Harvard Mental Health Letter

Commentary: The rise of pediatric bipolar disorder

Commentary

The rise of pediatric bipolar disorder

An article published in the September 2007 issue of the Archives of General Psychiatry provides strong evidence that the diagnosis of bipolar disorder is rising in popularity, especially in children. Analyzing survey data from the National Center for Health Statistics, the authors identified trends in the diagnosis and treatment of bipolar disorder by measuring visits to physicians.

Office visits by children diagnosed with bipolar disorder multiplied 40-fold from 1994 to 2003. The number of office visits per 100,000 children went from a quite rare 25 to a much more common 1,003 in that period. Adult office visits during the same period almost doubled (905 to 1,679), which would be impressive on its own if the childhood increase were not so stunning.

Few can agree about what this means. Some see the shift as progress, pointing out that a problem that had previously gone unnoticed is now being identified and treated, with consequent improvements in symptoms and quality of life. Others, however, see in these numbers rampant overdiagnosis. They say thousands of children — in some cases as young as two or three — are receiving too many medications they don't need and that cause uncomfortable and sometimes dangerous side effects.

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