CHICAGO (AP) — An analysis suggests that the number of U.S. children diagnosed with bipolar disorder spiked, but researchers question whether the surge is real and say some children have been mislabeled.
Researchers looked at the number of times that patients younger than 19 went to the doctor and were diagnosed with or treated for bipolar disorder, also known as manic depression. They found a 40-fold increase — from an estimated 20,000 visits in 1994 to 800,000 in 2003. The jump coincided with children’s rising use of anti-psychotic medicine.
The numbers echo other estimates suggesting that as many as 1 million U.S. children are bipolar, but the diagnosis in children remains controversial. That’s partly because their symptoms often differ from adults’ and because most powerful anti-psychotic drugs used to treat bipolar disorder were approved for adults and have not been well-studied in children.
Some doctors doubt that bipolar disorder occurs in children, and until last month, only one drug had been approved to treat the illness in children.
The study’s lead author, Dr. Mark Olfson of Columbia University and the New York State Psychiatric Institute, said the results likely reflect overdiagnosis now or underdiagnosis in the past, rather than a true increase. Dr. Olfson has received speaking fees from Janssen LP, which makes one of the pediatric bipolar drugs, and has consulted for other makers of psychiatric drugs.
Dr. Sharon Hirsch, a University of Chicago psychiatrist, said that although she is treating increasing numbers of bipolar children, she doubts there is a “vast epidemic.”
More public awareness about mental illness, spurred partly by heavy marketing of psychiatric drugs, could have contributed to the surge. Early in the study, a leading manual of psychiatric illnesses expanded criteria for diagnosing bipolar disorder, Dr. Olfson noted.
Symptoms include extreme mood swings and disruptive behavior. In children, extreme irritability is sometimes the main symptom.
Bipolar disorder affects more than 5 million adults. The causes are uncertain, but the disorder tends to run in families.
Dr. Thomas Insel, director of the National Institute of Mental Health, which partially funded the research, said the study “waves a flag saying we’ve got to do much, much better in finding ways to validate psychiatric diagnoses in children. This is an area that really needs hard science.”
The study appears in the September issue of Archives of General Psychiatry.
It follows a report showing a big increase in U.S. children hospitalized with bipolar disorder, from 1.3 per 10,000 in 1996 to 7.3 per 10,000 in 2004, published in June in the journal Biological Psychiatry.
Dr. Olfson and colleagues analyzed annual surveys of outpatient visits from the National Center for Health Statistics. Adult visits for bipolar disorder also increased during the study but not as markedly.
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