So you think medicine is always about science? You think that everything in the medical industry is about evidence, experience and reason? Think again.
Medicine is as prone to fads as the fashion industry; it merely speaks a different language. Already in 2007, an organization called NARSAD reported that the number of children being diagnosed with bipolar disorder is now 40 times greater (that’s right, forty!!) than it was 10 years ago. And we aren’t talking forty times more often than in Roman times, or than before the advent of modern medicine, but 40 times more often than a mere 10 years ago.
Who is NARSAD? The National Alliance for Research on Schizophrenia and Depression, is a charity that also funds research into other childhood psychiatric disorders such as bipolar disorder and anxiety disorders. NARSAD’s scientific advisory board includes three Nobel prize winners (Eric Kandel among them) and professors of psychiatry from universities across the country as well as researchers from the National institutes of Mental Health (NIMH). It flies in the face of reason to imagine that 40 times as many children actually have bipolar disorder today. And the increase in this diagnosis among children far outstrips the increase among adults. Over-diagnosis, anyone? Medical fad and fashion?
And if it were just over-diagnosis, that would be bad enough, but this diagnosis is a serious one and leads to serious medication use — often more than one medication at a time — medications with potential for significant side effects. And even this might be only half so bad if follow-up care by general practitioners, pediatricians and psychiatrists was thoughtful and rigorous. Yet I continue to receive medical records of many children who are prescribed major medications for this diagnosis and are seen only once a month, sometimes once every two months, and in one recent case, once every six months. Typically, recommendations of clinical studies into these medications are not followed despite clear guidelines. This is simply irresponsible.
And then there’s the breathtaking cost. One month’s supply of 5 mg per day dissolvable Zyprexa may cost as much as $359.82, and for the 10 mg per day variety as much $520.80 per month. A month’s supply of the lowest dose of Abilify (2 mg per day) can be as much as $500.58! Of course, you could always use the old standby, lithium ($204.18 per month), but it would require careful assessment of serum blood levels, urinalysis monitoring at regular intervals and is often poorly tolerated. In recent years there has also been an increase of use of anti-convulsants (anti-seizure medication) to treat bipolar disorder, some that can have serious side effects and require reliable contraception because of the high potential for birth defects (Depakote), or can cause blood abnormalities or kidney problems (Tegretol).
The purpose of this cautionary tale is not to scare parents off of necessary medication (some of which I prescribe myself), but to advocate for parents asking questions, to advocate for more careful diagnosis and, crucially, very close follow-up by responsible providers when these medications are used to treat children. If it were my child being diagnosed with a brain disorder I know I would be asking questions, and I hope you are, too.
