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http://www.infowars.com/articles/ps/treating_kids_young_as_4_bipolar.htm

Treating children as young as 4 for bipolar disorder

AHRP | May 26, 2005

A report in The Wall Street Journal should raise serious concerns
about the legitimacy of psychiatric diagnosing and drug prescribing
for children.

The Journal reports that close to 20,000 US children are being
diagnosed with bi-polar disorder, a condition that had, until recently
been very rare according to responsible child psychiatrists. "The
number of children diagnosed as bipolar rose 26% from 2002 to 2004, to
19,776 cases" according to patient records kept by health-care
information company NDCHealth Corp. "Increased use of antipsychotic
medicines, such as Seroquel and Risperdal, was a big driver of
pediatric drug costs last year, according to pharmacy-benefit manager
Medco Health Solutions Inc."

Yet, the Journal reports that a heated debate is brewing between two
camps of powerful child psychiatrists--all of whom are proponents of
psychotropic drugs. Leading child psychiatrists disagree about whether
children should even have to meet the diagnostic threshold for a
diagnosis of bipolar before being prescribed some of the most powerful
mind altering psychotropic drugs on the planet. Their decisions may
irrevocably harm children.

Bipolar disorder is a severe, disabling psychiatric condition broadly
defined in the diagnostic bible of psychiatry--the DSM IV. To meet the
diagnostic criteria for bipolar in adults, patients must exhibit:
Inflated self-esteem or grandiosity; Decreased need for sleep;
Increased or pressured speech; Flight of ideas/racing thoughts;
Distractibility; Increased goal-directed activity; Risk-taking
behavior--"bipolar disorder causes people to cycle between manic,
euphoric highs and crushing, depressive lows that last a week or
more." Presumably, a psychiatrist prescribing powerful mind-altering
drugs to a patient meeting those symptoms would be justified.

The drugs prescribed for bipolar disorder are the so-called 'atypical
antipsychotics'--including Risperdal (risperidone), Zyprexa
(olanzapine), Seroquel (quetiapine). These drugs have not been
approved for children. Neither were they approved initially for
bipolar disorder in adults. These antipsychotics were at first
approved only for schizophrenia--the most severe, debilitating
psychiatric disorder in which psychosis, hallucinations, hearing
voices, are the core symptoms, affecting 1% of the population.

Unfathomably, these powerful--and harmful--psychotropic drugs have
beome blockbuster sellers, enriching Eli Lilly, Johnson & Johnson and
Bristol Myers Squibb, while producing diabetes in more than 30% of
youth.

Since doctors diagnosing children disagree about the basis for
diagnosing and treating children, their practice method may be
legitimately characterized as child abuse with chemical restraints.
Psychiatry's rather broad diagnostic criteria were established by a
group of leading psychiatrists. Therefore, current efforts to lower
those standards--both in terms of prevalence (quantity) and severity
(quality) of the symptoms, is a radical departure from psychiatry's
own standards such as they are: "A bipolar child can flip between a
high and low several times a day. There also is disagreement over what
constitutes the highs, with some doctors saying the manic phase in
children often reveals itself as extreme rages, violence and emotional
outbursts, rather than the traditional euphoria."

The push by an influential group of child psychiatrists at Harvard may
lie at the root of what is an epidemiological mystery: what disaster
can account for the staggering number of children being diagnosed with
bipolar disorder? It appears that the most radical of child
psychiatrists who recommend prescribing antipsychotics for children
are at Harvard. They are pressuring the profession to prescribe
antipsychotics for children --even without the criteria establshed by
their profession, and even in the knowledge that the risks of harm for
children are irrevocable.

Parents need help from Congress to stop the abuse. Parents and
healthcare public policy makers have a right to demand from state
licenced medical professionals that they adhere to evidence-based
medicine: what constitutes a legitimate psychiatric diagnosis in
children? What constitutes a scientifically valid diagnosis of bipolar
disorder in children? Clearly, it is not in a child's best interst to
be exposed to powerful drugs that alter brain function on the basis of
"vague" symptoms of attention derficit hyperactivity (ADHD).

How can a drug approved for a very small group of very disabled
patients, become Eli Lilly's best selling drug?

How many millions of dollars has Harvard and the members of its
psyciatry department received from the makers of these drugs?

Contact: Vera Hassner Sharav
212-595-8974

The Wall Street Journal
Treating Children for Bipolar Disorder; Doctors Try Powerful Drugs On
Kids
as Young as Age 4; An Overlap With ADHD
Leila Abboud.
May 25, 2005. p. D.1

CHILD PSYCHIATRY, roiled last year by revelations that antidepressants
could increase children's risk of suicidal behavior, now is embroiled
in another controversy: How to treat troubled children who have
explosive rages and dramatic mood swings that defy conventional
diagnosis.

Doctors increasingly agree that some of these children have bipolar
disorder. Once thought to be exceedingly rare among children, the
problem is being diagnosed more frequently and at younger ages than
ever before. A small but growing group of psychiatrists say they are
treating children as young as four for bipolar disorder, prescribing
mood-stabilizing drugs and antipsychotics that have rarely if ever
been used on patients so young.

The number of children diagnosed as bipolar rose 26% from 2002 to
2004, to 19,776 cases in a database of 113 million anonymous patient
records kept by health-care information company NDCHealth Corp.
Increased use of antipsychotic medicines, such as Seroquel and
Risperdal, was a big driver of pediatric drug costs last year,
according to pharmacy-benefit manager Medco Health Solutions Inc.

A debate is brewing over how to diagnose and treat these children. In
its classic form, bipolar disorder causes people to cycle between
manic, euphoric highs and crushing, depressive lows that last a week
or more. The picture in children often is muddier. A bipolar child can
flip between a high and low several times a day. There also is
disagreement over what constitutes the highs, with some doctors saying
the manic phase in children often reveals itself as extreme rages,
violence and emotional outbursts, rather than the traditional
euphoria.

Making diagnosis even harder is the great overlap between the symptoms
of bipolar and attention deficit hyperactivity disorder. Research has
shown that 50% to 80% of children with bipolar also have ADHD.

"We all agree that kids with classic symptoms definitely have
bipolar," says Boris Birmaher, professor of psychiatry and director of
a pediatric bipolar clinic at the University of Pittsburgh. "The
controversy is over the kids with vaguer symptoms."

The debate is a key topic at the annual meeting of the American
Psychiatric Association this week in Atlanta, where two camps are
airing theories about which children are actually bipolar and how to
treat them. One group, led by Joseph Biederman and Janet Wozniak of
Massachusetts General Hospital in Boston, argues that a child
displaying violent outbursts and rages is likely bipolar even without
classic weeklong manic symptoms that help define the disorder in
adults. The opposing group is led by Barbara Geller, at Washington
University in St. Louis, who believes children should display the
textbook grandiose feelings or elated moods. In their practices, many
pediatric doctors who treat bipolar disorder fall somewhere in between
and follow the treatment guidelines for adults.

The difference between the two positions isn't just academic. Children
incorrectly diagnosed with bipolar would be given powerful
mood-stabilizing medications they may not need, such as lithium or
Depakote, or a so-called atypical antipsychotic such as Zyprexa or
Risperdal -- few of which have been tested in children and all of
which carry serious side effects. Lithium can cause thyroid problems
and increased thirst, while the atypical antipsychotics can cause
serious weight gain.

If a bipolar diagnosis is missed, children are likely to be put on
antidepressants such as Zoloft, or ADHD drugs such as Adderall, both
of which can actually push bipolar children into a manic mode. Indeed,
some psychiatrists believe the whole flap linking antidepressants with
a heightened risk of suicide in children may be explained by the fact
that these children really were bipolar and not depressed.

A number of studies are exploring the diagnosis and treatment of
bipolar children. Among the research is a large, six-year study at the
Washington University School of Medicine and five other sites, funded
by the National Institutes of Health, that is trying to determine
which medications work best in bipolar patients who are six to 15
years old. The NIH is conducting another trial that will follow 700
children ages 6 to 17 to try to map what bipolar looks like in
children.

Dr. Biederman's group at Massachusetts General recently presented a
small study of 39 children ages 4 to 6, which showed that those with
bipolar benefited from treatment with antipsychotic drugs, though with
significant side effects including increased appetite and sedation.
The study was funded by the nonprofit Stanley Medical Research
Institute, the NIH and the hospital itself. Dr. Biederman's group has
received research funds from makers of atypical antipsychotics. He and
Dr. Wozniak also consult for some drug makers.

Ann Elliott's daughter, Chloe, was given Prozac for depression when
she was six years old, after a two-year history of rages, giddy spells
and self-destructive behavior, including bashing her head against a
bathroom sink. Within a month of starting on the drug, she became mean
and manic, says Ms. Elliott, a computer programmer from Northern
California. Prozac was stopped. Chloe later was diagnosed as bipolar.
Now eight, she is doing well on Trileptal, a mood stabilizer, and
Abilify, an antipsychotic.

Such extreme behavioral problems fall under an umbrella of symptoms
called "irritability" that Dr. Biederman and Dr. Wozniak think is
central to bipolar in kids. These children can have three-hour rages
touched off by something as routine as being told to brush their
teeth. The rest of their families walk on eggshells, never knowing
what could set the children off. Dr. Wozniak says these children are
bipolar, even though their symptoms differ from those seen in adults.

Dr. Geller and other psychiatrists, however, point out that
"irritability" can be found in many illnesses, like depression, autism
and retardation. The scientific data aren't yet convincing, she says,
to show that children who have rages, but not the conventional manic
symptoms, actually have bipolar disorder.

In a study funded by the NIH, Dr. Geller for four years followed 86
children whom she identified as bipolar. She identified grandiosity
and elated mood as two key symptoms. Since the two symptoms aren't
present in ADHD, Dr. Geller says, grandiosity and elation can
distinguish the children with bipolar from those with ADHD. She
concedes that current science can't give clear answers. "We need
biological tests or markers," she says. However, genetic tests or
brain scans are probably decades away.

Doctors say parents with such troubled children should consult with a
child psychiatrist who specializes in bipolar disorder at a large
academic medical center, where much of the research on bipolar
children is done. The Child and Adolescent Bipolar Foundation Web site
at www.bpkids.org also may be a helpful source.

Making a diagnosis can take months. It can involve interviews with the
child, parents, teachers and siblings, and even observation of the
child at school or at home.

It took more than eight years for doctors to diagnose Sue Cahalan's
daughter with bipolar disorder. The girl had tantrums and violent fits
going back to age 4. At age 8, she stole from family and neighbors. At
10, she tried to choke her mother in an argument over the telephone.
At 12, Ms. Cahalan came home to find her daughter holding a butcher
knife outside the upstairs bathroom in which she had locked her two
younger siblings. "The psychiatrist said he was finally ready to call
it bipolar," says Ms. Cahalan, a lawyer from the Chicago area.

Her daughter was put on lithium and her condition improved. For the
next few years, doctors had to tinker with her medication, but Ms.
Cahalan says her daughter slowly stabilized and was able to attend
high school at a residential facility and will head to college next
year. "I do wonder whether things would have been different had she
been diagnosed earlier," she says.

Medicating Kids

Some drugs being used to treat children for bipolar disorder:
-- Mood stabilizers
(Side effects can include thyroid or liver problems and increased
thirst)
Lithium (generic)
Depakote (Abbott Laboratories)

-- Atypical antipsychotics
(Side effects can include serious weight gain)
Risperdal (Johnson & Johnson)
Seroquel (AstraZeneca)
Zyprexa (Eli Lilly) ---

Defying Labels

Because many of the symptoms of bipolar disorder and ADHD are similar,
doctors often have difficulty making a diagnosis. Many children have
both conditions at once.

Bipolar

-- Elation
-- Grandiosity
-- Decreased need for sleep
-- Delusions
-- Cyclic, symptoms fluctuate a lot

Bipolar/ADHD

-- Hyperactivity
-- Impulsivity
-- Short attention span
-- Irritability/Rages
-- Daring behaviors
-- Depression

ADHD

-- Symptoms like those in the intersecting portion but more constant
-- though severity may fluctuate

Source: "New Hope for Children and Teens with Bipolar Disorder," by
Boris Birmaher