Last week, I wrote a post entitled “A Conspiracy of Neglect,” in which I reported on the tragic death of Rebecca Riley, a 4-year old girl from Massachusetts who had been previously diagnosed with bipolar disorder and ADHD, placed on a cocktail of powerful psychotropic medications, and then allegedly given an overdose of such by her parents. In today’s New York Times, Benedict Carey picks up the story, focusing in particular on the “Debate Over Children and Psychiatric Drugs“:

[T]he practice of aggressive drug treatment for young children labeled bipolar has become common across the country. In just the last decade, the rate of bipolar diagnosis in children under 13 has increased almost sevenfold, according to a study based on hospital discharge records. And a typical treatment includes multiple medications.

Rebecca was taking Seroquel, an antipsychotic drug; Depakote, an equally powerful mood medication; and Clonidine, a blood pressure drug often prescribed to calm children.

The rising rates of diagnosis and medication use strike some doctors and advocates for patients as a dangerous fad that exposes ever-younger children to powerful drugs. Antipsychotics like Seroquel or Risperdal, which are commonly prescribed for bipolar disorder, can cause weight gain and changes in blood sugar — risk factors for diabetes.

Some child psychiatrists say bipolar disorder has become an all-purpose label for aggression.

“Bipolar is absolutely being overdiagnosed in children, and the major downside is that people then think they have a solution and are not amenable to listening to alternatives,� which may not include drugs, said Dr. Gabrielle Carlson, a professor of psychiatry and pediatrics at Stony Brook University School of Medicine on Long Island.

Paraphrasing H. L. Mencken, Dr. Carlson added, “Every serious problem has an easy solution that is usually wrong.�

Others disagree, insisting that increased awareness of bipolar disorder and use of some medications has benefited many children.

“The first thing to say is that the world does not see the kids we see; these are very difficult patients,� said Dr. John T. Walkup, a child and adolescent psychiatrist at the Johns Hopkins University School of Medicine.

Dr. Walkup said that when drug treatment was done right, it could turn around the life of a child with a diagnosis of bipolar disorder.

Dr. Jean Frazier, director of child psychopharmacology at Cambridge Health Alliance and an associate professor at Harvard, said that up to three-quarters of children who exhibit bipolar symptoms become suicidal, and that it is important to treat the problem as early as possible.

“We’re talking about a serious illness with high morbidity, and mortality,� Dr. Frazier said, “and for some of these children the medications can be life-giving.�

Still, most child psychiatrists agree that there are still questions about applying the diagnosis to very young children. Recent research has found that most children who receive the diagnosis are emotionally explosive but do not go on to develop the classic features of the disorder, like euphoria. They are far more likely to become depressed.

And many therapists have found that some patients referred to them for bipolar disorder are actually suffering from something else.

“Most of the patients I see who have been misdiagnosed have been told they have bipolar disorder,� said Dr. Bessel van der Kolk, a professor of psychiatry at Boston University who runs a trauma clinic.

“The diagnosis is made with no understanding of the context of their life,� Dr. van der Kolk said. “Then they’re put on these devastating medications and condemned to a life as a psychiatry patient.� [full text]