bipolar disorder, Dr. Paul Markovitz  Q. I have a beautiful little girl who is suffering terribly. We are trying to get her diagnosed properly for early on set child bipolar disorder. One Doctor put her on 1.25mg of Zyprexa and 5mg of Paxil. At first the med's seemed to work but now she is out of control with energy and has become more aggressive. Is this a sign she is bipolar but just on the wrong med's? Can a five year old be bipolar? and if she cycles very frequently will we ever be able to stabilize her? She comes from a very stable, loving environment with two parents and two siblings that do not have the illness. We need help and feel like we are crying out and no one seems to know what is wrong with her. Is it common to go through many medications before the right one is found? How can you experiment with so many drugs in such a little body?

  A. . As a parent, I know how terribly you must feel to have an ill child. This particular illness is very difficult to treat, and that really is the crux of your query. Your daughter has mood swings, that is clear. Most psychiatrists would call this bipolar, and they would be correct. Treatment, however, is another matter.

It is tough enough to treat an adult that can explain exactly how they feel, let alone a child of five. The behaviors are not usually diagnostic for which medication to use. I tell most of my folks that behavioral symptoms are a lot like a telephone. If you pick up the phone and there is no dial tone (dial tone is a behavior in our analogy), it is impossible to say what exactly is causing the problem. Could be dead batteries, could be phone is not plugged into the wall, could be the lines to the building have fallen, or it could even be that the central switching office has blown up. All we have is a behavior--no dial tone--and a number of possible causes.

Your doctor is likely trying to go after what he or she thinks will fix the behavioral problem. If you have concerns, I would urge you to discuss them with your daughter's doctor and/or get a second opinion. Once the right medications are found, things should go better. In a way, it is almost better having the illness when you are younger since taking medications becomes a way of life, and compliance is better.