May 17, 2007

Doubling Up On Antipsychotics

Yesterday, a medical tracking firm reported that the use of anti-depressants and ADHD drugs by teens is down, but that the use of antipsychotics is way up. Antipsych use has doubled since 2001 to the point where 1.2 percent of boys and .75 percent of girls are popping Seroquel and Zyprexa. That works out to about 1.5 million Americans under 20 years old dosing on these drugs. And it ain't over a doubling of schizophrenia.

These meds are being prescribed for bipolar disorder, depression and ADHD. And people thought I was being a bit excessive when I started banging the drum on this a couple of years ago. Although I am sure plenty of apologists will offer various bromides that what a wonderful thing it is that all these troubled youngsters are being diagnosed and treated, I just don't see an advantage to the way we are doing things. Antipsychs don't work so swell in adults, they are barely researched in youngins, so what are we doing here exactly? You'd have a hard time convincing me that America's teens are twice as screwed up as they were in 2001.

I'm not the only one troubled by this trend. The New Scientist reports a fivefold increase in diagnoses of bipolar disorder in kids between 1996 and 2004. The mag links it the expanded definition of bipolar disorder that entered the DSM in 1994 (BP-II, cyclothymia and BP-NOS were added to classic BP-I). This doesn't trouble the fine folks at CABF.

"'I think it's down to increased recognition that the condition exists in children, which wasn't accepted until a decade ago,' says Susan Resko, executive director of the Child and Adolescent Bipolar Foundation."

Counters Michael Miller, a psychiatrist at Harvard Medical School in Boston:

"'We simply don't have all the information we need to connect the dots between behaviour, causes and symptoms. We don't know yet if kids are being under-medicated, over-medicated or mis-medicated'."

No kidding. The magazine also has an editorial but since I don't have a subscription I cannot read the whole thing. The editors note that "Something strange is going on."

Excessive? I think those of us who are asking questions are just ahead of the curve.

Posted by Philip Dawdy at May 17, 2007 12:03 AM
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Comments

It's easy to prescribe greed to these findings, but I'm not so willing to believe ALL psychiatrists are greedy. I wonder if there is a common consensus phenomenon here.

Years ago when I was first on Disability the psychiatrist I saw was almost eager to diagnose me Bipolar or schizophrenic. I wasn't either condition, but he wasn't happy with my diagnosis of Chronic Motor Tic Disorder and Depression. Instead, he constantly asked me if I was experiencing delusions of grandeur or hearing voices. EVERY time I visited him. Enough that I wondered what he was getting at. It was very unsettling. I can see how an insecure person might start wondering if they should be answering "yes" to those questions because he was so persistent. They might think "Does he know something that I don't?" I know I was more than curious about what aspect of me had him going on and on like that, but I'm far too self-aware to be manipulated in that way.


If the common consensus is that psychotic disorders are going untreated & undiagnosed and that more people suffer from psychotic disorders than are being treated, I could see how the psychiatric environment might foster the diagnosing of more patients as psychotic.


Douglas Cootey

The Splintered Mind

Posted by: D Cootey at May 17, 2007 02:22 AM

The answer's in the dirt--maybe kids should play outside more, and mud pies and dirt clods are more than kids play--could be a natural form of treatment.If treatment was really needed.

"The researchers used antigens derived from the bacterium Mycobacterium vaccae, a generally benign and ubiquitous agent found in dirt. After vaccination, they found that the subsequent immune activation was temporally associated with increases in serotonin metabolism within the ventromedial prefrontal cortex. Treatment with the vaccine seemed to alter behavior in mice similarly as is typically seen with antidepressants."


Bacteria, Serotonin, and Depression: A Possible New Approach to Treating Mood Disorders.

Posted by: Stephany at May 17, 2007 09:42 AM

Stephany, if the kids played outside in the dirt they might come into contact with thoughtfully disposed cat poop, and you know where that leads... :)

Posted by: Ruth at May 17, 2007 07:24 PM

Childhood Bipolar, Depakote vs. Placebo Trial:

Journal of Clinical Psychiatry,

781-Double-Blind,Placebo-Controlled Trial of Divalproex Monotherapy in the treatment of symtomatic Youth at High Risk for Developing Bipolar Disorder.

Robert L. Findling,Thomas W. Frazier, Eric A. Youngstrom, Nora K. McNamara,Robert J. Stansbrey,Barbara L. Gracious,Michael D.Reed, Christine A.Demeter, and Joseph R.Calabrese.

Divalproex no better than placebo in treating 'at-risk' bipolar youths

18 May 2007J Clin Psychiatry 2007; 68: 781–788

"The results of a double-blind, randomized trial show that divalproex sodium is no better than placebo in treating young people who are at risk for developing bipolar disorder."


"The researchers report that, overall, both treatment groups showed similar and significant decreases in symptoms and improvements in psychosocial functioning.

"Youths with the highest family loading of psychiatric illness discontinued more quickly than youths with lower loadings," Findling et al writes in the Journal of Clinical Psychiatry. "These youths… appear to be in greatest need of intervention."

Posted by: Stephany at May 18, 2007 09:13 AM

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