to three with
mood stabilizers. Another severe side effect was diabetes (Labbe). Other less serious metabolic
side effects are constipation, nausea and vomiting (NIMH). Some patients have to deal with
the severe side effects of atypical antipsychotics, the newer forms of antipsychotics.

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Atypical antipsychotics were effective in treating mania but not depression (Samalin et.
al.). A group of psychiatrists who published their article in the Dove Press Patient Preference and
Adherence section and it was published on the U.S. National Center for Biotechnology
Information website. They conducted a study where they analyzed patients with bipolar disorder
who were prescribed risperidone. It was conducted to analyze both the effectiveness and efficacy
of treating patients with risperidone. It also analyzed the patients opinion of the medication and
how they continued their medications. This means it would be more likely to work in patients
who have bipolar I disorder. Patients would also have to take another medicine to manage their
depressive episodes. The study also found that antipsychotics did not induce depressive
symptoms unlike antidepressants.
Long term use of antipsychotics may cause the very rare but extremely serious, tardive
dyskinesia meaning that patients may lose control of their mouth, tongue, facial and upper limbs
movement (Collingwood). Antipsychotics may also cause seizures (Source). The less serious and
more common side effects include fatigue or feeling drowsy, feeling dizzy, dry mouth, low
number of white blood cells and low blood pressure and blurred vision (NIMH). When
symptoms are so severe that patients need something that works quickly, the benefits may
outweigh the side effects.
Mood stabilizers are a third treatment alternative and the most effective medication
option relative to side effects when treating bipolar disorder in children and adolescents. These
are the most common type of medication used in treating bipolar disorder as some, such as
lithium, lamotrigine and quetiapine treat both mania and depression (Labbe). They work by
regulating hormone levels, neurotransmitters and promoting normal moods. They increase and
decrease dopamine, norepinephrine or serotonin depending on the particular medication in a

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similar way to antidepressants. They work to balance neurotransmitters and get them to a normal
level. Lithium is the oldest medicine used that is still used to today to treat bipolar disorder.
There are also anticonvulsant mood stabilizers. These medications were originally used to treat
seizures but were found to be effective in stabilizing moods (NIMH). Mood stabilizers are very
commonly used when treating bipolar disorder because they normalize moods long term.
Mood stabilizers have many benefits. First, they do not have some of the severe side
effects associated with antipsychotics. The latter work very quickly so some doctors will treat
their patients with both antipsychotics and mood stabilizers at first, if their symptoms are very
severe (Schwartz). Once their symptoms start to improve, doctors will try to wean their patients
off of antipsychotics and treat them with mood stabilizers (Wynn). If they do use antipsychotics,
they use low doses of them when treating young patients (Schwartz). Mood stabilizers do not
cause the severe metabolic side effects that antipsychotics are known to cause. In one previously
mentioned study, lithium and divalproex sodium only caused the patients to gain an average
weight of three pounds and risperidone caused a weight gain of seven pounds (Labbe). STEP-BD
discovered that after a longer period of time, mood stabilizers became just as effective the
antipsychotics (Labbe). Mood stabilizers are a safer long term alternative for treating bipolar
disorder in children and adolescents. This makes it the ideal option out of the types of medicines
previously mentioned to treat bipolar disorder in children and adolescents.
Mood stabilizers treat both mania and depression unlike antidepressants (Collingwood).
This could lead to a patient taking fewer medications which is a more viable option. The less
medication means the fewer side effects a patient has to face. Mood stabilizers work as long as a
patient consistently takes them.

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Another benefit is they can lessen the severity of the mood episodes (Arryal et. al.). One
ultimate goal of treatment is to lessen mood swings, mood episodes and making symptoms less
severe. When a medication effectively improves a patients symptoms, it makes it easier for him
or her to cope with the illness and improves his or her quality of life. Using mood stabilizers can
help the patients families because their mood is not as unpredictable and makes their social life
easier. Patients also will notice an improved mood over time which is a great benefit of taking
mood stabilizers.
Although, the benefits are fantastic, mood stabilizers have side effects like all other
medications. They can cause tiredness and small weight gain among others (source). However,
these side effects are not as severe as antipsychotics. Another drawback of mood stabilizers is
how many of them there are. Initially it would be harder to find the right one and take multiple
tries. It could be a negative at first because a patient has to wait longer to experience a remission
of symptoms. The diversity of mood stabilizers makes it easier to find a medicine that can meet
each patients individual needs, meaning it could correct a particular hormonal imbalance in a
patient.
Mood stabilizers are the best way to treat bipolar disorder in children and adolescents for
several reasons. They do not cause the severe side effects that are associated with antipsychotics,
which may cause diabetes and more weight gain. Antipsychotics may also cause the rare but
severe side effect of tardive dyskinesia. Antidepressants are not a good treatment option for
bipolar disorder as they can induce mania in bipolar patients. They also do not have a high
response rate in terms of causing a remission of depressive symptoms sometimes being less
effective than the placebo. Mood stabilizers should be the first thing used in children and
adolescents when they are diagnosed with bipolar disorder. Their side effects are not as severe

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which is important in a medication used to treat bipolar disorder. In the future, medicines with
less side effects should be developed. These medicines should also work faster, have higher
response rates and lower discontinuation rates. Though, they are many medications being used to
treat bipolar disorder, more effective ones with less side effects need to be developed.
Neuroscientists and psychiatrists should work to develop a medicine that can regulate all three
neurotransmitters. These medicines should also be able to encourage the reuptake of hormones or
inhibit the reuptake of these hormones as needed to limit the amount of a medicine needs to take.

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