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Dr. Eric Kodish, a bioethicist, said a team of experts, called an institutional review board, approved the operation.

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One challenge is the changing definition of bipolarity."What we have seen over the past few years is the expansion of the bipolar spectrum," said Dr. Sharma. It may be helpful to look at unipolar depression and bipolar disorder as opposite ends of a continuum, rather than distinct diseases, he added.

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"We don't know how many choices kids really make," Dr. Birch said.

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After adjusting for age, sex, disease duration, and other potential confounders, prior coffee intake was associated with a 56% to 63% reduced risk of blepharospasm, lead author Dr. Gioanni Defazio, from the Uniersity of Bari in Italy, and colleagues note.

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