Antipsychotics in Kids: The New York Times Gets it Right - and Wrong

But hold on one second. Bipolar kids are not anorexic teens. Whether one chooses to call these kids bipolar or not, something very serious and in dire need of medical intervention is going on. For those who have never witnessed the phenomenon nor have listened to the parents of these kids, here is an example from the third edition of “The Bipolar Child,” by Demitri and Janice Papolos:

"One day, after [mother] Melissa refused to buy him candy, Eric [kindergarten age] ran out of the grocery store and attempted to run across the street. A few times he attacked her – hitting, kicking, and biting. Once, when sent to his room for a time-out, he opened the second-story window, knocked out the screen, and threatened to jump. Later he told his mother he thought he could fly."

In the nine years that I have been reporting on drug industry malfeasance, I have also been keeping close watch on the bipolar child controversy. I can assure you that bipolar in kids is not a fad diagnosis. Yes, there is considerable debate over what constitutes a bipolar diagnosis in kids (ironically, Dr Papolos sets more stringent criteria than for the adult diagnosis in all but actual length of the episode), and the public has every reason to be concerned about treating kids with meds not adequately tested in this population, but the fact remains that we have a clearly observable group of youngsters who exhibit bipolar tendencies, whose illness in fact is more severe than bipolar in adults.

These are kids who don’t simply require a hug or strong parental discipline.

For those who think we shouldn’t be giving these kids antipsychotics, here is the other consideration. Prescribing them an antidepressant for misdiagnosed depression or an ADHD med to calm then down is likely to make them much worse. In 2003-2004, the FDA conducted an investigation that resulted in safety warnings regarding issuing antidepressants to kids. Part of the warning included that before prescribing an antidepressants, kids should first be screened for bipolar.

At one of the public hearings related to the FDA investigation, the Child and Adolescent Bipolar Foundation, run by parents (but with industry funding), testified that 20 percent of their members who responded to a survey were convinced that their own children became suicidal due to treatment with an antidepressant.

Hard Decisions

So now we come to the antipsychotic option. The leading psychiatrists I have listened to are not exactly enthusiastic about antipsychotics. After all, these are very imperfect medications, even in adults. Dr Papolos, for one, is getting good results on some of his patients employing a natural substance as part of the total treatment package. But he is not afraid to prescribe an antipsychotic.

Parents are not exactly eager to stuff pills down their kids’ throats, either. One mother I listened to, in relation to her kid being treated with meds, had this to say: “They felt they had solved my problem. I felt I had lost my child.”