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Beyond the bipolar disorder dilemma

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BEYOND THE BIPOLAR DISORDER DILEMMA

by

Suvarna A. Bhatt

A Professional Project Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
MASTER OF ARTS
(ONLINE JOURNALISM)

May 2008

Copyright 2008 Suvarna Bhatt
ii

TABLE OF CONTENTS

Abstract...................................................................................................................... iii
Beyond the Bipolar Disorder Dilemma..................................................................... 1
Bibliography.............................................................................................................. 21
iii
ABSTRACT
Today, as many as 1 million American children are diagnosed with bipolar
disorder, and the number is growing rapidly. As a result, many parents are wrestling
with questions such as: How do I really know if my child has bipolar disorder? How
young is too young to medicate my child? And, can a wrong diagnosis be dangerous
or even deadly?
The bipolar surge is the most controversial area in child psychiatry today
because the disorder was traditionally thought to be an adult disorder, and because the
illness is treated with drugs that are approved for use in adults, but not in children.
A movement to increase drug testing in children is underway, and controversial
breakthroughs in genetic testing techniques are on the verge of entering the market.
However, a larger issue lies behind why the number of pediatric bipolar cases is on the
rise and cries out to be heard
1
Linda Peterson’s daughter was boisterous from the day she was born: she
hated being swaddled, resisted being on her back, and rarely slept. She was always
awake and ready to go. At the age of four, she became too difficult for her parents to
handle. “She was too strong-willed, stubborn, high-strung and smart,” Peterson said.
Peterson thinks she should have known something was different even before her
daughter was born. She could feel her baby kicking around at 18 weeks. “From that
point on, if I went an hour without feeling her, I was poking at her to make sure she
was OK,” Peterson said. The couple waited until their daughter was five to take her to
a child psychiatrist. It was then that she was diagnosed with Attention Deficit
Disorder, a popular diagnosis for hyperactive children who have difficulty
concentrating.
Now, three years later, she is diagnosed with a far more serious illness, bipolar
disorder, which not too long ago was unheard of in children. Peterson and her
husband were so consumed understanding their daughter’s new illness, that they didn’t
notice their son’s attention problems until they were approached by his preschool
teacher when he was four years old. “I felt awful,” Peterson said. “I didn’t take her
seriously at that point, because his symptoms were so mild compared to his sister’s
that I thought he was ‘normal.’” It was when he started kindergarten that he was
diagnosed with ADHD a few months ago.
In most ways, the Petersons are a typical, happy family: they have a solid
marriage, a supportive network, and a beautiful home in Florida. For a long time, they
were reluctant to accept their children’s diagnosis and waited until their daughter was
2
seven to medicate her. “I didn’t want to be the mom that put her kids on medication
because she was too lazy to parent them,” Peterson said. “I really feel like I tried
everything I could before we started meds.” Still, Peterson feels guilty about her
children’s illnesses. “I feel like I should have done something differently; that I could
be a better parent,” she said.
It’s taken a long time for Peterson’s husband, a surgeon, to accept the
diagnoses. Mental health issues are a “cut ‘em and fix ‘em issue” for him. “He’s not
convinced of their merit,” Peterson said. He thinks parenting is the root of the
problem, and if his wife was more strict and consistent with their kids, they’d be fine.
“He’s slowly coming around,” Peterson said. “He’s naturally suspicious of anything
you can’t prove with a scan, blood test, or other good science. It’s not easy and has
taken us a long time to find the best solution.”
The Petersons’ predicament reflects a larger trend facing American families.
Over the last 10 years, there has been a steep rise in the diagnosis and treatment of
childhood mental illnesses that include ADHD, bipolar disorder, depression and
anxiety. Bipolar disorder, formerly called manic depression, has drawn the most
controversy. Today, as many as 1 million children have been diagnosed with the
condition and the number is growing.
As a result, many families across the country are wrestling with questions such
as: How do I really know if my child has bipolar disorder? How young is too young
to medicate my child? And can a wrong diagnosis can be dangerous and even deadly?
3
The answers to these questions and many more are pertinent to more parents today
than ever before.
The increasing number of bipolar cases is worrisome because the illness is
usually treated with drugs that are approved for use in adults, but have not been tested
in children. While the widespread use of adult medication in children is alarming, the
larger issue is why the number of bipolar cases, traditionally an adult disorder, is on
the rise in American children.
Experts are not sure whether the prevalence of pediatric bipolar disorder is in
fact rising or whether there are other reasons behind the boom. Some are certain it’s a
sure sign that doctors are too aggressively diagnosing kids. Others fear that the culprit
is parents–frustrated by difficult children and swayed by today’s quick fix culture.
Many parents may incorrectly seek solutions for their moody but otherwise normal
child. Some kids are naturally peaceful and un-provocative, others are anxious, over-
react, have temper tantrums, and are aggressive if they don’t get their way.
Experts agree it’s extremely difficult to make a diagnosis in anybody under the
age of 10 because it’s challenging to distinguish whether a child’s acting out is normal
or whether it’s caused by a true physiological imbalance in the child’s brain. A lot of
children experience mood swings during the day and loose their temper often. “It’s
become quite fashionable to call those kids bipolar,” said Dr. David Shaffer, chief of
child psychiatry at Columbia University.
Bipolar is a type of mood disorder in which an individual experiences one or
more episodes of abnormally elevated mood, called mania, lasting at least one week.
4
Typically, episodes are “mixed,” meaning they are followed by periods of normal or
depressive moods. The disorder is cyclic and episodes can last 3 to 6 months. Late
adolescence and early adulthood are peak years for the onset of the illness.
Peterson says her daughter seems to fit the criteria for bipolar, except her
episodes cycle much faster, sometimes within a couple of hours or by the end of the
day. “She’s a brilliant little girl, straight ‘A’ student, incredibly talented artist, and
very creative,” Peterson said. “She also turns from a happy, sweet kid to a possessed
monster at the drop of a hat.”
When her daughter’s moods escalated into hitting, scratching, and throwing
things at Peterson in addition to verbal lashing out, her doctor diagnosed bipolar
disorder and prescribed Abilify, an adult antipsychotic medication that works by
changing the actions of chemicals in the brain. As of now, Peterson is not noticing
any improvement with her daughter’s relatively low dose.
Bipolar disorder was long believed to exist only in adults, until a series of
studies published in 1996 by Dr. Joseph Biederman, Chief of Clinical and Research
programs in pediatric psychopharmacology, and adult ADHD at the Massachusetts
General Hospital, and professor of psychiatry at Harvard Medical School.
Biederman, the second highest producer of psychiatry papers in the world, took
the criteria for ADHD and compared them to the criteria for bipolar disorder. He
theorized that many children with ADHD were actually being misdiagnosed. In fact,
his study found a stunning 23 percent of the ADHD population also met the criteria for
bipolar disorder. “He put forward an idea that was widely criticized, but nevertheless,
5
became attractive to people,” Shaffer said. Since Biederman’s study, there has been a
dramatic increase in the number of pediatric bipolar cases, and gradual steadying in
the number of reported ADHD cases.
In September 2007, a Columbia University study found the number of children
treated for bipolar increased 40-fold in the United States just between 1994 and 2003.
The estimated annual number of office-based visits of children with bipolar increased
from 25 between the years 1994-1995 to 1,003 visits in 2002-2003 per 100,000 in the
population. The Columbia researchers also found that children were likely to receive
a dual diagnosis of ADHD and bipolar disorder. They found 86 percent of patients
received psychotropic medication during their visits.
But, there are doubts about what the results of this new study mean. Even Dr.
Mark Olfson, the lead author of the study and clinical psychiatry professor at New
York State Psychiatric Institute, isn’t sure the findings of his own investigation
demonstrate an actual increase in the number of children with bipolar disorder.
“There is no evidence the rate of bipolar disorder has changed in the population,”
Olfson said. “My strong sense is there’s significant over-diagnosis of bipolar in young
people.”
Significant problems stand in the way of accurately diagnosing bipolar
disorder, which may account for the staggering number of cases. One of the biggest
controversies about making the diagnosis in children is that the disorder falls under the
adult illnesses category in the official manual used in the United States for psychiatric
diagnosis, called the Diagnostic Statistical Manual, (DSM-IV).
6
There is, in fact, no such thing as pediatric bipolar disorder in the manual.
“Nobody’s shown any evidence that the condition that’s getting the name pediatric
bipolar is related to bipolar,” Shaffer said. For that reason, he doesn’t think bipolar
disorder will ever fall under childhood diagnosis in the DSM. Shaffer says a lot of
people are calling excessive childhood moodiness juvenile bipolar, but they have yet
to demonstrate that the condition they’re describing is really related to bipolar
disorder. “It might be something entirely different,” he said. Because of these
inherent difficulties, Olfson says more attention needs to be devoted to developing
criteria for bipolar disorder that are specific to children and adolescents. In pediatric
cases, symptoms often present differently than they do in adults. As with the
Peterson’s daughter, cycling between depression and mania can occur very quickly,
sometimes within the same day or the same hour while in adults, as much as 6 months
can lapse between manic and depressive episodes.
Certainly, some of the increase in bipolar disorder diagnosis may be accounted
for by the broadening of the official definition for bipolar that took place in 1994.
Until then, there was only the classic definition, in which a patient experiences
episodes of mania, including grandiosity or euphoria, and then spirals in the opposite
direction exhibiting extreme irritability and hostility. This was renamed bipolar I and
three new variations to the disorder were added called bipolar II which is a milder
form of bipolar I and cyclothymic disorder in which mood-swings are more subtle. A
fourth, more controversial category was also established called bipolar disorder not
otherwise specified (NOS), a catch-all category for people who don’t meet the other
7
criteria. Doctors make this diagnosis when it’s not clear which type of bipolar
disorder is emerging. Adding new categories may have increased confusion in an
already nebulous situation.
“Broadening the criteria to include the not otherwise specified category is a
subtle change that opened the door for increasing bipolar diagnosis,” said Dr. Lisa
Cosgrove, a clinical psychologist at the University of Massachusetts, Boston.

“Whenever you increase the symptomology, you increase the prescription pool,”
Cosgrove said.
However, those who argue that bipolar disorder is a legitimate childhood
illness don’t believe defining the bipolar NOS category is contributing to over
diagnosis. “These children are just as impaired [as those with classic bipolar
disorder]” said Susan Resko, executive director of the Child and Adolescent Bipolar
Foundation, an advocacy group for families with bipolar children. “They need to be
diagnosed and treated every bit as much as those meeting the traditional criteria for
bipolar.”
Further increasing the chances of misdiagnosis, symptoms of bipolar disorder
overlap those of other disorders such as ADHD, depression, and even schizophrenia.
Children with ADHD and bipolar disorder both exhibit emotional volatility, inability
to concentrate and impulsivity such as ripping up bits of paper. It can be difficult to
distinguish between normal restlessness, the fidgeting of children with ADHD, and the
hyperactivity of mania. Similarly, because of overlapping symptoms, children with
8
bipolar disorder are often misdiagnosed with depression since it is one phase of
bipolar disorder that could last weeks or months before cycling to a manic episode.
Misdiagnosing and treating only the depressive side of bipolar disorder can
have serious implications when it comes to the prescription of medication as it did
with Katrina Williams. Williams, a young mother living in Orange County,
California, was diagnosed with depression when she was 17. and was prescribed the
anti-depressant Paxil. Her depression eased over the next six years of her life, but she
became increasingly aggressive and violent towards her then-husband. “I felt like I
wanted to explode,” said Williams. The first year Williams sought help, she was
prescribed 10 different drugs. “My doctor just kept saying, ‘Let’s keep trying
something new if nothing works.’ I don’t think she knew what was happening to me.”
Williams slowly began to wonder why her medication wasn’t working. The problem
was Williams’ doctor was prescribing drugs to treat her depression, but didn’t observe
the manic part of her illness, which manifested in rage and verbal abuse toward her
husband. “I just haven’t been treated with the right drugs,” she said. Early this year,
Williams was re-evaluated by a psychiatrist and diagnosed with bipolar disorder. She
is now on mood stabilizing drugs that have helped treat both sides of her disorder.
A large part of the confusion over differentiating debilitating, but quite distinct
mental illnesses is the result of inadequate information. Still very little is known about
the disease, how it manifests, and what exactly causes it. Bipolar disorder was first
characterized as manic-depression in 1913. Only in the early 1970s, were laws
enacted and standards established to help those afflicted with the disorder. A change
9
in public attitudes towards those with mental illnesses also took place, and the
founding of the National Association of Mental Health (NAMI) in 1979 brought even
greater national awareness and research.
Among the consequences of increased research, studies suggest that genetics,
early environment, and neurobiology all contribute to bipolar and most scientists now
agree the debilitating illness has no single cause. It is known that there is a strong
genetic component to developing bipolar because it tends to run in families. In recent
years, researchers have been searching for specific genes–the inherited units of DNA
that determine how our body develops–that may increase a person’s chance of
developing a mental illness.
However, studies of identical twins, who share the same genes, have shown
genes are not the only factor. If the condition was caused entirely by genes, then the
identical twin of someone with the illness is guaranteed to develop the illness, and this
is not the case. According to a 2004 study published in the American Journal of
Psychiatry, if one twin has the disorder, than the other has only a 40 percent likelihood
of having the disorder as well. Still, if one twin has bipolar, the other is more likely to
develop the illness than is another sibling.
Uncovering the genetics behind bipolar is a very complex topic because the
exact genes associated with the disease haven’t been pin-pointed yet. Also, it appears
that many different genes act together and in combination with the environment to
cause bipolar disorder. A 2007 study spearheaded by the National Institutes of Mental
Health identified a number of genes likely to be involved in the expression of bipolar
10
disorder, confirming bipolar disorder may be a polygenic, meaning inheritance of the
disease may be due to the interaction of two or more genes.
Still, the genetic avenue is a hot and promising area to many researchers. In
2003, researchers published a study of 428 families that found a mutation in the GRK3
gene was associated with roughly a three-fold increase in the risk of bipolar disorder.
However, the mutation was rare and found only in 3 percent of those with bipolar
disorder and in 1 percent unaffected by the disorder, implying it’s not a main cause for
the illness.
In spite of this, scientists are close to developing gene tests for psychiatric
disorders. One of those is Dr. John Kelsoe, a psychiatric geneticist at University of
California, San Diego, who is author of the study that found a variant on the GRK3
gene is a possible cause for bipolar–he is also now chief scientific officer of a new
biotechnology company in San Diego, California, called Psynomics, Inc., which
announced in February that it’s one of the first to offer genetic tests for bipolar
disorder. While some have seen this as psychiatry’s breakthrough into genetic testing,
it has also raised suspicions. The new bipolar disorder test is sold directly to patients
from the company’s website for $750. The customer receives a small kit in the mail
that collects and preserves a saliva sample which is then mailed to a UCSD lab for
genetic testing. The DNA results are then sent back to the company for analysis. A
designated physician later receives the results, which are explained to the customer.
Kelsoe urges the test is only for people that have a psychiatric illness, but who are
unclear about their diagnosis. He stresses the test is only for adults and adolescents.
11
But since it can be purchased over the Internet, there is a chance it may be used for an
unintended population, such as children. According to Kelsoe, the genetic test is
easily available to the general public in part due to a broader movement going on right
now to “empower patients and give them more access and control over their medical
information,” he said.
Kelsoe knows he and his company are under a lot of scrutiny, especially from
the psychiatric community. And he admits a single variation in the gene may only
apply to a small patient population. However, Kelsoe says, given the average 7 years
lapse between first symptoms and accurate diagnosis of bipolar disorder, “GRK3 and
other gene tests can now aid the doctor in making the correct diagnosis of bipolar
disorder earlier in the course of a patient’s illness,” he said.
Some practitioners think it’s still too early for a marketed gene test for
psychiatric disorders. Dr. Alan Soloman, a psychologist with a private practice in
Torrance, California, says diagnosis methods need to improve but he’s not sure
genetic tests that are sold directly to patients are the right solution just yet. “It’s too
early to market a test that doesn’t have strong data behind it,” Soloman said. “There’s
still no definitive gene variant found to cause bipolar disorder, as there have been for
other genetic diseases such as breast cancer or cystic fibrosis,” Soloman reasons.
However, a product directed at patients may have a large market among people
that are trying everything they can for an accurate diagnosis. Some parents think
genetic tests would help eliminate the confusion that goes along with diagnosis. Elsa
Pearson, living in Milpitas, California, suffers from major depression and her
12
daughter, 18, has panic disorder. Pearson went undiagnosed for many years and
wishes she had a remedy for her mental illness earlier in life. Pearson was 13 when
she first realized she was always sad, but she waited until she was in college to finally
seek help and received treatment for her depression. “I didn’t know what I was going
through for a long time, I thought it was just me, just the way I was,” Pearson said.
She says she would give genetic tests a chance because the “repercussions of having a
mental illness are bad enough,” Pearson said. “A chance for early diagnosis would be
a major break-through.”
Unfortunately, the volatile mood swings associated with bipolar disorder can
only be treated with medications that often haven’t been tested for safety in children.
The danger of prescribing untested drugs to children grabbed national attention a year
ago with the story of Rebecca Riley in Hull, Massachusetts. Rebecca was diagnosed
with ADHD at the age of two and bipolar disorder at the age of three. She was
prescribed three powerful drugs by a licensed child psychiatrist at Tufts-New England
Medical Center. Rebecca was taking clonidine, a blood pressure medication that is
used “off-label” to calm children, valproate, a mood stabilizer and anti-convulsant and
quetiapine fumarate, an anti-psychotic to stabilize her mood. Off-label means that the
drug is being used for a purpose other than the indication approved by the United
States Food and Drug Administration. None of the drugs Rebecca was taking were
approved by the FDA for use in children, for any purpose. She was four years old
when she died of an overdose of these medicines last year. Experts in the field like
Olfson at the New York State Psychiatric Institute say he has “no idea” how a child as
13
young as Rebecca Riley was diagnosed with bipolar and prescribed these medications.
“I’m not saying those kids don’t have a disturbances–they do, the reason we have to
be careful what we label them is because of cases like the Rebecca Riley,” Olfson
said.
Generally, doctors aren’t required to disclose to a patient or their parents
whether a drug is being prescribed off-label or not. The practice is common amongst
doctors and is usually done with backing of scientific data and often reflects the latest
research trends. However, the problem with using drugs off label in children
compared to drugs which have been approved for a particular indication is often
adequate evidence. “Off-label drug use isn’t necessarily a bad thing,” said Dr. Randall
Stafford, associate professor of medicine at Stanford University. “But it mandates the
use of those drugs be restricted to situations where other drugs have been tried first–
drugs that are approved for the particular situation and the clinical circumstances
actually warrant it.” Stafford cited the example of Avastin, a drug approved for lung
and colon cancer that has also been used successfully to treat breast cancer patients for
many years. The drug received formal approval for its use in breast cancer just this
year. Avastin is also popularly used off-label for the treatment of patients with an eye
disease called wet age related macular degeneration. Sometimes doctors use a drug
off-label simply because the drug approval process is arduous and patients requiring
medication simply cannot wait for its FDA approval. In other instances, doctors have
to experiment with a medley of powerful medications before one that is tolerated is
found. “If none of the other drugs are approved for children, the physician has a tough
14
decision to make,” Stafford said. “I’m not going to stand here from a distance and say
what’s right or wrong.” Certainly, Stafford thinks parents should be aware that there’s
some uncertainty with off-label medication and they should take the potential risks
seriously.
With so many drugs on the market, finding the right drug to work can take a
long time. “It’s actually a leap of faith using a drug,” Stafford said. The result is that
small children are put on heavy medications and the effect of the drug on the child’s
brain is unknown.
In adults, bipolar disorder has traditionally been treated with drugs such as
lithium. But now, doctors are increasingly prescribing newer medications called
atypical antipsychotics. In children, the FDA has officially approved only a handful of
psychiatric medicines for use, and many children like Rebecca Riley, are prescribed
antipsychotics off-label which have unknown efficacy and well-understood risks.
Anti-psychotics have a black box for elderly people with dementia but no
warnings for kids because there isn’t any known data that suggest they increase
suicide risk. “That doesn’t mean they might [increase suicide risk],” said Robert
Temple, Director of Medical Policy and the Director of the Office of Drug Evaluation
at the FDA, who has final authority on new drug approval. “But we need data to put a
black box warning on a drug.”
Officials at the FDA have been aware for years about the lack of research on
child medications, but they say more medications are being tested in children today
then in the past. “It’s perfectly true that until the last 10 years, it was very unusual to
15
carry out studies in a pediatric population,” Temple said. “But, drug companies aren’t
reluctant to do studies on children any more.”
The former reluctance was based on two factors, the first being the obvious
ethical concerns. “It’s dicey to conduct studies in children–people get very nervous
about it if anything bad happens,” Temple said. “And the market in children is very
small so there’s no particular economic incentive to conduct clinical trials,” Temple
said.
But more recently, a law that went into effect in 1997 called the Best
Pharmaceuticals for Children Act (BPCA), has made it much more likely that drug
companies will carry out further testing on children once a drug is approved for adults.
One of the goals of the BPCA is to get actual data about how children react to
approved drugs so clinicians can make better decisions about what drugs to prescribe.
The BPCA also offers drug companies lucrative patent extensions as an
incentive to conduct more clinical trials in children. If drug companies do the
pediatric studies the FDA requires, they get a 6-month patent extension. This patent
exclusivity means the same drug cannot be made into a generic drug from a rivaling
drug company.

Results of these studies are always included in the “pediatric use”
section of the labeling. For example, the anti-convulsant medication Depakote is
frequently prescribed to children who have rapid cycling between mania and
depression. The pediatric use section of the drug’s label states that the safety and
effectiveness of the drug for migraine and for seizures in children under ten has not
been established.
16
Temple admits it would be “unusual” for a parent to actually read the package
insert, because it’s not written in a way that’s easy to understand by the general public.
If there’s something worrisome about a particular drug, it would be found in the med-
guide, information directed to the patient or the patient’s care-giver when medicine is
picked up at the pharmacy; it can also be found on the Internet.
According to Decision Resources, one of the world’s leading research and
advisory firms for pharmaceutical issues, the expiration of patents will be the most
significant factor in decreasing market sales of bipolar disorder medications including:
Eli Lilly’s Zyprexa, Janssen’s Risperdal, Bristol-Myers Squibb’s Abilify and Pfizer’s
Geodon from $5.7 billion in 2006 to $5.3 billion in 2016 in the world’s major
pharmaceutical markets. This is why patent extensions for expensive drugs like
psychiatric medications are worth a lot, giving them extra time to market the drug. “A
single extension could mean as much as a billion dollars; their [drug company’s]
enthusiasm for doing these trials went through the roof,” Temple said.
As a result of the 1997 legislation, pharmaceutical companies launched as
many as 200 studies on psychiatric drugs used in children including anti-psychotics.
The results suggest that many of the medications, such as Paxil and Effexor, don’t
work very well in children. Out of the 10 antidepressants used in pediatric populations
the only one that showed good evidence of effectiveness was Prozac. “The others had
some tendency towards positive results but we have not approved pediatric use in any
of them,” Temple said.
17
Clearly, the interest of big pharmaceutical companies to make profits from
drug sales cannot be easily separated from their outward desire to research and
approve new drugs. Last year, bipolar and schizophrenia medications brought in $12
billion in sales. “Psychotropic drugs are the pharmaceutical industry’s most lucrative
product,” contends Cosgrove of University of Massachusetts, Boston. Cosgrove led a
study that found strong financial ties between the pharmaceutical industry and
members of the panel responsible for revisions to the DSM-IV, the key psychiatric
diagnosis manual.
Her research showed of the 170 DMS panel members, 56 percent had one or
more financial associations with companies in the pharmaceutical industry. A
stunning 100 percent of the members of the panels on mood disorders, schizophrenia
and other psychotic disorders had financial ties to drug companies. “Pharma
companies have a definite industry impact on prescribing practices,” Cosgrove said.
“There needs to be greater transparency on the part of the drug companies.”
Cosgrove argues drug makers and their psychiatrists have been encouraging
doctors to actually look for the disorder in children, since several drugs were approved
to treat illnesses like bipolar disorder. In August 2007, for example, the FDA
approved Risperdal to treat bipolar in children. Cosgrove says the approval will
increase the use of Risperdal in young people and ultimately contribute to the use of
medications and the so called “bipolar surge.”
Now, drug companies are the primary supplier of information to both patient
and doctor. Pharmaceutical sales representatives work hard to educate doctors about
18
new medications and drug advertising litters television and are ubiquitous in
prestigious psychiatric medical journals. The pervasiveness of the advertising, critics
like Cosgrove say, influences doctors and their prescribing.
Parents are worried about the pharma connection as well, and often for very
good reasons. “The pharma industry is in bed with physicians,” said Susan Slings, the
mother of child diagnosed with bipolar disorder who attends a support group for
families of bipolar patients held in Huntington Beach, California, “Doctors don’t want
to solve the problem; they just want to refill prescriptions.” Slings said her daughter,
28, is over-medicated by the drugs her doctor prescribes. Along with six other
medications, her daughter takes oxicodine, a narcotic which both patient and doctor
think helps her fatigue. But Sling, who is burdened with her adult-child’s daily living
and care thinks “It just leaves her drugged up,” she said.
Slings case does not hold true for every family. In general, the consensus in
the medical community is that both parents and doctors are reluctant to give
medication to young children. “I think there’s quite a lot of resistance to giving
medication to children in the U.S.” Shaffer said. “Drugs in this country consistently
get a bad press.” However, it’s the handful of cases across the nation where parents
are eager to find a quick fix to their child’s mood problems through a magic pill that
are troublesome.
Dr. Debbie Hutchinson, director of the outpatient bipolar partial hospitalization
program at St. Joseph’s hospital in Orange, California, says there is “no question,”
parents come to her for a solution. “They just throw up their hands and don’t know
19
what to do,” Hutchinson said. “It’s the clinicians that are stuck to make a decision
when a kid is bouncing of the walls–what doctor isn’t going to try a little medication?”
For desperate parents who want simply that their children lead normal lives,
trying medication to remedy their behavior is worth it. Those parents are not
concerned about the dangers associated with drugs because for them, erratic behavior
and bouts of depression could be a question of life and death. For them, the focus is
on how medication might actually help. “We weren’t worried too much about the side
effects because we were just looking for something that worked,” Pearson said. “We
had no other choice.”
Moving toward a biomedical model for treatment of diseases, part of a larger
trend affecting all medicine, is contributing to increased prescription of drugs. “If you
can help a child having difficulty in school by giving them medication that helps them
focus, you don’t want to miss that opportunity either,” said Elizabeth Keschull, a crisis
counselor at the University of Southern California. “It’s a very tricky question, as a
society we are becoming more comfortable with medications, maybe too
comfortable.”
Giving kids the tools they need to express themselves, talk about their feelings,
and reflect, integral parts of a child’s mental and social development, are often
neglected in today’s fast-pace life styles, according to Keschull. “People want an easy
fix instead of searching for the answer,” Keschull said. “Sometimes that’s a lot harder
then giving medication.” Shaffer agrees, and says the “tablet becomes very inviting”
20
when parents don’t have access to a really good behavior therapist who might be able
to bring about a big improvement.
Still, because genetics, environmental factors, and stress can trigger mental
health issues among the youth, experts say these factors all need to be analyzed
carefully before arriving at a diagnosis and prescribing powerful medication. As the
debates about diagnosing and medicating children continues to spread across the
country, and as more and more cases are being reported and discussed, parents of
young children with bipolar disorder hope that their children will one day become
successful members of society. “I have high hopes,” Peterson of Florida said about
both her daughter and son. “My daughter is so much like my husband and he’s an
overachiever–I hope she’ll use her strong personality to her advantage in the future.”
Peterson has finally accepted that bipolar disorder is a chronic condition. “If that’s
what my daughter has, so be it. I don’t look at it any differently that being a diabetic or
having high blood pressure.”
21
BIBLIOGRAPHY

Abel, David. “Hull Parents Arrested in Girl’s Poisoning Death.” The Boston Globe 6
February 2007.

Cosgrove, Lisa. Telephone Interview. 6 December 2007.

Hutchinson, Debbie. Personal Interview. 9 November 2007.

Kelsoe, John. Telephone Interview. 13 March 2008.

Keschull, Elizabeth. Personal Interview. 21 September 2007.

Olfson, Mark, MD. Telephone Interview. 24 September 2007.

Pearson, Elsa. Personal Interview. 28 December 2007.

Peterson, Linda. Personal Interview. 7 December 2007.

Shaffer, David. Telephone Interview. 9 January 2008.

Soloman, Alan. Telephone Interview. 14 November 2007.

Slings, Susan. Personal Interview. 23 November 2007.

Stafford, Randall. Telephone Interview. 9 January 2008.

Temple, Robert. Telephone Interview. 12 January 2008.

Williams, Katrina. Personal Interview. 20 November 2007.

Abstract (if available)

Abstract Today, as many as 1 million American children are diagnosed with bipolar disorder, and the number is growing rapidly. As a result, many parents are wrestling with questions such as: How do I really know if my child has bipolar disorder? How young is too young to medicate my child? And, can a wrong diagnosis be dangerous or even deadly?

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Asset Metadata

Creator Bhatt, Suvarna A. (author)

Core Title Beyond the bipolar disorder dilemma

School Annenberg School for Communication

Degree Master of Arts

Degree Program Journalism (Online Journalism)

Publication Date 04/26/2010

Defense Date 04/01/2008

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag bipolar disorder,OAI-PMH Harvest

Language English

Advisor Cole, K. C. (committee chair), Pato, Michele (committee member), Pryor, Lawrence (committee member)

Creator Email suvarnab@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-m1198

Unique identifier UC1292291

Identifier etd-Bhatt-20080426 (filename),usctheses-m40 (legacy collection record id),usctheses-c127-59466 (legacy record id),usctheses-m1198 (legacy record id)

Legacy Identifier etd-Bhatt-20080426.pdf

Dmrecord 59466

Document Type Project

Rights Bhatt, Suvarna A.

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Repository Name Libraries, University of Southern California

Repository Location Los Angeles, California

Repository Email cisadmin@lib.usc.edu