Thursday, September 06, 2007

Diagnosis du jour

Like changing hemlines, there are fashions in mental health. In the 1980s, taking Prozac was hip and, on the cocktail circuit, you were embarrassed if you weren’t taking the little blue and white capsule. A decade later, attention deficit hyperactivity disorder (ADHD) was the ‘in’ condition, not just among children and adolescents, but also among driven adults. And now, in the new millennium, the diagnosis of the moment is bipolar disorder.

A new study conducted by researchers at Columbia University finds that 1 in every 100 youth aged 19 or younger has bipolar disorder (and 2 in every 100 adults). That may not sound so bad – just 1 percent – but taken in the context of trends, it is disturbing: the rate of bipolar diagnosis has increased forty-fold in ten years among adolescents.


What the hell’s in the water?

Probably nothing. Historically, bipolar disorder has been under-recognized, under-diagnosed, and under-treated, especially in pediatric populations. The mood swings, excess energy, and restlessness associated with bipolar parallel the signs and symptoms seen in other conditions, including ADHD, oppositional defiant disorder, psychotic disorders, and garden-variety depression. Not to mention the normal angst and sturm of adolescence.

But now it appears we may be swinging to the other side of the pendulum: over-diagnosis. And a consequence of any diagnosis is usually a treatment. The medications used to treat bipolar disorder – lithium and other mood stabilizers, anxiolytics, antidepressants, and antipsychotics – are not innocuous. They are powerful, mind-altering drugs which, when used appropriately, confer tremendous medical benefit. But they also have potent and dangerous side effects, ranging from the inconvenient and uncomfortable (loss of libido, dry mouth, shaking) to the downright dangerous (blood dyscrasias, weight gain, diabetes).

In BRIGHTER THAN BRIGHT, Ben is bipolar. Diagnosed at age 16, he’s a model patient, compliant with his lithium and psychotherapy for the past four years. But a series of events cascade and lead him to ‘forget’ his happy pills and he starts the upward spiral into mania…

My very atoms vibrate: from caffeine, from sleep deprivation, from the constant moving forward. From erratic consumption of my mood regulators. But my mind is sharp, focused; my dreams, Technicolor wonders. Everything I touch explodes from this magical, sub-cellular energy surging within me. When I press the closed hollow-wood door to Bruce’s office, it flies open with a bang. The knob gouges the plaster wall. He sits at his desk, the room dim but for the green glow of a single lamp, head down, not noticing my tumult.


  1. Wow, I really can't wait to read the next version of your book. This is great!

    Reading yoru blog made me think of a question, how are people sure that a person has one thing and not another? Especially when symptoms overlap?

  2. Thanks for the compliment - I can't wait for you to read it either!

    Great question... and unfortunately, a lot of it is hit or miss. Most companies do not include children in clinical trials, and the difficulties of researching the natural course of disease in this population is difficult due to consent issues. In other words, there is a huge gap between evidence-based knowledge and actual practice. The key to successful treatment management in kids with mental illness is provision of excellent and appropriate psychiatric and psychologic care, constant monitoring and involvement of health care providers, family members, friends, and educators, and access to medications, many of which are prohibitively expensive. Now, if only we could get insurance to pay for all of this...