Children With Bipolar Disorder: Medical Fact or Dangerous Fad?
Exactly, says Weller. To date, according to her, none of the drugs being used to treat bipolar disorder has been tested and proven superior to a placebo in good clinical trials. "Why would you expose children to medications for which you don't even know the long-term effects on the developing central nervous system?" she asks. Caution should be the operative word.
Yes, say both experts, the bipolar disorder is real. And yes, it's important to catch it early, as delayed diagnosis and treatment can mean a worse long-term outcome. But there is certainly no pediatric bipolar disorder epidemic. "[Bipolar disorder] affects 1% of the adult population, 1% of the adolescent population, and we don't know, but we guess that it's also 1% of the prepubescent population," says Weller. "So it's there, but the chance of an average doctor seeing a lot of cases is very low."
So why the sudden hysteria? Weller tells WebMD that it's a combination of factors. "Twenty years ago when we first described pediatric [bipolar disorder], no one believed that these kids existed. Now any child throwing a severe tantrum is shipped to the doctor to see if they are bipolar. Parents are desperate to get help, and clinicians are willing to do whatever it takes to get these kids to settle down."
And the current system isn't helping, she says. "With managed care, doctors can't possibly take the time they need to get to the bottom of a child's behavioral problems, and you can't make the proper diagnosis in the allotted one or two hours." Furthermore, some doctors may be stepping outside the bounds of their expertise. "There are really very few experts in this field," Weller says. While "follow-up can be done by a less-experienced doctor," a pediatric bipolar diagnosis should always be made by a specialist.
"My recommendation is that we be very careful," says Rosenfeld. "There are young kids that carry a biological vulnerability for bipolar disorder, and hopefully in the future we'll be better able to distinguish them. What we need right now is public calm, so we don't overdiagnose this and put kids on medications that are really contrary to their best interests."