November 1, 2007

Bipolar Rates Are Increasing As Long As You're Willing To Call Everything Bipolar And Defy God's Will

Do you dare defy the Will of God?

In 1994, there were 20,000 visits for pediatric (under age 19) bipolar disorder.  In 2003, the number was... 800,000.  The diagnosis, therefore, was 25/100,000 in 1994, and now it's 1000/100,000.  In other words, 1% of the population. 

To compare: for adults the rates were 905/100,000 in 1994, to 1679/100,000 in 2003.  In other words, 0.9% up to 1.7%. 

I've heard this justified as a step forward.  While "visits" isn't the same as incidence or prevalence in a population, it makes sense as a proxy.  The adult rate is about 1-2%, consistently.  Bipolar was severely underdiagnosed in 1994, and it's better diagnosed today.  Since bipolar is a biological disorder with a strongly heritable component, it only makes sense that the child rate should be the same as the adult rate, assuming good diagnostic skills.  So the diagnosis rate has simply risen to match the adult rate.

The only problem is this: in 2003, 2/3 of the children visiting were males.  But 2/3 of the adults were females.

So you have some options:

  1. The male children have a disorder that is actually different than the adult females have, i.e. one of them is not bipolar.
  2. The male children with bipolar got cured during puberty.
  3. Bipolar disorder turns boys into women sometime around age 19, obviously using the power of Satan.

The ridiculousness of this increase in diagnosis is only exceeded by the potential harm such an increase is actually causing.  Forget about the safety or lack of safety of bipolar medications in kids, which is worrisome enough.  A problem few seem to want to talk about is the impact of a bipolar diagnosis on a person, for the rest of his life.  Let's say, for the sake of argument, pediatric bipolar is overdiagnosed.  Then all those people who were misdiagnosed are, in fact, not bipolar; however, they have no way of ever finding that out.  They have to carry this with them for the rest of their life.  When they're 30 years old, and they're asked on routine checkup if they've ever had a psychiatric diagnosis, they have to say, "well, pediatric bipolar, but I think that's not right."  Sure it isn't.  When that 30 year old guy has kids, and those kids grow up, they'll be asked, do you have a history of major psychiatric illness in your family?  Hmm.  "Maybe bipolar... but my Dad told me he thinks that wasn't right."  Oh, ok.  Did your Dad have a temper?  "Well, he did yell a lot when he was mad."  I see.  Did he go without sleep?  "Oh my God, when we were kids-- lots of times."  Then it's settled.

If pediatric bipolar is being accurately diagnosed,  then either psychiatrists are now more sensitive to its detection-- a unlikely possibility since the diagnosis has been around for a long, long time-- did we suddenly develop a better test for it?  Or else something has changed in the world to cause it to be more frequent (a toxin in bottled water?  MySpace?  Iraq?)

Early treatment of bipolar-- let's call it the "real" bipolar-- doesn't slow down the progression of the illness.  It helps you today,  but it doesn't change symptoms 10 years from now, they way aggressive early treatment of diabetes actually prevents physical pathology from worsening.  So it may be worth, oh, I don't know-- conservative management?