Between 1994 and 2003, the rate of outpatient visits for juvenile bipolar disorder rose a staggering forty-fold. Meanwhile, the experts continued to maintain that treating children with antidepressants and stimulants was not causing bipolar disorder, but was merely revealing a pre-existing condition. A 2004 paper in the Journal of Affective Disorders suggested "In children genetically determined to develop bipolar disorder, the use of antidepressants and stimulants may advance the onset of bipolar disorder even before puberty."
If all these drugs were doing was advancing the date of onset of bipolar disorder, that would be bad enough, but in fact, the proportion of both children and adults disabled by bipolar disorder has skyrocketed since the beginning of the modern psychopharmaceutical era. In his 2010 blockbuster work of non-fiction Anatomy of an Epidemic, author Robert Whitaker breaks it down. In 1955, the number of patients in the United States hospitalized for all affective disorders was 50,000. An estimated one out of four, or about 12,500, suffered from bipolar disorder. Today, some six million adults suffer from this disorder, and 83% of these are 'severely impaired" in one or more aspects of their lives. A condition that affected perhaps of 100 people out of one million now afflicts something like 40,000 per million.
What does the future hold? Again, Whitaker tallies up the toll for us. Assuming 25-50% of children treated for depression will go on to develop bipolar disorder, and multiplying this by the total number of children treated, he arrives at an estimate of 500,000 to one million cases of bipolar youth created by the antidepressant pathway.
What about stimulants? Using Wozniak's and Biederman's estimate of 11% of children treated for ADHD that go on to become bipolar, and multiplying this figure by the total number of children treated, he arrives at a figure of an additional 400,000 cases of bipolar youth created by the stimulant pathway.
Can this possibly be correct? In 2008, the Government Accountability Office reported over 600,000 bipolar children in the United States. That's actually a lowball figure, as it does not include children who were homeless, institutionalized, or incarcerated.
During the same period that diagnoses for juvenile bipolar disorder skyrocketed, prescriptions for antipsychotics skyrocketed as well. A 2006 paper in Ambulatory Pediatrics reported that between 1992 and 2002, prescriptions for antipsychotics to children rose 450%.
Psychiatrist David Healy analyzed RCT data for the antipsychotics Risperdal, Zyprexa, Seroquel, Serdolect, and Geodon. He found the rate of suicidal acts in the treatment arm was almost almost four times that of the placebo arm. There were no suicides out of 1,351 patients given placebo, whereas the 12,817 patients in the treatment arm included 33 completed suicides.
Or as Dr. Healy put it, graphically and succinctly, "When it comes to dead bodies in current psychotropic trials, there are a greater number of them in the active treatment groups than in the placebo groups. This is quite different from what happens in penicillin trials or trials of drugs that really work."
A 2006 paper in the British Journal of Psychiatry examined the relationship between antipsychotic drugs and death rates. After controlling for age, gender, somatic disease, and other risk factors, the researchers found that the death rate rose a whopping 250% for each additional antipsychotic drug prescribed.
In a telephone interview Dr. Healy blasted the idea that antidepressants and stimulants "unmask" a pre-existing mental illness. "There's absolutely no reason to think these pills reveal the underlying disorder," he told me. "That's just nuts." Much as drugs like cocaine are said to be "gateway drugs" leading to more dangerous drugs, he said ADHD has acted as a "gateway diagnosis" leading to more serious diagnoses and harmful treatments.
Indeed. The long-term prognosis for children diagnosed with bipolar disorder looks grim. Early-onset bipolar disorder is a particularly pernicious form of this condition, being associated with more psychotic features, more manic episodes, and higher rates of eating disorders, alcohol abuse, drug addiction, divorce, suicide, and violence. Many of these children exhibit what is called "ultra-ultra-rapid cycling," switching back and forth continuously between depression and mania.
For that matter, the prospects for adults with bipolar disorder don't look so great, either. Dr. Healy and his colleagues examined outcome data for patients with bipolar disorder in northwest Wales in the 1890's, before any of the modern psychotropic drugs were introduced, and compared them to data from the 1990's. In the intervening century, the population of northwest Wales had changed almost not at at all in terms of size, age composition, ethnicity, or rurality. But the number of bipolar patients had risen six times, and the median number of hospitalizations per patient increased by 50%. With proper scientific caution, Dr. Healy and his co-authors noted:
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"These data are incompatible with simple claims that mood stabilizing drugs 'work.'"
"If medical treatments are fully effective, the index condition should disappear, as general paralysis of the insane disappeared after the introduction of penicillin.
"Modern treatments [for bipolar disorder] appear to offer few benefits compared with treatment 100 years ago."
Two years later, a paper published by Harvard psychiatrists Nancy Huxley and Ross Baldessarini seemed to confirm all this. Few patients with adult bipolar disorder ever return to their pre-morbid level of functioning. After painting a bleak picture of divorce, unemployment, poverty, loneliness, and cognitive impairment that is the lot of too many of these patients, the authors write "Prognosis for BPD was once considered relatively favorable, but contemporary findings suggest that disability and poor outcomes are prevalent, despite major therapeutic advances."
Next: Part 6: Rebecca Riley
List of Sources
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Reichart, C.G. and W.A. Nolen 2004. Earlier onset of bipolar disorder in children by antidepressants and stimulants: An hypothesis. Journal of Affective Disorders 78:81-84.
Whitaker, R. 2010. Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and theAstonishing Rise of Mental Illness in America. Broadway Books.
Schürhoff F. et al. 2000. Early and late onset bipolar disorders: Two different forms of manic depressive illness? Journal of Affective Disorders 58:215-221.
Perlis, R. et al. 2004. Long-term implications of early onset in bipolar disorder: Data from the first 1000 participants in the systematic treatment enhancement program for bipolar disorder (STEP-BD). Biological Psychiatry 55:875-881.
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Birhamer, B. 2007. Longitudinal course of pediatric bipolar disorder. American Journal ofPsychiatry 164:537-539.
Cooper, W.O. et al. 2006. Trends in prescribing antipsychotic medications for US children.Ambulatory Pediatrics 6:79-83.
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Harris, M. et al. 2005. The impact of mood stabilizers on bipolar disorder: The 1890's and 1990's compared. History of Psychiatry 16:423-434.
Huxley, N. and R. Baldessarini 2007. Disability and its treatment in bipolar disorder patients. Bipolar Disorders 9:183-196.
