In the space of a single decade, there has been a 4,000 per cent increase in the number of children diagnosed with bipolar disorder, according to a documentary lately broadcast on US public television.
Previously called manic depression, bipolar disorder was long believed to occur only in adulthood. But in the mid-1990s, children sometimes as young as four began to be diagnosed with the same condition at much higher rates.
The documentary, Frontline: The medicated child [1], which is free-to-view online, spotlights families dealing with children who have been diagnosed as bipolar and considers their predicament against a backdrop of disturbing trends:
“It's really to some extent an experiment, trying medications on these children," admits Dr Patrick Bacon, who was among those interviewed for the documentary. "It's a gamble. And I tell parents there's no way to know what's going to work."
Why the increase in diagnosed disorders? The short answer is that no one's sure. It’s not clear if the prevalence of childhood mental health problems is increasing or if clinicians are getting better at identifying it and catching it earlier.
And why is data so lacking? A major reason, according to the documentary makers, is that research requires comparing children who receive a particular medication to those who receive a placebo. And there’s been a reluctance to deny some children a medication while giving it to others. However, David Axelson, director of the Child and Adolescent Bipolar Services Clinic at the University of Pittsburgh Medical Center, notes that in the absence of research physicians deny children effective treatment every day.
“We don't know really for sure what treatment is better … without placebo, we oftentimes can't figure out whether a medication really truly works.” And without data, physicians are left to refer to research on adults, which does not necessarily apply to children.
Another possible problem is that researchers who advocate the use of psychiatric medications in the US frequently receive support from drug companies. Critics believe that industry-funded studies unduly influence doctors' decisions. So not only is there a dearth of data, but some of the data that does exist is questioned because of drug company support and the drug industry’s obvious interest in evidence that their products work.
A possible solution to this troubling state of affairs comes from the field of pediatric oncology. In the documentary, F. Xavier Castellanos of the NYU Child Study Center notes that as recently as the 1970s, cancer was a death sentence for children. Now about 90 per cent of children who contract cancer are cured. The change resulted from a commitment among pediatric oncologists to research. They decided that, in order to receive treatment, young cancer patients had to participate in studies. In this way, a large body of evidence became available and treatment improved. Castellanos and others have recommended the same approach for childhood mental illness.
• For information on an initiative to increase research on psychiatric medications for children, see website for the Child and Adolescent Psychiatry Trials Network [2].
Links:
[1] http://www.pbs.org/wgbh/pages/frontline/medicatedchild/
[2] https://www.captn.org