Furious Seasons

September 04, 2007

Bipolar Disorder Diagnosis Is Up, Up And Away

A new article in the Archives of General Psychiatry asserts that diagnoses of bipolar disorder in children and teens up to 19 years-old increased 4,000 percent between 1993 and 2003. The study also notes that diagnoses roughly doubled in adults, mostly in women. I haven't seen the paper itself yet, but most of the press accounts have cast this news as being all about children. I'm not convinced that teens and adults aren't just as important.

Keep in mind that the increase in diagnosis is likely to be higher now, four years after this study stops looking at data.

According to one press account, one of the study authors is even critical of the diagnosis of bipolar disorder in youths. I am, too, since there is very mixed evidence on whether it even exists in kids younger than about 12. This issue was recently taken up by Australia's ABC radio. Here's a transcript.

But whatever one makes of the diagnosis itself, I think the psych researchers who have been pushing this paradigm for unruly children should be ashamed of themselves. That's because the treatment paradigm of mood stabilizers and antipsychotics has barely been studied in children and teens, and has not been studied at all long-term. The injuries that can be caused by these drugs are well known. And to judge by what I glean from places like the bipolar groups on MySpace, it appears that these treatments are not proving to be effective in long-term use. And clinicians and researchers are well aware of this. My own view is that most of these drugs are not acceptable for long-term use except in extreme cases.

You'd think that should argue for some caution in the psych world and maybe some introspection about what it is that is apparently making America's youth (and adults) so much screwier than in 1993. But there's little except for silence on that front, and nothing but bloviating from the defenders of the faith at Harvard. No one is asking why they aren't making anyone well much less making them whole.

Have we become so lazy as a culture that this is the best we can do?

Posted by Philip Dawdy at September 4, 2007 12:05 AM

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Comments

4 or 5 years from now, the headlines will read:

Diagnoses of Dystonia & Dyskinesia Jump 4,000%,

Scientists Baffled by Epidemic of Movement Disorders

Posted by: Ben Hansen at September 4, 2007 09:44 AM

From CNN to the New York Times to the Washington Post to Evelyn Pringle, everybody is on this story. CNN has a bulleted item on their site that reads, "Pediatric bipolar symptoms often differ from adults'( http://www.cnn.com/2007/HEALTH/09/03/bipolar.kids.ap/ )

There is no test to diagnose bipolar disorder. Even Fuller Torrey would agree that at this point the only way to get that label is from an evaluation of symptoms, so if pediatric bipolar symptoms are different from adult bipolar symptoms, what on earth makes it bipolar?

Excellent use of "bloviating." Hopefully the vast overdiagnosis of bipolar disorder in adults will get such scrutiny. Hopefully the vast amount of coverage this is getting won't be drowned with the bs argument that "child bipolar" was just underdiagnosed before.

Posted by: Sally at September 4, 2007 09:59 AM

Wouldn't you expect to see an explosion in drug-induced mania, leading to the diagnosis of bipolar, in the same decade stimulants like Ritalin have taken off? Just google ritalin induced mania for lots of references on this.

I'm sure it's not a complete explanation, but along with increased use of anti-depressants, which also kickoff mania, it may be a factor.

Posted by: Susan at September 4, 2007 12:24 PM

Remember in the 90's when prozac was the wonder drug, then after it was noticed that for most people, it ceased to "work" after several months, it was time to rush new ssri's to the market, and then, after a few years of ssri bingo with cocurrent klonipin addiction and bizarro interactions with ambien (which it was supposedly impossible to become addicted to ;), folks got to be bipolar just as new brochures were coming out and the kids were ready for their first adhd med, and then what do you know, every body is bipolar.

Posted by: Sally at September 4, 2007 01:47 PM

Very good point Susan. I am certain that drug induced mania from prior treatments with stimulants and/or antidepressants explains at least part of this picture with the bipolar explosion.

Posted by: sara at September 4, 2007 02:59 PM

"along with increased use of anti-depressants, which also kickoff mania"

Excepting Fluoxetine (Prozac) is the only SSRI approved for paediatric use, and has the lowest risk of manic switching.

Posted by: oxstu at September 6, 2007 06:22 AM

I think you're right on to question the huge increase in psych diagnoses for children. I also think that same skepticism is congruent with this story: http://www.slate.com/id/2171131/pagenum/all/#page_start

Posted by: Steve at September 6, 2007 08:03 AM