Rapid rise in bipolar disorder among American youth

6 September, 2007:

The number of American children and adolescents diagnosed with bipolar disorder has risen 40-fold from 1994 to 2003, researchers have reported in the most comprehensive study on the subject.

Experts say that the number has almost certainly risen further since 2003.

This increase stresses the need for “reliability studies” to determine the accuracy of diagnoses of child and adolescent bipolar disorder, according to the researchers whose report appears in the latest issue of the Archives of General Psychiatry.

Bipolar disorder is a psychiatric illness that typically involves periods of mania (abnormally elevated mood) and depression.

Bipolar disorder is also known as manic depression or manic depressive illness. It is a psychiatric disorder in which the brain does not work in the normal way.

In the manic phase, a person becomes hyperactive, talks a lot, gets more energetic, has racing thoughts, gets easily irritated, impatient and can take risks or do impossible tasks. Sometimes manic episodes have hallucination and other psychotic symptoms (extreme cases). Patients suffering from manic depression run a high risk of committing suicide.

Prior to the 1990s, doctors and researchers were of the opinion that bipolar disorder struck patients once they reached adulthood. However, since the 1900s, doctors have been studying the possibility of the disease striking earlier.

Dr Mark Olfson, from Columbia University, New York, and researchers at the New York State Psychiatric Institute, compared increases between 1994-1995 and 2002-2003 in office visits that culminated in a diagnosis of bipolar disorder among individuals aged 19 and younger to that among adults aged 30 and older.

They found that outpatient visits with a diagnosis of bipolar disorder in the younger age group increased approximately 40-fold, from 25 per 100,000 in 1994-1995 to 1,003 per 100,000 population in 2002-2003. During the same time, the diagnosis of bipolar disorder in adults increased nearly 2-fold – from 905 to 1,679 per 100,000.

There are two possible reasons for the “impressive increase” in cases of bipolar disorder in young people, the authors say. Either bipolar disorder was historically under-diagnosed in children and adolescents and the problem has now been rectified or bipolar disorder is currently being over-diagnosed in this age group.

“Without independent systematic diagnostic assessments, we cannot confidently select between these competing hypotheses,” the authors noted.

Dr Olfson’s team also found that the vast majority of youth and adults were prescribed a psychotropic drug at the time of diagnosis of bipolar disorder, including mood stabilizers, antipsychotic drugs, and antidepressants.