We knew it was coming, we were just waiting for it — mainstream media’s report on the fact that children are being diagnosed with a condition that isn’t considered a childhood diagnosis, bipolar disorder. Sure, it’s been going on for many, many years, but does that make it right?
Scott Allen, of The Boston Globe, sheds some light on bipolar diagnoses in children today.
I was disappointed to read how the article appears to paint Biederman as an egomaniac:
Biederman dismisses most critics, saying that they cannot match his scientific credentials as co author of 30 scientific papers a year and director of a major research program at the psychiatry department that is top-ranked… “Not all opinions are created equal.”
Nothing like bringing out one’s true colors when faced with real questions about one’s conclusions. Beiderman appears to be pompously suggesting that if you’re not in his category of publishing as co-author 30 scientific papers a year or are the director of a major research program, you really have no place to question his opinions. But other doctors of the same caliber, not to mention well-read professionals such as myself, are.
The diagnosis of bipolar disorder in children is an embarrassing train wreck with not enough empirical backing to be doing it wholesale, and with not enough regard for the serious adverse treatment effects.
Wait until Beiderman discovers the Internet! lol.
But the most distressing point of the article is that diagnosis of this adult condition — bipolar disorder, but in children — is based upon fairly thin empirical research:
Nonetheless, the Mass. General studies were enormously influential: their 2001 study, in which 23 children diagnosed as bipolar received the drug Zyprexa for eight weeks, became one of the most frequently quoted articles in the history of the Journal of Child and Adolescent Psychopharmacology. The study showed that the drug eased outbreaks of aggression, though children typically gained more than 10 pounds.
23 children! Sorry folks, but an N = 23 for only 8 weeks for research is about as small as you can get with a study and have it even published. To have such a study act as one of the cornerstones of this whole controversy is almost ridiculous if the stakes weren’t so serious — children can die when improperly prescribed antipsychotic medications and improperly diagnosed.
The other problem is, of course, nobody is prescribed any medication for only 8 weeks. What is the long-term impact of these very powerful drugs on a child’s development? Nobody can tell you, because the research hasn’t yet been done. Should we really be prescribing such medications wholesale without the resulting research having been conducted (and gone through the FDA approval process, which guarantees a certain safety and efficacy threshold is met)?
The rapid rise raised concerns at the National Institute of Mental Health, prompting its top officials to convene leading specialists, including Biederman, to urge them to come up with diagnosis and treatment standards. The resulting guidelines, released in 2001, acknowledged that Biederman was right: Bipolar disorder can strike before puberty. However, the guidelines also stated that identifying the disease among children is challenging because normal children are prone to be irritable, aggressive, or giddy.
Dr. Steven Hyman, who was then director of the mental health institute and is now provost at Harvard University, said he remains very concerned about the growing use of “big gun” antipsychotic drugs such as Zyprexa, Risperdal, and Seroquel on children.
Keep in mind, too, that 10 years ago, it was virtually unheard of to prescribe antipsychotic medications to treat bipolar disorder. Bipolar disorder was traditionally treated with safe, understandable (but generic) medications like lithium and Depakote. Why not try treating kids with supposed bipolar disorder with these other, older and safer medications first?
Well, that’s not where the money is. When antipsychotics were approved for treatment of bipolar disorder in adults, it seemed only natural to explore their benefits (and enhanced revenue potential) in children.
Hyman wisely concludes, “We don’t know the first thing about safety and efficacy of these drugs even by themselves in these young ages, let alone when they are mixed together.”
If that’s true — and it is — why would doctors like Biederman be so quick to prescribe them to children?
The point of the Globe article is that the diagnosis of bipolar disorder in children is tricky and, because it’s so tricky, it should be done very conservatively. Furthermore, when prescribing treatments to such children, it should be done very carefully — not as a “matter of fact” or taken for granted (especially given the FDA hasn’t even approved a single medication for treatment of bipolar disorder in children!).
And of course, the usual pharma bias argument rears its head (but I don’t think really compares to Biederman’s own ego):
Biederman has received research funding from 15 drug companies and serves as a paid speaker or adviser to seven of them, including Eli Lilly & Co. and Janssen Pharmaceuticals, which make the multi billion-dollar antipsychotic drugs Zyprexa and Risperdal, respectively. […]
Biederman’s boss said he does not believe the money affects Biederman’s judgment.
Well, there ya go! His boss says it’s okay, so it must be okay! Thanks Boss!!