Bipolar in Diapers
Among the many so-called adult diseases now being diagnosed among the diaper-set, one of the most startling is bipolar disorder. In fact, according to a study just published in the Journal of the American Academy of Child & Adolescent Psychiatry, the number of children between the ages of two and five diagnosed with the disease has doubled in the past 10 years. Although it's almost inconceivable that kids might display manic-depressive symptoms before they even can talk, these very young children are being prescribed anti-psychotic medication, a fact that has stirred up plenty of concern.
"It is a worrisome trend, partly because very little is known about the short-term, let alone the long-term, safety of these drugs in this age group," said the study director, Dr. Mark Olfson, a professor of clinical psychiatry at Columbia University. The issue came to a head in the aftermath of the death of Rebecca Riley, age four, from an overdose of bipolar medication. Though her psychiatrist had prescribed the drugs, her parents now face murder charges for administering them. The courts cleared the shrink, but contend that the parents overmedicated the kid to subdue her.
The fact is manic-depressive diagnoses have been spiking in all age groups, and as alarming as the swell is in the toddler set, the figures for older children are far more shocking. In the nine years between 1994 and 2003, the number of children under age 18 newly diagnosed as bipolar skyrocketed by 4000 percent. Put another way, between 1994 and 1995, the rate of diagnosis of bipolar disorder for kids under age 19 was approximately 25 per 100,000. By 2002-2003, the number of diagnoses increased to 1003 per 100,000 youth. Experts concur that the rate of diagnosis has continued to go up since 2003, bypassing even the 4000-percent marker, although exact figures aren't available yet. In that same period of time, adult diagnoses doubled.
Most of the kids diagnosed as bipolar take two or more drugs for their supposed condition. Interestingly, the anti-psychotic drugs that control bipolar disorder typically cost three to five times the amount that drugs for other mental health or behavioral conditions, like depression or ADHD, cost. Only 40 percent of these kids also receive psychotherapy, and incredibly, less than half even had a mental health assessment before starting drug treatment. In other words, drug treatment is the sole remedy administered. While some professionals claim that the surge in diagnoses reflects new wisdom about what really makes Johnny so uncivilized, others suggest that the trend reflects aggressive marketing by drug companies, which have campaigned hard to sway medical opinion.
"We are just inundated with stuff from drug companies, publications, throwaways, that tell us six ways from Sunday that, Oh my God, we're missing bipolar," said Dr. Gabrielle Carlson, a professor of psychiatry and pediatrics at the Stony Brook University School of Medicine on Long Island. But in spite of the pressure from drug companies to recognize the disorder in the very young and prescribe accordingly, an article in The New York Times says that so-called pediatric bipolar disorder usually disappears magically as the child matures…without treatment.
What symptoms qualify a kid for the bipolar label and accompanying medications? The Times says, "Most children who qualify for the diagnosis do not proceed to develop the classic features of adult bipolar disorder like mania, researchers have found. They are far more likely to become depressed." According to Dr. Mani Pavulari of the University of Illinois, "These are kids that have rage, anger, bubbling emotions that are just intolerable for them, and it is good that this is finally being recognized as part of a single disorder." According to a report in Biological Psychiatry, symptoms include "impulsive, volatile, aggressive" behavior. Other sources site extreme irritability as a clear symptom. Dr. Manuel Mota-Castillo, author of the book Protecting Your Children From Bad Medicine, said that he watches for disrespectful behavior when interviewing kids.
The most common medication prescribed to "bipolar" kids is risperidone (Risperdal), an antipsychotic. Those kids most likely to get risperidone are males aged four to five. The side effects may include tremors, weight gain, respiratory problems, anxiety, lethargy, impaired motor control, joint pain, vomiting, diabetes, stroke, blood clots, and death. The drug has only been tested on adults, so the impact on kids, both short-term and long-term, still is unclear. In spite of these issues, sales of risperidone currently net $2.1 billion in global sales each year.
Certainly, some parents of acting-out kids consider the drugs a boon. Previously bratty kids become subdued and manageable on the drugs, and in truth, some kids do need extra help. Still, throwing dangerous, untested drugs at kids as young as age two without even giving them a psychiatric work-up first simply doesn't add up. As Dr. Peter Jensen, co-director of Child Psychiatry at the Mayo Clinic, says, "We have no doubt there are prescribing practices out there that are very, very worrisome." Dr. Olfsun adds, "There might be a role for these drugs but only after you've tried other interventions, with the parents, or with the parents and child together, but that is not happening when you examine the billing records."
I might add that looking at the kid's diet should be a first step before resorting to any dramatic interventions.