Bipolar and ADHD: Boys and Breasts

It has always been the worst nightmare for any Child Psychiatrist to be faced with a schizophrenic boy. It is such a serious condition that there is no choice but to treat with an antipsychotic. However, the risk of breast enlargement (gynaecomastia) is extremely high and for boys, this is particularly unpleasant.

Fortunately incidence of true schizophrenia in early adolescent boys is rare and it is this group that are most vulnerable to this particular side effect: gynaecomastia secondary to raised prolactin (a hormone for milk production) level.

As newer antipsychotics came on to the market, claims were made that traditional side effects such as Parkinsonic symptoms and breast enlargement were rarer or non existent. Unfortunately they were only claims.

Then the situation became more serious when antipsychotics began to be liberally used for other fashionable child psychiatric conditions.

First came ADHD. The use of stimulants benefits mainly teachers during school hours. Parents and doctors soon find a quick fix in antipsychotics, and for good measure the newer ones, believing that they have fewer side effects.

This was soon followed by Bipolar Disorder. Many believe that Dr Biederman, Child Psychiatrist from Harvard, single-handedly led the movement to diagnose Bipolar Disorder in children, many as young as 2 or 3 years old. This recent trend meant that suddenly there is justification for the use of antipsychotics in very young children.

Biederman, as I reported in a previous blog, is being paid by pharmaceutical companies that manufacture the very same antipsychotics that are now causing concern, major concern.

New York Times headline:

Use of Antipsychotics in Children Is Criticized
New York Times: November 18, 2008
“Powerful antipsychotic medicines are being used far too cavalierly in children, and federal drug regulators must do more to warn doctors of their substantial risks, a panel of federal drug experts said Tuesday.

"The meeting on Tuesday was scheduled to be a routine review of the pediatric safety of Risperdal and Zyprexa(Olanzapine), popular antipsychotic medicines made, respectively, by Johnson & Johnson and Eli Lilly & Company. Food and Drug Administration officials proposed that the committee endorse the agency’s routine monitoring of the safety of the medicines in children and support its previous efforts to highlight the drugs’ risks.

“More than 389,000 children and teenagers were treated last year with Risperdal (Risperidone), one of five popular medicines known as atypical antipsychotics. Of those patients, 240,000 were 12 or younger, according to data presented to the committee. In many cases, the drug was prescribed to treat attention deficit disorders.

“But Risperdal is not approved for attention deficit problems, and its risks — which include substantial weight gain, metabolic disorders and muscular tics that can be permanent — are too profound to justify its use in treating such disorders, panel members said.”

“Prescription rates for the drugs have increased more than fivefold for children in the past decade and a half, and doctors now use the drugs to settle outbursts and aggression in children with a wide variety of diagnoses, even though children are especially susceptible to their side effects.” The New York Times article continued and surprise surprise, the panel in the end rejected the FDA’s proposal.
The panel members spoke at length about Risperdal, but their concerns applied to the other medicines in its class, including Zyprexa, Seroquel, Abilify and Geodon.

The Problems:
In the United States:
“From 1993 through the first three months of 2008, 1,207 children given Risperdal suffered serious problems, including 31 who died. Among the deaths was a 9-year-old with attention deficit problems who suffered a fatal stroke 12 days after starting therapy with Risperdal.”

Boys and Breasts: The WSJ detailed concerns by doctors on breast enlargements in children especially boys at the same FDA meeting and reported that six teenage boys are seeking compensation from Johnson and Johnson. Two of the boys required mastectomies (surgical removal of the enlarged breasts).

Many great poets, musicians, writers and artists are believed to have suffered from Bipolar Disorder but were unrecognised. Imagine them being diagnosed as such in their formative years and treated with antipsychotics. Would they still have become great poets, musicians, writers and artists?
The question to ponder is: do children diagnosed with ADHD and Bipolar fare better with antipsychotics? What if the diagnosis is suspect in the first place?

When you look closer, many children present with behaviour problems. Parents find it easier to accept the diagnosis shared with famous people: Bipolar Disorder. Instead of using a mood stabiliser, an antipsychotic is used as a behaviour controlling drug. For good measure the drug is recommended by a famous Child Psychiatrist. That he is paid by the drug company is really neither here nor there.

So perhaps there really is no epidemic in Bipolar Disorder in children, nor indeed ADHD.

Related Posts:

Lithium Bipolar and Nanking
Bipolar Disorder in Children
Bipolar and ADHD: Boys and Breasts
Statins-Harvard-Roosevelt
Bipolar Disorder: Biederman Einstein God.
Antipsychotics: Really?
Grand Round: Medicine and War
Bipolar Disorder: Lithium-The Aspirin of Psychiatry?