The bipolar brain is miswired

A mania for drugging children: Part 7

Health and Medicine | Comments | July 31, 2016

In the year following the death of Rebecca Riley, Newsweek magazine, which had already published not one but two laudatory cover stories on Prozac as well as a puff piece on childhood depression, weighed in with yet another cover story, "Growing up bipolar: Max's world," which told the story of Max Blake, a boy who suffered from temper tantrums, attacking teachers and playmates without warning, biting and kicking and spitting at them. When Max reached the age of two, his parents took him to the Tufts-New England Medical Center, the same institution where Rebecca Riley was diagnosed and treated for bipolar disorder. Not surprisingly, Max also was diagnosed as bipolar by the doctors, who prescribed Depakote, and then Zyprexa, then another medication and then another. By the time Max was ten years old his doctors had prescribed a total of thirty-eight different psychotropic drugs. At the age of twenty-eight months he was kicked out of day care. Later he was kicked out of the special-needs classes at the local public school and sent to a special school for troubled children. He suffered rages, weight gain, and tics, blinking his eyes, clearing his throat and pulling at his clothes like he wanted to get out of his skin. He accused his mother of poisoning him; the article describes the boy's accusations as "delusional and paranoid." "The bipolar brain is miswired," the article informs us, without adducing a shred of evidence for this assertion. The article goes on to admit there are no studies on the long-term effects of psychotropic medications on children, then tells us "Yet untreated bipolar disorder can be disastrous; 10 percent of sufferers go on to commit suicide," begging the question of how many of those 10% were "untreated" (i.e., undrugged). Any of them? Then we are told "Parents must choose between two wrenching options: treat their children and risk a bad outcome, or don't treat and risk a worse one." But since the author has already told us that there are no long-term studies on the effects of medication on these children, that second clause is a preposterous non-sequitur. We don't have any reason to believe that drugging these children decreases the likelihood of a bad outcome.

Later we are told "The bipolar brain tries to compensate for its weak prefrontal cortex by roping in other areas to help; these areas may now become dysfunctional, too." Again, not a shred of evidence is adduced for this astonishing statement. Finally we are offered this tepid endorsement of psychotropic medication by Dr. Janice Wozniak, a protégé of Joseph Biederman of the Pediatric Psychopharmacology Unit at Massachusetts General Hospital and Harvard: "With kids like Max, she adds, parents often have to settle for 'just having one part of the symptoms reduced.'" At the time the article was written, Max had reached the age of ten, and his condition seemed to be stabilizing. He still was in special-needs classes, and he still exhibited violent tantrums, but he also had made a friend his age, and was taking lessons in horseback riding and karate. The article tells us Max had never acted out in karate class. Perhaps this is because Max's doctors have finally hit upon the right combination of medications for him, or perhaps this is because Max is finally growing up, as most of us eventually do. The article doesn't say. The week after the Newsweek article came out saw the release of Is Your Child Bipolar? by the aforementioned Dr. Wozniak along with Mary Ann McDonnell, a board-certified advanced- practice registered nurse. The authors begin by telling readers "We are forever indebted to our mentor, Dr. Joseph Biederman, chief of pediatric psychopharmacology research at Massachusetts General Hospital." They describe juvenile bipolar disorder as "the elephant in the living room" and then proceed to tiptoe around the role of psychopharmacology in creating the current epidemic. "The actual percentage of children with bipolar disorder may be increasing," they tell us. "Studies have not yet revealed clear reasons for this." They go on to note that half of children treated for depression go on to develop bipolar disorder, as do twenty percent of children treated for ADHD, and they even acknowledge that antidepressants can "trigger" mania in children who have never suffered the condition before, but they never explain the difference between "triggering" mania and causing it.

The authors explain what causes bipolar disorder: "A physically based brain malfunction short-circuits some thoughts and feelings. It is an illness caused by a physical organ (the brain)." [Italics in the original] No evidence is cited in support of these claims. Then, after providing readers detailed instructions on how to obtain a diagnosis of bipolar disorder for their children, the authors warn parents of dire consequences of leaving children unmedicated. "There's the terrible risk of suicide," they advise. "As many as 18% of untreated children die by suicide before their eighteenth birthdays." Again, not a shred of evidence is cited in support of this astounding claim. The authors go on to describe some actual case histories of children (one of them only three years of age) they have diagnosed and treated for bipolar disorder. In four out of these five cases, we are explicitly told that the child's first episode of mania did not occur until after the child was dosed with stimulants and/or antidepressants. Ten-year old Kurt was an excellent student, "cheerful and helpful," with above-average intelligence and plenty of creativity. But he became despondent after his the death of both his beloved grandfather and his dog who had been his constant companion for many years. He was diagnosed with depression and prescribed Zoloft, after which he experienced explosive rages, throwing furniture, smashing anything that was breakable, and attacking his own father. His parents took him to Dr. Wozniak and Nurse McDonnell, who stopped the Zoloft and prescribed Risperdal, lithium, Depakote, Ativan, and "several antianxiety medications." Now, fourteen years later, he is being maintained on a cocktail of Risperdal, Lamictal, lithium, Zoloft (again), BuSpar, and Klonopin. He has given up his dream of going to an Ivy League university, as his father did, but he is attending a local college part-time, still chipping away at his bachelors degree at the age of twenty-five. Apparently the authors consider this a success story. Kurt did fare a whole lot better than Lonnie. As a young girl Lonnie was diagnosed with ADHD and prescribed Tegretol, Tenex, Ritalin, clonidine, and Dexedrine. At the age of ten she already had a history of erratic mood cycles, hypersexuality, drug and alcohol abuse, and suicide threats and attempts. Her parents took her to Wozniak and McDonnell, who phased out the clonidine, continued the Dexedrine, and added lithium, Risperdal, Paxil, and nortriptyline. The child suffered increased thirst and bloating (both known toxic effects of lithium) so they discontinued the lithium, added Klonopin and Zoloft, and increased the dose of Risperdal. Throughout her teens, her medications were changed regularly as her various symptoms flared and shifted. She continued to suffer from sleep problems, anxiety, depression, mood swings, eating disorders, and substance abuse. She began running away from home and acting out sexually. At the age of sixteen, she was placed in a therapeutic boarding school; at nineteen, she was being maintained on a cocktail of Lamictal, Abilify, Seroquel, and Klonopin. She tried college, and ended up attempting suicide by swallowing an entire bottle of Tylenol. She sustained severe liver damage and all her medications were abruptly stopped. Shortly after that she killed herself.

That same week Is Your Child Bipolar? came out, the Johns Hopkins University Press released Mania: A Brief History of Bipolar Disorder by psychiatrist David Healy, who summed up matters thusly: "Institutions that once might have been thought of as sober, like Massachusetts General Hospital, have run trials of Zyprexa and Risperdal on children with a mean age of four years old. "[T]housands of children are having adverse reactions to stimulants and antidepressants, and the response has commonly been that this reaction proved that they were in fact bipolar. "[W]e now have instead a system that inhibits our abilities to find cures while encouraging companies to seek short-term profits by co-opting bipolar disorder for the purposes of increasing the sales of major tranquilizers to infants." Next: Part 8: A tale of two psychiatrist List of Sources

Carmichael, M. 2008. Growing up bipolar: Max's world. Newsweek 17 May 2008.
McDonnell, M.A. and J. Wozniak 2008. Is Your Child Bipolar? Bantam Books.

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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.