Treating Bipolar Illness, Cont.

Since filing a post earlier this week about the national spike in diagnoses for bipolar disorder, I’ve been alerted to two pieces, both of which suggest that the category may be too broad and that doctors may be overprescribing. First, from the LA Times:

Dr. Gabrielle A. Carlson, a psychiatrist at Stony Brook University in New York, said 1 of every 5 children referred to her with a diagnosis of bipolar disorder actually had it. The rest had autism, depression, anxiety or another psychological disorder. All these conditions involve different treatments, with drugs, behavioral therapy or both.

Carlson, who has studied the increase in bipolar diagnoses, said some parents seemed to prefer a diagnosis of the disorder because the illness, which is thought to be largely genetic, absolves them of blame.

“They don’t have to deal with their chaos, their psychiatric disorder, their marital troubles or abuse,” she said.

She said that in some cases, providers would diagnose psychological problems in children as bipolar disorder to obtain insurance reimbursement for hospitalizations, a practice called upcoding.

And, from the financial news wire Bloomberg News, an article focusing on the enormous profits Johnson & Johnson and Pfizer are reaping as the market for their drugs to treat bipolar illness grows:

The expanded use of bipolar disorder as a pediatric diagnosis has made children the fastest-growing part of the $11.5 billion U.S. market for antipsychotic drugs. Some experts say the treatments are bringing needed help to troubled kids, while others call it a fad that is exposing children to serious risks, including weight gain and diabetes.

“I call it the juvenile bipolar juggernaut,” says Joseph Woolston, chief of child psychiatry at Yale-New Haven Hospital, affiliated with Yale University in New Haven, Connecticut. “The diagnosis has been broadened considerably, and I think that’s a big problem.”

Lower in the Bloomberg piece is this anecdote about Brian Sherry, a 13-year-old in Dallas who was diagnosed as bipolar in 2005 after becoming manic while taking antidepressants for irritable bowel syndrome and anxiety:

Brian…had a manic episode after a school band trip in May 2005 that left him “talking real fast, unable to control the flood of thoughts coming into his head,” said his father, Duane Sherry. The Sherrys were contacted through a patient advocacy organization and plan no legal action in connection with Brian’s treatment.

Arnold Mech, a psychiatrist in Plano, Texas, diagnosed Brian with bipolar, obsessive-compulsive, social anxiety, generalized anxiety and attention-deficit hyperactivity disorders. Mech prescribed Geodon and the Pfizer antidepressant Zoloft, along with Lilly’s Strattera, a non-stimulant attention-deficit drug. To counteract the sedating effect of Geodon, he added Cephalon Inc.’s Provigil, a drug that promotes wakefulness.

Over the next seven months, Brian had only fleeting relief from anxious, angry moods and rages, he says. The drugs made him so tired he could barely function, his father says. Duane decided to wean his son off the medicines and start him on a regimen of vitamins and herbal supplements.

Since the switch, Brian says his moods and his relationships with schoolmates are better.

“The biggest thing was it kind of slowed down my thinking process,” he says. On the medications, “I would make very rash decisions and get in trouble at school. When you slow down and think things through more rationally, it really helps.”

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