"Long before it's in the papers"
April 29, 2009

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Surge in youth bipolar disorder diagnoses seen

Sept. 4, 2007
Courtesy NIH/National Institute of Mental Health
and World Science staff

The num­ber of vis­its to a doc­tor’s of­fice that led to a di­ag­no­sis of bi­po­lar dis­or­der in youths has risen 40-fold in the U.S. over the last dec­ade, re­search­ers have found.

The surge probably re­flects a “re­cent ten­den­cy to over­di­ag­nose bi­po­lar dis­or­der in young peo­ple, a cor­rec­tion of his­tor­i­cal un­der-recognition, or a com­bina­t­ion of these,” said Mark Olf­son of Co­lum­bia Un­ivers­ity’s New York State Psy­chi­at­ric In­sti­tute in New York, a mem­ber of the re­search team. “Clearly, we need to learn more” about how doctors are di­ag­nosing the dis­or­der in chil­dren and ado­les­cents.

Bi­po­lar dis­or­der is a men­tal ill­ness char­ac­ter­ized by cy­cles of de­pres­sion and ela­t­ion, or ma­nia.

Al­so over the past dec­ade, the num­ber of vis­its by adults re­sult­ing in a bi­po­lar dis­or­der di­ag­no­sis al­most dou­bled, Ol­son’s team found, adding that the cause of this is al­so un­clear. The study is pub­lished in the Sep­tem­ber is­sue of the re­search journal Ar­chives of Gen­er­al Psy­chi­a­try.

Doc­tors face tough ques­tions when de­cid­ing on treat­ment for young peo­ple, Olf­son and col­leagues said. Guide­lines for treat­ing adults with bi­po­lar dis­or­der are well-doc­u­ment­ed, but few stud­ies have looked at the effects of psy­chi­at­ric med­ica­t­ions for treat­ing chil­dren and ado­les­cents with the dis­or­der. De­spite this lim­it­ed ev­i­dence, the re­search­ers found si­m­i­lar treat­ment pat­terns for both age groups in terms of psy­cho­ther­a­py and pre­scrip­tion med­ica­t­ions. 

Of the med­ica­t­ions stud­ied, mood sta­bi­liz­ers, in­clud­ing lith­i­um, were pre­scribed in two-thirds of the vis­its by youth and adults, the team found. An­ti­con­vul­sant med­ica­t­ions, such as val­proate (De­pakote) and car­ba­mazepine (Tegre­tol), were the most fre­quently pre­scribed type of mood sta­bi­liz­ers.

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The number of visits to a doctor’s office that resulted in a diagnosis of bipolar disorder in youths has increased 40-fold in the U.S. over the last decade, researchers have found. The surge probably reflects a “recent tendency to overdiagnose bipolar disorder in young people, a correction of historical under-recognition, or a combination of these,” said Mark Olfson, of Columbia University’s New York State Psychiatric Institute, a member of the research team. “Clearly, we need to learn more about what criteria physicians in the community are actually using to diagnose bipolar disorder in children and adolescents.” Bipolar disorder is a mental illness characterized by cycles of depression and elation, or mania. Also over the past decade, the number of visits by adults resulting in a bipolar disorder diagnosis almost doubled, Olson’s team found, adding that the cause of this is also unclear. The study was published in the September 2007 issue of the Archives of General Psychiatry. Doctors face tough questions when deciding on proper treatment for young people, Olson and colleagues said. Guidelines for treating adults with bipolar disorder are well-documented, but few studies have looked at the safety and effectiveness of psychiatric medications for treating children and adolescents with the disorder. Despite this limited evidence, the researchers found similar treatment patterns for both age groups in terms of use of psychotherapy and prescription medications. Of the medications studied, mood stabilizers, including lithium, were prescribed in two-thirds of the visits by youth and adults, the team found. Anticonvulsant medications, such as valproate (Depakote) and carbamazepine (Tegretol), were the most frequently prescribed type of mood stabilizers in both groups.