Friday, February 16, 2007

Bipolar in Kids: The BS Train Keeps Running

Earlier in this week, I wondered how Charles Nemeroff, "key opinion leader" in psychiatry at Emory University could make the following statement with a straight face...
"The concerns about antidepressant use in children and adolescents has paradoxically resulted in a reduction in their use, and this has contributed to increased suicide rates."
Note that the data do not actually show a decrease in SSRI prescription for teens during the timeframe when suicides increased, and that even if it did, such a relationship could have just been a coincidence.

But now, I believe that Nemeroff's statement does not even make for the least-supported (i.e., most fictional) statement of the week in psychiatry. The award instead goes to (extended drum roll, please...)

Jean Frazier of Harvard University. The New York Times quoted her as follows:
Dr. Jean Frazier, director of child psychopharmacology at Cambridge Health Alliance and an associate professor at Harvard, said that up to three-quarters of children who exhibit bipolar symptoms become suicidal, and that it is important to treat the problem as early as possible.

"We’re talking about a serious illness with high morbidity, and mortality," Dr. Frazier said, "and for some of these children the medications can be life-giving."

NICE! To my knowledge, there is little to no data to show that bipolar disorder is a valid diagnosis in young children, nor that early treatment is helpful, nor that treatment reduces risk of suicide for "bipolar" children, nor that 75 percent of "bipolar" children become suicidal. This is absolute nonsense, the type of statement that leads to unnecessary medication and leads people to falsely believe that bipolar disorder is a terrible epidemic among youth.

It gets even more detached from reality when we consider the case of Rebecca Riley, a four year old who was prescribed a very high dose of Clonidine, as well as being prescribed Seroquel and Depakote, and who died, reportedly due to the effects of her meds (clonidine seems to be the leading suspect).

Hat tip: Furious Seasons, who has been absolutely on fire as of late.


Anonymous said...

Excellent post, first time finding your work, and can see that we are on the same train! - and I agree with you about our Furious Seasons colleague, great stuff.

One of my most consistent pet peeves [a phrase which trivializes the incredibly bad situation] as a psychiatrist and psychopharmacologist is the current perfect storm of bipolar over diagnosis.

Hey, if you don't know what to call it, call it bipolar. Forget all the other important questions, it's a mood thing... But, as you probably know it could be a poop thing!

Phenotypic diagnosis is slowly but surely winding down the hall on its way to the back door. But it will be a while.

You mentioned clonidine, yes, but I am still completely befuddled why "academics," probably some you know, still think TCAs should be studied and discussed as possible interventions for ADD!!

This is an amazing world.

Thanks, keep up the good work,


KGC said...

Hate to break it to you, but childhood-onset bipolar disorder (aka pediatric bipolar disorder) is definitely a recognized illness and it's criteria are outlined in the DSM-IV-TR. There is also A LOT of empirical proof that Bipolar disorder exists in children.
Early treatment is extremely helpful. Treatment is primarily medication (since BP is a neurological disorder, as brain scans show), but other psychosocial therapies, such as family therapy is also extremely helpful. Studies have also been done on the use of Cognitive Behavioral Therapy with Bipolar children, and also Dialective Behavioral Therapy.
I suggest you read "The Bipolar Child" by Papolos & Papolos. That would be the first place to start. If you need more proof I can send you at least 100 peer-review journal articles describing empirical studies of pediatric bipolar disorder.
As a school psychologist I have seen it and, sorry, IT DOES EXIST!

CL Psych said...

Date rant,

Well, if you insist that you've seen it, then I suppose it MUST be so.

The research that I have seen has often used altered DSM-IV criteria for bipolar when diagnosing kids. These criteria tend to be more inclusive than full DSM criteria. Maybe you have over 100 peer-reviewed articles to the contrary?

Brain scans show that bipolar is a neurological disorder. Um, okay. So kids are being diagnosed based on brain scans?

And which articles are you referencing that have shown that early treatment of "child bipolar" is "extremely helpful"?