Younger and younger children are being diagnosed with Bipolar I Disorder (formerly "manic-depressive illness") despite the fact that there are few studies to support this practice.
Once diagnosed, children may be put on so-called “mood stabilizing” medications (e.g. lithium, divalproex, lamotrigine, trileptal) whose efficacy has not been thoroughly studied in pediatric populations. The use of these medications in children has increased almost 300 percent in the last decade as the increase in diagnoses of Bipolar I Disorder in children has increased 40-fold. Clearly something is wrong as this would indicate an “epidemic” of Bipolar I Disorder that we are not seeing in any other age range.
Bipolar I Disorder is typically a chronic, disabling disorder with early-onset considered age 13, but currently children as young as 3 or 4 are receiving the diagnosis. The percentage of the general population thought to suffer from the disorder is between 0.4 percent and 1.6 percent, and those prevalence rates have not increased 40-fold like the diagnosis in children has.
Further, there are different types of Bipolar Disorders. Bipolar I Disorder is characterized by severe mood swings between mania and major depression. In Bipolar II Disorder the mood swings are between major depression and hypomania. In Cyclothymia mood swings are between lower grade depression and hypomania (a period of high energy that is not necessarily dysfunctional). These are not gradations of the same disorder and may in fact represent three different conditions.
We do not know why people get Bipolar I Disorder, but the evidence to date points to genetic vulnerability, which when triggered results in abnormalities in brain structure and function even at the cellular level including neurons and the cells that “insulate” neurons called glial cells. To date there is no physiological marker that can be tested to see if a person has Bipolar I Disorder.
Children who act out impulsively are also sometimes placed on mood stabilizing medication. Some in the psychiatric community working on the forthcoming diagnosis manual (DSM-V) believe that sub-threshold symptoms should be diagnosable and medicated despite a lack of evidence that this is a sound strategy. These “subthreshold symptoms” could very well include “acting out” behaviors which would place a large percentage of children under a “Bipolar Spectrum” diagnosis that leads to unnecessarilly medicating them.
What can parents do? First know, that there are no pediatric criteria for Bipolar I Disorder, and if someone suggests that diagnosis for your child demand evidence of thorough assessment and manic-depressive mood swings.
Second, if your child is prescribed a psychotropic medication ask specifically which “symptoms” or behaviors the medication is supposed to reduce and how long before that reduction is apparent.
Third, if your child is on a medication that is not reducing symptoms, advocate that the child be taken off the medication that is not working before being put on another. If a doctor suggests several medicines ask her what evidence (published studies) she has suggesting multiple medications would be useful.
While children do suffer from mental health disorders, the belief that Bipolar I Disorder has onset in childhood requires far more research support than it currently has. Parents have a right to advocate for their children and understand the evidence the doctor or mental health professional is relying on before allowing a diagnosis of Bipolar I Disorder for a child.