Bipolar Disorder Cases Rise Sharply in U.S. Children

(September 3, 2007) -- The number of American children and adolescents treated for bipolar disorder increased 40-fold from 1994 to 2003, researchers are report in the most comprehensive study to look at the controversial diagnosis. And experts say the numbers have almost certainly risen further in the years since.

The magnitude of the increase in an illness that until recently was thought to emerge only in adulthood, is surprising to many experts, and it is likely to intensify a debate that has shaken the field of child psychiatry in recent years.

Some psychiatrists say that bipolar disorder, which is characterized by extreme mood swings, is too often missed, and that youngsters who suffer from it are now, as a result of increased awareness, beginning to get the treatment they need. Others say that bipolar has become a diagnosis du jour, a catch-all term for explosive, aggressive children who, once labeled, often receive treatment with powerful psychiatric drugs that have few proven benefits and potentially serious side effects, like rapid weight gain.

The increased use of the diagnosis has also been a boon to drug makers, these experts say: Treatment typically includes medications that can be three to five times more expensive than those prescribed for other disorders, like depression or anxiety.

"I think the increase shows that the field is maturing when it comes to recognizing pediatric bipolar disorder, but the tremendous controversy reflects the fact that we haven't matured enough," said Dr. John March, chief of child and adolescent psychiatry at Duke University 's school of medicine, who was not involved in the research.

"From a developmental point of view, we simply don't know how accurately we can diagnose bipolar disorder, or whether those diagnosed at age 5 or 6 or 7 will grow up to be adults with the illness," he said. "The label may or may not reflect reality."

Most children who qualify for the diagnosis do not go on to develop the classic features of adult bipolar disorder, like mania, researchers have found. They are far more likely to become depressed.

But Dr. Mani Pavuluri, director of the pediatric mood disorders program at the University of Illinois , Chicago , said that that label was often better than any of the other diagnoses that difficult children often receive. "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," to better tailor treatment, she said.

In the study, researchers from New York , Maryland and Madrid analyzed data from a National Center for Health Statistics survey of office visits, which focused on doctors in private or group practices. The researchers calculated the number of visits in which doctors recorded a diagnosis of bipolar disorder, and found that the numbers went up from roughly 20,000 such diagnoses in 1994 to about 800,000 in 2003.

"I have been studying trends in mental health services for some time, and this finding really stands out as one of the most striking increases in this short a time," said Dr. Mark Olfson of the New York State Psychiatric Institute at Columbia University, the senior author of the study, which appears in the September issue of Archives of General Psychiatry, to be published Tuesday.

The increase makes bipolar disorder more common among children than clinical depression, the authors said. The study found that psychiatrists made almost 90 percent of the diagnoses, and that two-thirds of the young patients were boys. About half the patients also had been identified as having other mental difficulties, most often attention-deficit disorder.

The treatment given the children almost always included medication. About half received antipsychotic drugs, like Risperdal from Janssen or Seroquel from Astrazeneca, both developed to treat schizophrenia; a third were prescribed so-called mood stabilizers, most often the epilepsy drug Depakote; and antidepressants and stimulants were also common. Most children were on some combination of two or more drugs, and about 4 in 10 received some psychotherapy.

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Their regimens were very similar to those of a group of adults with bipolar diagnoses, the study found. "You get the sense looking at the data that doctors are generalizing from the adult literature and applying the same principles to children," Olfson said.

The rise in bipolar diagnoses in children reflects several factors, experts say. Bipolar symptoms do appear earlier in life than previously thought, in teenagers and young children who later develop the full-blown disorder, recent studies suggest. The label also gives doctors and desperate parents a quick way to try to manage children's rages and outbursts, in an era when long-term psychotherapy and hospital care are less accessible, they say.

Source: International Herald Tribune

Last updated: 09/07

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• Addressing Educational Needs of Children with Bipolar Disorder
• Living with Bipolar as a Teen: Dealing with School (for teens)
• Mood Swings and Substance Abuse
• Girls with Bipolar Disorder

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