In the over 30 years that I have been around in this profession, I've seen fads come and go. I've seen agoraphobia skyrocket in numbers with counseling centers set up to deal with it, and then fade out. And then every woman who was depressed or anxious had to have been sexually molested as a child and couldn't remember it. That came and went, as enough evidence indicated this retrieval of memories can't be remembered was bogus and mostly produced by the feminist nutcases who had licenses and just told people that was it.
Now we're in a different kind of fad...and there are reasons for these fads. It's not that people don't have disorders, but these huge increases are a bit suspect. Now, today, everybody is bipolar. Generally speaking, you'll hear "this person's bipolar, that person's bipolar" and these diagnoses are made by somebody in 15 minutes and it's just a mind-bender.
To make more money for the drug companies, it seemed every kid was ADD and then ADHD. According to research in the Archives of General Psychiatry: between 1994 and 2003, there was a 40-fold increase in the diagnoses of bipolar disorder in kidlets. . Some people are saying, "Well, we just have an improved awareness of the diagnosis."
Others feel the diagnosis has been over-sold and is used to describe a lot of angry, explosive kids.
In Minnesota, spending on powerful antipsychotic drugs to treat bipolar and other disorders in children has risen 17-fold since 2000 and exceeds $6 million annually...that's just in one state. The medical community seems to be having a reversal that has few parallels in history. Psychiatrists are now backing away from this diagnosis. Thousands of kids have received the diagnosis in error and there are lots of reasons: over-zealous doctors, desperate parents wanting an answer, quirks in the health insurance system and aggressive marketing by drug companies. Dr. Stephen Setterberg, a child psychiatrist said, "Some of the doctors that got going with that early on, they sort of drank their own Kool-Aid. They talked themselves into believing that many kids were bipolar. It essentially was a diagnostic fad."
The drugs they're given are serious drugs. They come with increased risks of obesity, diabetes, muscle spasms and more. A child psychiatrist with Children's Hospitals and Clinics of Minnesota said, "A substantial number of those kids, if you take them off the problem medication, those symptoms go away, and then they don't have bipolar; they just had a medication-induced problem." And of course, if you give a kid the wrong diagnosis, you're not going to get the right treatment.
If it's bipolar disorder, it's incurable and you've got to drug it so that means alternative therapies like cognitive behavioral therapies and others which have been developed for these angry, impulsive kids aren't happening.
Bipolar disorder has a genetic component, and it runs in families, but there's no brain test or scan to confirm it. I have always said the first line of defense is to look at the family. Look at the parents: are they divorcing? Are they drunk? Are they violent? Are they abusive to the kids? Are they sexually exploitive of the kids? Do they not pay any attention to the kids and don't feed them and let them run around? Kids get angry, impulsive and out of control for all sorts of reasons. Just drugging them probably misses some of the things that could be dealt with more healthily.
In 2001 a New York psychiatric hospital examined 120 kids who were sent there because of bipolar disorder. To the best of their analysis in 2001, barely half might really be bipolar; the rest not.
Now I always think "follow the money". The U.S. Food and Drug Administration issued a "black box" warning in 2004 on antidepressants, noting they carried a heightened risk of child suicide. Well, that had a chilling effect on antidepressant drug use and pushed doctors toward other treatments -- especially the "big gun" antipsychotics. And so it's driven by drugs. The research shows a rise in bipolar diagnoses for kids matches the drug trends. Follow the money...follow the money.
No one believes the children mislabeled with bipolar disorder are okay. They're not okay. There's something wrong. They have extreme tantrums, and sometimes get violent or harm themselves. There's definitely something going on there above and beyond a "phase". It, indeed, might be biological, but I don't think that (and I never thought that) drugs should be the first line of defense. Dr. Stuart Kaplan, who wrote a book called "Your Child Does Not Have Bipolar Disorder," believes kids with bipolar diagnoses generally have behavior problems that require therapy, not just drugs. I think it is more benevolent to be patient and see what's going on in that kid's life before jumping to very expensive antipsychotic medication, which precludes any other kind of cognitive therapy. That's the story. These kids have some kind of problem, but just knee-jerk bipolar "give them antipsychotics" is not necessarily the solution at all.