About a month ago, results from a NIMH-sponsored statistical study that determined the rate at which children were being labelled and treated for bipolar disorder were published, and reported widely in the popular press (I initially read about it on September 4th in the Sunday New York Times). Twenty years ago, bipolar disorder was a relatively uncommon diagnosis for individuals below 20 years of age. The incidence of the diagnosis was obviously increasing over the subsequent years (it had risen to 20,000 in the U.S. by 1984). That suspected increase in incidence or diagnosis in children inspired the NIMH to ask for proposals from epidemiologists to MEASURE its rate of occurence or diagnosis between 1984 and 2003.
You have probably already heard about these results, but they are worth repeating. In 2003, 800,000 children and adolescents were diagnosed AND AGGRESSIVELY TREATED for bipolar disorder — A 40-FOLD INCREASE. If you look at the charts documenting the rates of increasing diagnosis and treatment, you quickly realize that over the following 4 years (2004-2007), this incidence has probably doubled again, i.e., in 2007, there are likely 1.5 MILLION or more children (approximately 2 in every 100) being diagnosed — and treated — as having bipolar illness.
I’m not certain how this growth in diagnosis and treatment shall progress, but remember that once you really have a bipolar disorder, it’s for life. There’s no escaping it, folks. Miraculously, over a little more than a decade, we have ‘discovered’ that we have almost as many children with this dreadful malady as we have adults! By the time the psychiatrists are through ‘catching up’ with all of the earlier-missed identification of this illness in children, we’ll see that (Mercy, me!) 5 or 10 or 15% of our kids have it! THAT’S a plague, for certain!! Let’s hurry up and get those mind-altering, meat-ax drugs to that 5 or 10 or 15% of our kids just as fast as humanly possible, for their great benefit!!!
About half of these 800,000 treated children in 2003 were prescribed anti-psychotic drugs designed to treat schizophrenia (Risperdal and Seroquel were the most commonly prescribed). About 40% were enrolled in psychotherapy programs. About 1/3rd received “mood stabilizers”. Antidepressants and stimulants were widely prescribed. Sort of makes you wish you had a little more J & J or Astrazeneca or other Big Pharma stock in your portfolio, doesn’t it?! Sort of makes you appreciate how much a little marketing to psychiatrists (one of the most drug-oriented of all professional communities) can really pay off, doesn’t it?! Sort of helps you understand why child psychiatry is now such a flourishing practice area, doesn’t it?!
Personally, I wonder what on earth can lie in the future of a society that allows this kinds of systematic abuse of the physical, chemical and functional brains of its children. What the hell are you child psychiatrists thinking? Let’s say, just for a moment, that bipolar disorder IS increasing this rapidly in our society. Why aren’t you raising the red flag and demanding that the government determine WHY this is happening? Doesn’t it matter to you enough to get you off of your collective keisters? Are you HAPPY delivering all of these strong chemicals to the brains of the children who cross your office thresholds? And how on earth can you prescribe psychoactive drugs in various combinations that have unknown impacts on the development of human ability and spirit (but which everything tells us should variously modify or limit them) so damn casually and so extraordinarily liberally? Have THOSE impacts been measured, in the FDA trials that led to the approval of Risperdal for the treatment of bipolar disorder in children? Surely you understand that these drugs have powerful, general, brain-altering impacts. Surely you understand that their impacts are not exactly specific or selective. Surely you appreciate the fact that the brain on these drugs is not NORMAL, and that by chronically administering it, it never shall be.
The article in the New York Times stated that “symptoms (of bipolar disorder) appear earlier than was previously thought.” Balderdash. Or if so, why?
TELL US WHY.
Unlike schizophrenia, we know that cognitive weakness in bipolar disease cannot be easily recorded in individuals before they develop the illness, nor in the siblings or parents of affected individuals. They EMERGE as the bipolar patients goes through the first cycles of mania and depression, and strengthen progressively as the illness progresses. The diagnosis of this newly-emergent disorder appears to be based on the contemporary child’s emotional instability and gross conduct problems (their ‘mania’). In my own view : a) it is unlikely that very many of these children have, or are truly destined for bipolar disorder, since the true mania of bipolar disorder is almost certainly linked to the changes manifested by cognitive deterioration; b) either serendipity reigns, or a treatment based on this diagnosis is going to almost always be mis-targeted; c) chronic administration of these drugs can — of course — have large-scale, enduring impacts, all on their own; and d) because antipsychotic drugs like these impact dopamine and serotonin and adrenergic and cholinergic processes that are key regulators of mood and learning and addiction and cognitive development and a dozen other things that define the operational abilities of we humans, I personally would be pretty reluctant to give them to my dog or cat — unless that was ABSOLUTELY lifesaving.
One final note:
If the incidence of bipolar disorder IS truly increasing — or if the misconduct and emotional development of American children so often goes amiss that it now REQUIRES treatment with powerful drugs to fix it, it is certainly in the public interest to figure out what the hell is causing this dramatic change in American children. I challenge the child psychiatrists out there on the front lines to put their shoulders to the wheel and determine the CAUSE of this epidemic.
Prevention, as we all know, IS the best medicine.
And for the ‘bipolar disorder’ kid, on strong pills for life, an ounce of prevention is worth quite a few pounds of ‘cures’.