Seeing bipolar children and adolescentrs over last 20 years(yes, we clinicians saw the number of patients with these condition and virtually always with family history).We had seen these conditions ,as usually years before academia noticed and profusely written about..Problem of treatment is serious issue.New antiepileptic drugs are use in adult dosages and my main task is,when I am replacing psychiatrist, to decrease the size of drug coctail and reduce the amount of drugs children are taking.I have suspicion samo of demands for a new antipsychotic drugs are for somebody else in family who does not have adequate insurance coverage and many children are not using it(montly cost could be over 500.$ for new antipsychotic drugs).What is compliance rate,50-70% or less.The parents have own ideas what they would give to child.At what age is appropriate to use such diagnosis?Are old antipsychotic drug useful in terms of effectivness,cost and safety profile?

It is hard to shake the religion of people who believe that mental illness is a brain chemical imbalance.

it is the result of overlapping interests of pharmaceutical companies who want to maximize profits, research psychiatrists hungry for the academic prestige of publication, advocacy groups convinced of their righteousness, an FDA that is asleep at the switch and parents who are, in my opinion, backing off their responsibilities as protectors of their children's physical and psychological liberties.

Philip--great reasoning . . . I don't see a bit of "faulty logic" here. But you didn't really include practicing medical professionals as part of the equation. Because of their "expert-ism" they HAVE the authority to question, to demand answers, and to withhold judgment until scientific evidence--not pseudoevidence--supports any emerging medication or treatment. They (M.D.'s) expect us, like lemmings to unhesitatingly defer to their authority; from a layperson's view, it appears to me that many of them (M.D.'s), are willing to cede their authority to pharmaceutical/educational scientists who oftentimes have a vested interest in presenting skewed "evidence."

Fantastic post and very timely for my purposes as well. I just posted on the same topic yesterday (not so beautifully articulated and executed as your post)and edited it today to include a link to this post. Thank you so much for your brilliant work on this so very important issue.

Here's an opinion from a rabid typer:

I don't care what McMan labels me as:

I'm not going to ever accept a misdiagnosis from age 11-17 of childhood bipolar in my daughter; see her suffer ill effects (as in permanent)from Depakote.Zyprexa,Ativan,Risperdal,Mellaril,BuSpar,Lithobid,Abilify,LiCarb,Klonopin,Trileptal,Prozac,Zoloft,Immipramine,and Clozaril. (and others!)

In the name of a childhood diagnosis of Childhood Bipolar Disorder. Ask her what she thinks of that diagnosis now. Call her rabid.

Call me rabid.

My daughter's new psychiatrist calls me "amazing"; and the chaplain at Children's hospital calls me "remarkable."

I just call myself a Mother.

Maybe I should call myself a self-absorbed and rabid mother. One others should listen before they get a complex diagnosis, use adult psych meds, and possibly find out after 8 years; the doc's changed their minds.

A person cannot get their life back once they are dead. They cannot get years back, especially pre-teen, and teen years! Does anyone wonder if my daughter was able to make friends? keep the few she had? hate being called "The Beast" in Junior High by boys when she gained 50 lbs. on Zyprexa?!

I appreciate Childhood Bipolar Supporters not wanting to be de-throned by a King of Self-Love.

Oh well. Too damn bad.

Sometimes the truth hurts. I imagine supporters of this theory will feel their toes have been stepped on, and become rabid in their self-defense.After all, if a person has research or a book to pimp, those people cannot bite the hand that feeds them.Instead they must protect their belief in the product; and lash out at others who are saying what they believe in could be questioned, and should be questioned. The deaths and dangers of these psych meds being recklessly over-prescribed is just too BIG to ignore.

.."I refer to the reach of the bipolar child paradigm, which is being pushed on children as young as two-years-old."

According to the February 2005 article, "Going to Extremes: Experts Question Rise in Pediatric Diagnosis of Bipolar Illness, a Serious Mood Disorder that ran in the Washington Post; Martha Hellander, co-founder of C.A.B.F. bpkids org says:

"Medications are a cornerstone of treatment, Hellander said, even for very young children. She said the youngest patient she's heard of is an 18-month-old girl who was diagnosed as bipolar largely because she screamed incessantly and had a bipolar mother. Hellander said the baby was medicated with lithium."

"Others are narcissistic bloggers who specialize in interviewing their own keyboards."



LOL. As soon as I read that I knew he was talking about you, Philip. Props, man.

.."Harvard bipolar child mafia and others have over-stepped the proper boundaries of their profession by pressing for the legitimacy of the bipolar child paradigm and its application to millions of children."-Dawdy

Here's another quote from the 2005 Washington Post article I refer to, and can't help myself for posting it here, because of how arrogant Biederman appears:( in my opinion,basically comparing himself to Galileo.)

.."Joseph Biederman, a professor of psychiatry at Harvard and one of the most forceful advocates of the aggressive treatment of preschoolers, thinks bipolar disorder has been "severely under-diagnosed" in children.

He likens the criticism he has encountered to the outrage that greeted Galileo's challenge to the notion that the Earth was flat."

Haven't you learned by now? If you dare question ANYTHING in psychiatry you are accused of having an antipsychiatry agenda. Just take your pills and be quiet.

ha yes. actually i have been pleased at the number of psych docs i've spoken with who've told me they think the bipolarizing of children has gotten out of hand.

Phil you are famous.

check out

http://psychcentral.com/blog/archives/2007/03/19/the-ongoing-child-bipolar-diagnosis-controversy/

Excellent post and what a cheap shot by McManamy whether he's talking about you or not! This is so typical. When shrinks (or their advocates) can't defend the way they make their diagnoses they start attacking people who question them with personal attacks rather than presenting substantive information about why they might be right. These guys are getting backed into a corner and they know it and they're coming out swinging, but it only makes them look more absurd.

BTW - NYTimes select is now free for those in the tower -

http://nytimes.com/gst/ts_university_email_verify.html

Could this be the forerunner of this prophecy?

http://www.wired.com/news/culture/0,1284,64110,00.html

Well, my keyboard thinks it's a crock... My keyboard also thinks that the spherical nature of the world was already well-established by Galileo's time. Perhaps "Professor" Biederman needs to stop looking in the mirror and get a keyboard that has heard of Ptolemy. Even Christopher Columbus would do for Christ's sake.

Maybe I am too much the social libertarian, but I think it is madness for our society to demand that anyone--child, teen or adult--be medicated unless they are a clear and present danger to the physical liberty and bodily integrity of other members of society.

So the social libertarian stance is to allow unmedicated bipolar adolescents (and perhaps some children) to commit suicide?

Of course it seems ridiculous to diagnose bipolar in a 3 year old. But what about a 17 year old? A 12 year old? Misdiagnoses abound at those ages, often major depression.

The Surgeon General's report, Depression and Suicide in Children and Adolescents, is informative:

"Bipolar disorder is a mood disorder in which episodes of mania alternate with episodes of depression. Frequently, the condition begins in adolescence. The first manifestation of bipolar illness is usually a depressive episode. The first manic features may not occur for months or even years thereafter, or may occur either during the first depressive illness or later, after a symptom-free period (Strober et al., 1995)."

And new research is suggesting a genetic basis for bipolar disorder, most recently a defect in the Clock gene that controls circadian rhythms.

The Surgeon General is not surgeon or a general...where did I read that?

Until psych medications are data-backed with long-term efficacy data; and labeled "safe" for children under age 18 to use: then prescribing any of these medications was/is off-label use; and in my opinion criminal actions.

"So the social libertarian stance is to allow unmedicated bipolar adolescents (and perhaps some children) to commit suicide?"

The ONLY time my daughter attempted suicide was when she was placed on antidepressants.

The threat to parents who challenge a diagnosis, as I did; was always this statement:

.."and perhaps some children) to commit suicide?"

This is about a round up of kids innocently being diagnosed bipolar and drugged up; for acting up.

Give me a break. I've got a kid who lost her entire life to that piece of bullshit advice to me "Don't take her off of meds or she will die."

Brainwashing parents is what that is all about; scare tactics.

Any teen who seeks treatment, should get CBT or DBT therapy first; and if necessary careful addition medications as a last resort.

I had one psychiatrist use this line on me when I questioned his reasoning for wanting to admit my 11 year old daughter into a psych ward:

"IF it was MY child, I would." That is a quote from a now fired psychiatrist. (fired by my daughter.)

All in the name of a diagnosis that has no diagnostic criteria for children; all diagnoses made is based on adult criteria; and treated with medications approved for adult-use.

interesting questions neurocritic. first, the sg's reports are little more than political statements posing as science. this is true of sg's reports on almost every front--booze, smoking, mental illness, etc. if the sg issued a report on sex...well, you get the picture there. my point here is that i am very skeptical of sg's reports.

as for suicide and children, kiddos have by far the lowest rates of suicide in america (ages 0-14). also, i am suspicious of the '15 to 20 percent of bipolars kill themselves' argument that's floated around often by pharma companies to tout their meds and by researchers on the pharma payroll. i haven't been able to examine the baseline data they are working from, but some of this just doesn't pencil out. if there are 10 million or so bpers in america--number only used for illustration--and the suicide claim is true, then 1.5 million to 2 million of them will kill themselves. with suicide at about 30k per year, it would take over 50 years for that to happen and that's assuming that all of the 30k suicides a year are committed by bpers. and no one makes the argument that all suicides are committed by bpers. so there's something up with those numbers that tells me they are overstated. as i suspect they are for depression and schizophrenia.

either way, if a kid is suicidal, feel free to medicate them. the situation demands it. but be damn careful what you medicate them with and for how long.

either way, there's no claim i've made that bp or any other mental illness doesn't have a genetic component of some kind. that research is hardly new. but that doesn't make genes the prime driver of the illness and behavior.

i worry greatly that the 'it's all genetic' argument will feed into the whole preventive psychiatry paradigm, ie medicate young folks (or adults) based on a claimed genetic predisposition to a mental illness. projects like the PRIME study have had very poor results.

anyhow, back to work i go. and thanks for your questions.

Thanks for your reply. OK, OK, I shouldn't have linked to the SG. You'd have to go way back to Clinton years to find a great one (who was fired, btw - Jocelyn Elders). Anyway, the quoted description was based on a study by Strober et al. 1995:

Strober M, Schmidt-Lackner S, Freeman R, Bower S, Lampert C, DeAntonio M. (1995). Recovery and relapse in adolescents with bipolar affective illness: a five-year naturalistic, prospective follow-up. J Am Acad Child Adolesc Psychiatry. 34(6):724-31.

How about NIMH, or is that also a questionable agency? It's a little out of date (2000), but here goes:

Child and Adolescent Bipolar Disorder: An Update from the National Institute of Mental Health

Anyway, I agree that genetic screening/preventive psychiatry raises many ethical dilemmas, besides being a too-simplistic approach.

Stephany - I'm very sorry your child has gone through hell, but that doesn't give you the right to dictate appropriate treatment for other parents' children.

I suppose you would also object to statistics cited by The American Foundation for Suicide Prevention, since they recommend both psychotherapy and medication as treatments.

Bipolar Disorder and Suicide Prevention

Almost 2 million Americans currently suffer from bipolar disorder. An estimated 3-20 percent of persons diagnosed with bipolar disorder die by suicide.

Approximately 20 percent of all patients with bipolar disorder have their first episode during adolescence but diagnosis is often delayed for years. Delayed recognition that low moods (depression) and highs (mania) are symptoms of a treatable mental disorder can foster related problems, such as substance abuse and suicidal behaviors.

Early recognition and treatment of bipolar disorder may prevent years of needless suffering and death by suicide. Eighty percent to 90 percent of people who have bipolar disorder can be treated effectively with medication and psychotherapy.

thanks. man that's a pretty wide range afsp is citing, but at least they are being honest about how wide the range is. a lot of groups aren't.

my major frustration with suicide stats when they are pinned to a particular disorder is that they get used by pharma companies, public health officials, the media, school officials and so on to scare the hell out of patients--such as myself--when it's pretty clear to me, in retrospect, that the stats are pretty up in the air. what they are precisely is an open question, but i just don't think a 20 percent suicide rate in bp is even supportable--here i am nitpicking pharm companies who often use that figure in press releases--and creates in patients a sense that they are doomed. hope is always explained in terms of meds, when sadly we are working with fairly weak technology.

the 80-90 percent effective treatment claim for bpers interests me since it depends on what one considers effective (no relapses, some relapses, 50 percent symptom reduction???? etc etc) and at what point in time one is measuring effectiveness (soon after first taking meds, 6-12 weeks later--that would be the standard in most clinical studies--or two years later or 18 years later???). i'm not trying to be a nitpicker or nay sayer here. but i am trying to point out that groups like nami, mha, afsp and so on--well intentioned folks all--take the most wildly optimistic scenarios and use them as they see fit. in some ways, i cannot object to that since we are after the same goals. but in some ways i can object because the sad sad sad fact is that the reality faced by patients--and i have interviewed and talked with hundreds and hundreds of them--is something like (and this is for patients who get dx'd properly, take meds regularly etc): 30 percent success for meds and depression (about another 20 percent of a half success rate); about a 25 percent success rate for bpers; and a very close to zero success rate for schizophrenics. by success i mean complete symptom elimination.

the reality is that for depression, bp and schizophrenia, the vast majority of all patients will continue to experience symptoms, regardless of what age they begin treatment and no matter how well they play by the rules. the claimed prophalactic effect of meds is largely fictional (in the short term you can prove some effect, but not in longer term and the long term is where most of us live), but i know my opinion is very much against the mainstream there. i also have become pretty skeptical of the kindling theory. but that's for another day.

the even sadder thing is that if a bper say presents to a doc with some level of symptom breakthroughs they are going to get slapped with even more meds and i am not convinced that the paradigm of polypharmacy we are following these days is delivering solid real world results. in fact i know it isn't.

since you probably don't know my own experience, here's a short version--dx'd bp in 1989, on meds ever since (17 of them) religiously (some worked ok for a time, others really messed me up), two masters degrees, constantly employed, no hospitalizations. and so on.

i can assure you that my perspective isn't uninformed. and btw i have never advocated that anyone dx'd with any mental illness not take meds. but that doesn't mean that we shouldn't be brutally honest about what patients can expect and how the powers that be in the mental health world frame the discussion.

anyway i am late for a social event.

and again thanks for your perspective.

I was eight when I started having symptoms. At eleven I was contemplating suicide. There are scars on my wrists and terrible memories that aren't visible on the skin. Childhood was hell.

I was not diagnosed, or medicated, or treated at all.

I suffered. My family suffered. My mother independently agreed that the onset was at eight, that there were no traumas or triggering events. I changed. Depression set in then returned again and again, along with over-energized episodes, getting worse until finally I was properly diagnosed as an adult. I'm now stabilized on Depakote. CBT helped immensely. Lifestyle changes helped even more. It's not all about the drugs.

I was born a bipolar child. Symptoms emerged later than two years old, but they didn't wait until I turned eighteen. Eight.

It's just as extremist to claim there are no bipolar children as it is to say that all the new cases of inappropriate medicating of children are justified.

I do not dictate or prescribe any "appropriate" treatment for any other parents children.

Thanks for the compliment. I must be stirring a pot that counts.

Posted by alice at March 20, 2007 11:10 PM

Alice, as someone who takes a dim view of psychiatric interventions where children are concerned AND whose childhood experiences overlap very significantly with yours, I'd be very interested to hear more of your story, if you are comfortable with that. My email address is ruth_offlabel@yahoo.com.au, and my blog can be accessed by clicking on my name below.

Phillip Dawdy wrote: "I have to question the social imperative behind all of this"

It's not based on a social imperative. It's based on scientific achievement and profit maximization.

To have it be based on a "social imperative" would be a complete overhaul of not only our medical system but our socio-economic system.

The lessons of PRIME (Eli Lilly/Yale/NIMH) underline and bold the moral ineptitude of the biopharma-scientific achivement model in place at present.

PRIME

A controversial experiment, Prevention through Risk Identification, Management, and Education (PRIME), was initiated by Dr. Thomas McGlashan of Yale University, and director of the National Institute for Mental Health (NIMH), with funding from Eli Lilly and the NIMH. PRIME investigators tested a speculative schizophrenia prevention theory by exposing healthy youngsters for one year to Lilly’s blockbuster drug, the neuroleptic, Zyprexa (olanzapine).

From 1997 to 2003, sixty previously healthy youngsters were enrolled in the experiment: of whom half were exposed to Zyprexa (olanzapine).

None of the youngsters in PRIME met the diagnostic criteria of either condition for which the drug was approved. Absent a diagnosable condition, and absent any evidence to support the assumption that a drug can prevent schizophrenia, these healthy youngsters were exposed to a toxic drug on the basis of speculations.

The authors now acknowledge in their published report that the experiment had failed and that Zyprexa did not prevent schizophrenia.

Alan Breier, Vice President and Medical and Chief Medical Officer for Eli Lilly was involved in the PRIME project and was one of the chief medical authors of the clinical trials.

Prior to joining Lilly, Breier completed a three-year research fellowship at NIMH.