WhatFinger


A mania for drugging children: Part 3

Accident prone



A paper published in the April 1976 issue of the Journal of Diseases in Childhood described five cases of childhood mania. All the children described came from obviously troubled families. In three of the five cases the authors explicitly state that the mania did not develop until after the children had begun taking stimulants or antidepressants. The five case histories give us poignant glimpses into the lives of these children. A fifteen-month-old toddler, born to a mother with a history of episodic depression, became jealous of her baby sister, and would hit the baby and steal her bottle. The paper doesn't mention whether the child (or her mother) was offered any kind of therapy or counseling to help deal with the flood of feelings that must inevitably accompany the arrival of a new family member. Instead, the toddler was treated first with diphenhydramine, then dextroamphetamine, then nortriptyline, then phenobarbital. After the phenobarbital was discontinued, the child was kept on nortriptyline, at which point she experienced her first episode of full-blown mania, characterized by unintelligible speech, insomnia, hyperactivity, irritability, and delusional fantasies (pretending to be an airplane, she crashed into a wall and sustained two scalp lacerations). She was switched to Elavil, which made her condition worse, and then to thioridazine. Finally the mother discontinued all the drugs, and within a month the child's behavior became normal and remained that way at the time of follow-up at five years.
The most remarkable thing about this paper is the authors' utter lack of curiosity regarding the life circumstances that may have caused these distracted, confused, despondent, or enraged children to feel distracted, confused, despondent, or enraged. A three-year-old boy sustained fractures of both forearms along with several ribs and toes; the authors label him "accident-prone." A thirteen-year-old boy became manic after being dosed with Elavil and accused his doctors of poisoning him; the authors interpret this behavior as further evidence of his mental illness. In the ensuing years, the number of children being prescribed antidepressant and stimulant medication soared, and so did the number of children diagnosed with bipolar disorder. Could there be a cause-and-effect relationship? Mania is an acknowledged toxic effect of antidepressant medication, and many children who receive a diagnosis of depression go on to become manic. A 1982 paper in Archives of Psychiatry reported that in a sample of 60 adolescent children aged 13 through 16 who were diagnosed with depression, 20% developed bipolar disorder within four years. A 1994 study in the Journal of Affective Disorders surveyed members of the National Depression and Manic-Depressive Association who suffered from bipolar disorder and found that 28% of them were diagnosed with depression prior to the bipolar diagnosis. That same year, a study by Barbara Geller and colleagues published in the Journal of the American Academy of Child and Adolescent Psychiatry looked at 79 children diagnosed with major depressive disorder. They found that that children given tricyclic antidepressants, or TCA's (the class of drugs including Elavil, which Anne's son William had been taking) were 40% more likely to develop bipolar disorder than children who were not, although the difference did not rise to the customary 5% level of significance. Would a larger sample size have revealed a significant difference? The authors never consider this possibility, nor do they mention that their own data show that children given tricyclics were 580% more likely to develop the most severe form of bipolar disorder, known as BP I, than those who were not. (And yes, the difference was statistically significant.) They also never mention whether the children who did not receive TCA's were ever prescribed any other kind of psychotropic medication. Another study published in JAACP the following year looked at 26 bipolar youths and found that 21 of them, or 81%, had been diagnosed with affective disorder before receiving a diagnosis of bipolar. That same year a paper in the Harvard Review of Psychiatry by Gianni Faedda, Ross Baldessarini, and their colleagues estimated that 21% of children treated for depression will go on to become bipolar.

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What about stimulants? Mania is also an acknowledged toxic effect of stimulant medications which are commonly prescribed to children labeled as having Attention-Deficit Hyperactivity Disorder, or ADHD. Janice Wozniak and Joseph Biederman of the Pediatric Psychopharmacology Unit at Massachusetts General Hospital and Harvard Medical School examined 140 children referred for ADHD and found that 11% of them also met the criteria for bipolar disorder. Four years later, an addition 12% were found to be bipolar, for a total of 23%, or nearly one out of four children originally labeled ADHD--and remember, juvenile bipolar disorder was virtually unheard of just a few years previously. The May 1999 issue of JAACP featured a letter from Martha E Hellander, Acting Executive Director of the Child and Adolescent Bipolar Foundation, and Tomie Burke, Founder of Parents with Bipolar Children, who stated "Most of our children initially received the ADHD diagnosis, were given stimulants and/or antidepressants, and either did not respond or suffered symptoms of mania such as rages, insomnia, agitation, pressured speech, and the like...First hospitalizations occurred often among our children during manic or mixed episodes (including suicidal gestures and attempts) triggered by or exacerbated by treatment with stimulants, tricyclics, or selective serotonin reuptake inhibitors." Nevertheless, the proponents of these drugs maintained that stimulants and antidepressants did not cause bipolar disorder, but merely revealed the presence of an already-existing condition. The aforementioned Dr. Gellar wrote: "The possibility that TCA use is part of the pathogenesis of mania or hypomania is not at issue. Rather, TCAs may precipitate or determine the timing of the clinical manifestation of mania." The logic underlying this conclusion was not explained.

Next: Part 4: "A healthy productive life" List of Sources
  • Weinberg, W.A. and R.A. Brumback 1976. Mania in childhood: case studies and literature review. American Journal of Diseases of Childhood 130:380-385.
  • Strober, M. and G. Carlson 1982. Bipolar illness in adolescents with major depression. Archivesof General Psychiatry 39:549-555.
  • Lish, J.D. et al. 1994. The National Depressive and Manic-depressive Association (DMDA) survey of bipolar members. Journal of Affective Disorders 31:281-294.
  • Geller, B. et al. 1994. Rate and predictors of prepubertal bipolarity during follow-up of 6- to 12 year-old depressed children. Journal of the American Academy of Child and Adolescent Psychiatry 33:461-468.
  • Kovacs, M. and M. Pollock 1995. Bipolar disorder and comorbid conduct disorder in childhood and adolescence. Journal of the American Academy of Child and Adolescent Psychiatry 34:715-723.
  • Faedda, G., R. Baldessarini et al. 1995. Pediatric-onset bipolar disorder: A neglected clinical and public health problem. Harvard Review of Psychiatry November/December 1995 pp. 171-195.
  • Wozniak, J., J. Biederman, et al. 1995. A pilot study of childhood-onset mania. Journal of the American Academy of Child and Adolescent Psychiatry 34:1577-1583.
  • Biederman, J. et al. 1996. Attention-deficit hyperactivity disorder and juvenile mania: An overlooked comorbidity? Journal of the American Academy of Child and Adolescent Psychiatry 35:997-1008.
  • Hellander, M. and T. Burke 1999. Children with bipolar disorder. Journal of the American Academy of Child and Adolescent Psychiatry 38:495.


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Patrick D Hahn -- Bio and Archives

Patrick D Hahn is the author of Prescription for Sorrow: Antidepressants, Suicide, and Violence (Samizdat Health Writer’s Cooperative) and Madness and Genetic Determinism: Is Mental Illness in Our Genes? (Palgrave MacMillan). Dr. Hahn is an Affiliate Professor of Biology at Loyola University Maryland.



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