WebMD Medical News
Daniel J. DeNoon
Louise Chang, MD
Sept. 4, 2007 -- Today's children and teens are 40 times more likely to have
bipolar disorder than were the children of 10 years ago.
That's 20 times faster than the growth in diagnoses of adult bipolar
disorder over the same decade. Are we only now discovering a huge reservoir of
untreated psychiatric illness? Or is there an epidemic not of disease, but of
misdiagnosis and overtreatment?
The study that provides this alarming data doesn't answer this crucial
question, says study researcher Mark Olfson, MD, MPH, professor of clinical
psychiatry at Columbia University Medical Center and New York State Psychiatric
"We found a striking national increase in the treatment of young people
for bipolar disorder: from 20,000 youths in 1994 to 800,000 youths in
2003," Olfson tells WebMD. "The study does not tell us why so many more
kids are being diagnosed and treated for bipolar disorder. But it gives us
What, exactly, is childhood bipolar disorder? It's controversial. Bipolar
disorder used to be called manic depression because it is characterized by
bouts of depression and bouts of mania.
Mania in adults is characterized by euphoria, grandiosity, irritability,
racing thoughts, and frenetic activity. While some experts argue that childhood
mania must also exhibit signs of euphoria and grandiose behavior, others say
irritability may be the only sign.
"In children, the symptoms of bipolar disorder are very different from
the symptoms in adults," Julio Licinio, MD, chairman of the department of
psychiatry at the University of Miami, tells WebMD.
In January 2007, the American Academy of Child and Adolescent Psychiatry
(AACAP) set out a "practice parameter" acknowledging the controversy.
The AACAP's expert panel noted that for both children and adults, doctors are
much more often diagnosing bipolar disorder based on individual symptoms rather
than characteristic patterns of symptoms.
The AACAP panel noted that there's also debate over whether bipolar disorder
in children is even the same illness as bipolar disease in adults. What is
agreed on is that bipolar disorder is an increasingly common diagnosis in
children -- including preschool children.
"There was a real underdiagnosis of bipolar disorder in children. We've
gone to the other situation now," Licinio says. "Some of these children
are just irritable and cranky and negative. They get more brittle than manic.
And people can mistake juvenile delinquency for bipolar disorder. So there is a
potential for this to be really missed."
Olfson and colleagues used data collected annually by the National Center
for Health Statistics. The data come from questionnaires given to office-based
doctors who directly treat patients. The study compared reports on treatment of
bipolar disorder in adults with reports of bipolar disorder treatment of
children/teens aged 0 to 19 years.
The Olfson team's report, in the September issue of Archives of General
Psychiatry, shows that doctors treat bipolar disorder in youths the same
way they treat it in adults: with powerful psychiatric drugs.
In two-thirds of visits, youths
diagnosed with bipolar disorder receive mood stabilizers -- most often
anticonvulsants such as Depakote. Children are just as likely as adults to be
treated with antipsychotic drugs, although children are more likely to receive
the newer "atypical" antipsychotics. In six out of 10 visits, patients
regardless of age receive a combination of at least two drugs.
"The types of medications they receive resemble those received by
adults," Olfson says. "There are real risks associated with
misdiagnosis of children with bipolar disorder. These drugs have powerful side
effects and their long-term safety has not been established for
Worrisome as they are, drug side effects are not the only problem facing
children diagnosed with bipolar disorder. There's also the stigmatization of
having a serious, possibly lifelong mental illness.
"School personnel may treat the child differently, the options for
things like after-school programs and summer camp may be limited, and there may
be problems with getting health insurance," Olfson says. "And the
children may give up on themselves if they think they have a brain disorder
that has no cure. So there is the potential for serious risks."
So what should parents do if their doctor suspects their child has bipolar
"It can be a devastating thing for a parent to hear," Olfson says.
"Rather than overreact, parents should ask how the diagnosis was made. Did
the provider talk with the child's teachers? Did the psychiatrist or another
doctor look at the child over time? How much information went into this
Before deciding on treatment, Olfson recommends that parents consult an
expert in child and adolescent psychiatry.
Licinio says that while there may be a trend to overdiagnose bipolar
disorder in children, there are still many children who would benefit from
having their bipolar disorder recognized and treated.
SOURCES: Moreno, C. Archives of General Psychiatry, September 2007;
vol 64: pp 1032-1039. Blader, J.C. and Carlson, G.A. Biological
Psychiatry, 2007; vol 62: pp 107-114. "Practice Parameter for the
Assessment and Treatment of Children and Adolescents with Bipolar
Disorder," Journal of the American Academy of Child and Adolescent
Psychiatry, January 2007; vol 46: pp 107-125. Mark Olfson, MD, professor of
clinical psychiatry, Columbia University Medical Center and New York State
Psychiatric Institute, New York. Julio Licinio, MD, chairman, department of
psychiatry, University of Miami Miller School of Medicine.
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