I have bipolar-disorder-type-II-ultradian-cycling. I diagnosed myself when I was 20 years old, and once I finally agreed to see a doctor, he agreed sometime thereafter. My diagnosis was fairly easy for me. I’m very self-aware and I could pick out discrete moods and swings. But as a 20-year-old, in university, using research, and having a fairly high IQ, this is not terribly surprising. If I were five-years-old, the picture would have been a little different.
Epidemic of Children Diagnosed with Mental Illness
There is an epidemic of children, as young as two, being diagnosed with psychiatric disorders in North American right now. It’s made the cover of Time magazine and countless articles have been written on the phenomenon.
So, Antipsychotics Are Now Approved for Children
It was once thought that disorders like bipolar did not occur before adulthood, but thoughts on this seem to be changing as diagnoses go up and more drugs are approved for treatment of children.
Antipsychotics FDA-approved for use in children (under 18) is:
- Quetiapine (Seroquel) – schizophrenia, ages 13-17; bipolar I, ages 10-17
- Olanzapine (Zyprexa) – schizophrenia and bipolar I, ages 14-17
- Risperidone (Risperdal) – schizophrenia, ages 13-17; bipolar mania, ages 10-17; autism, ages 5-16
And so on. And of course, doctors are free to prescribe any medication off label to children just like adults.
Antipsychotics Can Fuck You Up
I have been on all three of those antipsychotics and all three have fucked me up. Specifically seen has been weight gain, blood pressure changes, twitching, extreme fatigue, incurable hunger, and in the case of Geodon, psychosis. Among other things.
What Do Antipsychotics Do?
Antipsychotics turn down the dopamine in your brain. That’s what’s the do. They also turn down serotonin. These are two of the “feel good” chemicals in your brain, and you are turning these down. This seems to help with certain disorders like schizophrenia, but dopamine in integral for motivation, reinforcement, learning, and memory. If, for example, your five-year-old eats his peas, and you praise him, he feels good because a shot of dopamine is released. This then reinforces the pea-eating behavior, so that next time, he will again eat his peas. If you take away dopamine, he may not be able to make this link. And if you take away dopamine from a child’s (naturally developing) brain for a long period of time, no one has any idea what would happen.
I cannot, in any world, imagine giving these drugs to a child.
We Don’t Know How to Diagnose Bipolar In a Child
The truth is, no one knows what bipolar looks like in a child, or if it even exists. There is no diagnostic criteria in the DSM. Psychiatrists are using relaxed versions of symptoms seen in adults for diagnoses. This is patently ridiculous.
Children are Naturally Crazy
Kids blur the line between fantasy and reality. Kids act out. Kids throw tantrums. Kids ignore you. Kids break rules. Kids often don’t show a great regard for their safety or the safety of others. Kids throw broccoli across the kitchen table. Kids do, the darndest things. They’re kids. It’s what they do. None of this makes them crazy.
Recently a friend of mine was talking about a girl who hallucinated a dead robot baby. Moreover, this same girl spent her recent birthday having an elaborate funeral for a bird found dead in her back yard. Sound crazy? Not for a seven-year-old. It might be a bit unusual, but to me this speaks of intelligence creativity and compassion, not a mental disorder.
And let’s face it, some kids are very challenging to handle. Some are overly aggressive, or sad, or obstinate. They hit their sister, break a vase, or refuse to stay in their room for a time-out. This still doesn’t make them crazy, this just makes them challenging. Parents don’t get a pass just because their job is harder than they thought it was going to be.
Kids Can Be Crazy and Still Perfectly Normal
Basically, kids can have almost any pattern of behavior and still be pretty darn normal. And that doesn’t take into account all of the environment factors that are effecting kid’s behaviors. I’ve never seen great parents with a kid with huge behavioral problems. Yes, I’m sure it happens, but generally, kids are a reflection of their home lives. And kids with bad home lives don’t need or deserve drugs. They deserve better home lives.
And on top of all of this, if a child really is having behavioral problems there are specialists who can help with that, they’re called child psychologists. They help children and parents all day long. And they don’t cause weight gain and high blood pressure.
And don’t get me started on how idiotic it is to diagnose a two-year-old with a mental disorder. Two? Really? It can take an adult two years for an adult to get a diagnosis of bipolar. That sounds like a parent disorder if ever I heard of it.
Children on Antipsychotics and Other Psych Medication Seem Like Lab Rats
It feels to me like these children are being treated as lab subjects, and not real people. I am highly suspicious of any doctor that would medicate a child. Could it possibly be a reasonable thing to do? Well, maybe. But you’d be hard pressed to convince me.
Mental Illness as Self-Fullfillment
And in addition to whatever drugs are being fed to these children, they are also being saddled with a diagnosis – for the rest of their lives. As an adult it can be extremely detrimental to be labeled “crazy”, but as a child I can only imagine it would be infinitely worse. These children don’t even have a chance to find an identity before they’re told they’re crazy. How can that label not result in self-fulfillment?
Victims of Fad Diagnoses
When the movie Cybil based on a woman with “multiple personality disorder,” came out, the diagnosis of this disorder exploded across the US. A disorder that had virtually never been seen was suddenly everywhere. But over the decades that followed, medical professionals were able to determine that these were not genuine cases. In fact, some doctors feel that there has never been a documented case of “multiple personality disorder” as featured in the film. There are other disorders with similar features, but the giant outbreak seen after the film, just didn’t exist.
Is Childhood Bipolar a Fad Diagnosis?
And one has to wonder if we’re seeing something similar here. If more adults are being diagnosed as bipolar, then naturally, we are looking for markers of it at younger ages, and in their genes. We want this information to help people, to help treat the disease, but it can just as easily be used to further label people before we even know how to do it properly. Multiple personality disorder looked like a correct diagnosis until we figured out it wasn’t.
And if someone as young as a toddler gets diagnosed with some behavioral disorder, don’t these children deserve time to correct this issue via safer methods than drugs? It seems that out of an eight year life, it’s impossible that enough other treatments have been tried to warrant drugs.
Now, it’s true, I’m not a doctor, or a parent. And I do have a strongly held belief that doctors and their patients should be able to choose treatments without judgment from the outside world. But I also think any doctor worth seeing is going to try the least harmful treatment first, especially in a population that has been radically understudied. True, behavioral therapy might not work, but it’s unlikely to cause debilitating side-effects. And what about waiting for a child to grow out of behavioral issues? I hear that was a thing that used to happen. Before we got all diagnos-y.
I’m not suggesting that no one under 18 is sick, or that no one under 18 should be treated with medication. What I am suggesting is that diagnosis and treatment of children needs to be handled with extreme care and caution. I’m an adult and I give informed consent to fuck with my brain; children do not have that ability, and yet, they will be the ones that have to live with the results. They deserve every possible solution that avoids nasty, unknown side effects. Parents need to be held to a higher standard of decision-making and not pick what is easiest for them, but what is best for their child. Doctors need to be held to a higher standard to care with children, ideally with third party monitoring of underage drug-treatment. This is not something to be taken lightly on any front.
Someone needs to sanity-check the parents. Kids need to be able to act crazy, without getting labeled crazy.
And how many years ago was that? Aren’t you in your 30’s?
B,
Insulting and ageist, your mother must be so proud.
I took the psychopharmacology class last year, so I’d say that’s fairly up-to-date. But like I said, if you’d like to point to some research, I’ll take a look.
– Natasha Tracy
Which edition was this? If this is the text I am thinking of, this is way outdated and was utilized mainly in undergrad courses.
Yeah, well. You’re wrong. They so cause the brain to grow new dopamine receptors. Read a little Nancy Andreason, or do what I did and actually study psychopharm at University. ;o)
B,
Actually, the above book is from a psychopharmacology course I took at university. I’m happy to look at something else if you have a link.
– Natasha Tracy
Hello B,
Well, you’re half right.
True, saying “turn down” dopamine isn’t terribly accurate but it’s better than having to explain it every time. There is no increase in dopamine receptors.
“antipsychotic drugs work because they block the dopamine receptors in the mesolimbic dopamine system and decrease this excessive activity.”
Antipsychotics also block serotonin receptors. Typical antipsychotics block more dopamine than serotonin and atypicals block more serotonin than dopamine.
From Drugs and Behavior – Introduction to Behavioral Pharmacology, William A. McKim
– Natasha Tracy
The antipsychotics don’t turn down dopamine. They BLOCK reception, which then creates a genuine disturbance in normal brain function, which triggers the brain to fight back by growing new dopamine receptors. This is why the drugs eventually stop “working”. This new receptor growth is also what leads to worse long-term outcomes and a course of chronicity in the troublesome “symptoms”. In addition to causing new dopamine receptors to grow, they also cause atrophy in the frontal cortex and other areas of the brain.
Good luck bpmerf. I hope it helps.
Thanks so much for your thoughts on this.. you have given me a lot to think about!
Hi bpmerf,
It sounds like you're dealing with a challenging situation. Please remember that I am not a doctor, but here are a few things to consider:
1. See a doctor to have a _full_ blood panel ensuring that all levels including hormone/thyroid levels are normal. There are any number of organic reasons for mood swings. Work with a doctor to rule these out. Check for _everything_.
2. Have you considered diet? Children are chronically given too much sugar and this can cause severe mood swings in some children. Trying a sugar-free, or at least low-sugar diet is certainly worth a try
3. Just because one therapist didn't help, doesn't mean therapy won't help. Did you go to a child specialist? You need someone who specializes in exactly what your daughter is going through. Just any old therapist isn't good enough. Some therapists are good, some aren't. You might have to try a few to find out.
4. What is going on in her home life? I know it's tough to look at yourself and your home, but is it possible that there is something there that needs dealing with? If you have bipolar, is it possible that she is learning behavior from you? Would therapy between the two of you help? What about the rest of the family? I know this is really hard but children really do reflect their environment.
5. I wouldn't put her on medication unless all 1-4 had been tried and failed. Diagnosing her isn't important, medicating her isn't important, helping her with her behavior is. Adults respond very well using cognitive behavioral therapy to manage their symptoms and there's no reason why your daughter can't too. We don't know what these meds will do to a 12-year-old, or their brain. I would be very hesitant to expose her to that risk.
6. If medication were the _only_ option and required for _serious_ reasons like having trouble in school, for example, then I would make sure that she received medication _and_ therapy. Studies show that patients do better on drugs + therapy than on drugs alone, and then I would work on getting off the drugs as soon as possible. This is not something to just be maintained through her teens.
And yes, it is possible that she many develop a mental illness in her adulthood, and even be on medication at that time, but that is a decision to be made by her, when she is an adult.
I'm not trying to judge you, or your choices, I'm only trying to suggest that there are many options besides medication. Remember than psychiatrists _only_ know how to medicate people, so that will almost always, without fail, recommend medication. You need to look outside of this paradigm for your daughter's sake.
In other countries children aren't medicated, period. And that's because they are concerned about the risks to the child's brain, and they understand that we have _no_way_ to properly diagnose adult disorders in children. Behavioral issues in children have been going on forever and do not require medication. Please consider this before falling into the "drug everyone" mentality the US currently has.
I hope you and your daughter both find relief from your symptoms. Feel free to comment or email me privately any time. Good luck.
OnDandelionWings –
I didn't even get into the cultural aspects of this issue, but you are correct, many countries simply don't diagnose mental illness, as such, in children. This is something that US doctors have decided to do.
This is closely related to the fact that it is easier both for the parent and the doctor to prescribe meds than it is to see a qualified child psychologist for a form of therapy. That would involve actual work. Not to mention the fact that many people are back into a corner as their insurance company will only pay for drugs, and not any form of therapy, so there are socio-economic factors at play too.
Thanks for this post. I have suspected my daughter, 12, may have Bipolar Disorder, as I do, but I am highly reluctant to medicate her. She takes a small amount of Zoloft for anxiety and some depression. She was having what we think were anxiety attacks so we felt we needed to get that under control. Poor thing. The doc does not think she has bipolar as of yet.. she says she's probably just hormonal and we need to just keep a close eye on her, especially since she is now taking anti-depressants/anti-anxiety meds. To read more, visit my blog… I'd be interested to hear your thoughts on this: http://bpmerf-blessedandcursed.blogspot.com/
I agree completely. Retrospectively, and when going through my primary school drawings and photographs and the like you can see signs and symptoms of the illness, planning events and then breaking down before they happened, pulling out all my top teeth at once 'because i was Tarzan' jumping off tall things to see whwat would happen, but this was all considered within the boundaries of normal behaviour, if a little extreme at the time. I could not imagine my life if I had began on medication so young. I would not have a sense of self. I can't even imagine what I would be likfe today (and I'm only 22) if I had started on antipsychotics in my teens, the side effects alone would have damaged my schooling far more than the moods. If parents are concerned, their children should be monitored, not medicated. They don't need to carry the stigma of mental illness through high school, let alone primary school! I have much love for my country as it is generally accepted that a diagnosis of Bipolar disorder is not given until the patient is 19.