The Bipolar Dilemma

Big announcement this week: pediatric bipolar disorders diagnoses have increased 40-fold from 1994 to 2003, and the prevalence is likely higher these days. Everyone’s weighing in: Better diagnosing? Environmental health crisis? Both? Sounds familiar.

Some say it doesn’t exist. Others insist it’s better diagnosing – either smarter doctors (unlikely) or new systems of classification (possible). Either way, it’s more. More children diagnosed with the formerly rare label of bipolar disorder – historically known as manic-depression and thought to be rarer than a northern hairy nosed wombat in young kids. Sounds eerily familiar to me… can anyone say “autism”? Bipolar disorder now comes as a spectrum, too – types I (classic manic-depression) or II (with less severe mood swings) and so on. I am not minimizing the importance of recognizing mental health crises in our youth. There does exist true biological depression, bipolar disorder, attention-deficit disorder, anxiety – and they need to be treated to alleviate true suffering. Families are torn apart by these medical crises. But it is important to note that there are also symptoms of all of these conditions that all children manifest some of the time. Who stands to benefit from such rising numbers? Those who make the treatments, of course. I’m not so skeptical as to say big pharma invented pediatric bipolar disorder, but the fact the medications were prescribed for over 90% of those children diagnosed with the disorder is troubling. Extremely. Especially when there’s such limited data on the short- and long-term efficacy and safety of these drugs. It’s notable, too, that nearly a third of the children diagnosed as bipolar in the recently published study were also diagnosed with ADHD. The distinction between bipolar and ADHD is really tricky – even skilled, experienced child psychiatrists (and there are so few of those) have troubling figuring that one out. So what do we do? Guess? Put the kids on bipolar meds and ADHD meds? Any research that’s looked at that combination? No.

How important are those labels? Author and child psychiatrist Scott Shannon, former head of the American Holistic Medical Association, offers us his take in the recently published book, “Please Don’t Label My Child.” One of the most important books in the field in some time, Shannon’s work is refreshing for his holistic, integrative approach to evaluation and treatment of pediatric mental health conditions. His focus on lifestyle factors (including exercise and nutrition) as well as on family dynamics and social support is much needed, and his inclusion of environmental considerations as a factor in the rise in prevalence of many of these conditions is honest and rings true to me. At the very least, we need to consider all of the possible reasons we are witnessing yet another epidemic rise in a childhood neurodevelopmental condition. And we need to research and consider all safe and effective therapies. Or we will be doomed to repeat our mistakes, over and over again, to our children’s detriment.