Nassir Ghaemi, MD, Psychiatry/Mental Health, 03:49PM Feb 13, 2014
It is a truism in child psychiatry: bipolar illness is overdiagnosed, and their treatments are overused, and, some will add, dangerous. The main bipolar drug classes are antipsychotics, anticonvulsants, and lithium. What is the evidence that they are overused? And how do they compare to the other two major drug classes in children: antidepressants and amphetamines?
There is new evidence from a recent large nation-wide survey in the US, part of the same dataset that is commonly cited regarding frequency of psychotropic drug use in the US. Indeed, all drug classes increased in usage from about the mid 1990s to a decade ago, mostly doubling in use.
But in the last decade, the only drug class whose usage has continued to increase in children is the amphetamine class, with a tripling of usage. The curve is a direct line headed to the ceiling, and it is two to three folds higher in usage than any of the other drug classes.
Where is the reaction? The anti-child bipolar phenomenon remains in full swing: the diagnosis is routinely condemned, lithium rarely prescribed, anticonvulsants often looked at askance. But there appears to be much less concern about the overdiagnosis of ADHD and use of amphetamines.
It bears repeating: the animal data clearly show that amphetamines are neurotoxic, harmful to the developing brain. But that's in animals not humans, we hear. Aren't humans animals? But it's not proven in humans that amphetamines are harmful, we are told. My reply: it's not proven that they are safe.
A question: Are we supposed to prescribe drugs until they are proven harmful? Or are we supposed to avoid prescribing drugs until they are proven safe?
But the amphetamines work, it is true: kids do better. That's proof of ADHD. Yet Opiates work too: adults feel better. That's proof of universal pain disorder. Amphetamines "work" in normal persons; they always improve attention, even if you're normal in your attention; you'll become super-normal. That's exactly why they are abused. Just like opiates, which reduce normal pain, and are abused.
This doesn't mean we shouldn't use opiates, nor amphetamines. But it does mean that symptomatic benefit of a drug with effects in normal persons is not proof of disease.