GREGORY HEISLER FOR TIME Ian Palmer, age 9

Young and Bipolar
	Once called manic depression, the disorder afflicted adults. Now it's striking kids. Why?
	By JEFF KLUGER AND SORA SONG

Posted Sunday, Aug. 11, 2002; 3:31 p.m. EST
It wasn't every day that Patricia Torres raced down the streets of Miami at 70 m.p.h. But then it wasn't every day that her daughter Nicole Cabezas hallucinated wildly, trying to jump out of the car, pulling off her clothes and ranting that people were following her, so this seemed like a pretty good time to hurry. Nicole, 16, had been having problems for a while now—ever since she was 14 and began closeting herself in her bedroom, incapable of socializing or doing her schoolwork, and contemplating suicide.

The past few months had been different, though, with the depression lifting and an odd state of high energy taking its place. Nicole's thoughts raced; her speech was fragmented. She went without sleep for days at a time and felt none the worse for it. She began to suspect that her friends were using her, but that was understandable, she guessed, since they no doubt envied her profound gifts. "I was the center of the universe," she says quietly today. "I was the chosen one."

Finally, when the chosen one was struck by violent delusions—the belief that she had telekinetic powers, that she could change the colors of objects at will—Torres decided it was time to take Nicole to the hospital. Emergency-room doctors took one look at the thrashing teenager, strapped her to a gurney and began administering sedatives. She spent two weeks in the hospital as the doctors monitored her shifting moods, adjusted her meds and talked to her and her parents about her descent into madness. Finally, she was released with a therapy plan and a cocktail of drugs. Six months later, doctors at last reached a diagnosis: she was suffering from bipolar disorder.

	Some 2.3 million adult Americans suffer from bipolar disorder—not including perhaps a million uncounted kids.

While emotional turmoil is part of being a teenager, Nicole Cabezas is among a growing cohort of kids whose unsteady psyches do not simply rise and fall now and then but whipsaw violently from one extreme to another. Bipolar disorder—once known as manic depression, always known as a ferocious mental illness—seems to be showing up in children at an increasing rate, and that has taken a lot of mental-health professionals by surprise. The illness until recently was thought of as the rare province of luckless adults—the overachieving businessman given to sullen lows and impulsive highs; the underachieving uncle with the mysterious moods and the drinking problem; the tireless supermom who suddenly takes to her room, pulls the shades and weeps in shadows for months at a time.

But bipolar disorder isn't nearly so selective. As doctors look deeper into the condition and begin to understand its underlying causes, they are coming to the unsettling conclusion that large numbers of teens and children are suffering from it as well. The National Depressive and Manic-Depressive Association gathered in Orlando, Fla., last week for its annual meeting, as doctors and therapists face a daunting task. Although the official tally of Americans suffering from bipolar disorder seems to be holding steady—at about 2.3 million, striking men and women equally—the average age of onset has fallen in a single generation from the early 30s to the late teens.

And that number doesn't include kids under 18. Diagnosing the condition at very young ages is new and controversial, but experts estimate that an additional 1 million preteens and children in the U.S. may suffer from the early stages of bipolar disorder. Moreover, when adult bipolars are interviewed, nearly half report that their first manic episode occurred before age 21; 1 in 5 says it occurred in childhood. "We don't have the exact numbers yet," says Dr. Robert Hirschfeld, head of the psychiatry department at the University of Texas in Galveston, "except we know it's there, and it's underdiagnosed."

If he's right, it's an important warning sign for parents and doctors, since bipolar disorder is not an illness that can be allowed to go untreated. Victims have an alcoholism and drug-abuse rate triple that of the rest of the population and a suicide rate that may approach 20%. They often suffer for a decade before their condition is diagnosed, and for years more before it is properly treated. "If you don't catch it early on," says Dr. Demitri Papolos, research director of the Juvenile Bipolar Research Foundation and co-author of The Bipolar Child (Broadway Books, 1999), "it gets worse, like a tumor." Heaping this torment on an adult is bad enough; loading it on a child is tragic.

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