Check out the story that appeared on August 30 on CNN.com titled “Growing Up Bipolar,” and the one on August 31 in the New York Times’s science section, titled “Lasting Pleasures, Robbed by Drug Abuse.” Both reveal a lot about the selective story-telling that forms our societal beliefs about mental disorders and psychotropic drugs.
The CNN story tells of how psychiatrists are getting better about diagnosing bipolar disorder in children, and how, once it is properly diagnosed, medications can be such a big help. But if you read the article closely, you’ll see that both of the children in this story were treated iitially with an antidepressant, which led to a manic episode in one child and to a further deterioration in behavior in the second child, and it was then they were diagnosed with bipolar disorder.
Before psychiatry began prescribing stimulants and antidepressants to children, juvenile bipolar illness was unknown. Researchers regularly concluded that bipolar disorder (or manic depressive illness, as it was called in the past,) simply didn’t occur in prepubertal children. But then psychiatry began prescribing those drugs to children and youth, and the juvenile bipolar boom followed. Indeed, when researchers have surveyed juvenile bipolar patients, they have found that the overwhelming majority had been treated with a stimulant or an antidepressant prior to their being diagnosed with bipolar disorder.
In other words, the CNN story should perhaps have been titled: “Creating the Bipolar Child: The Risks of Prescribing Antidepressants to Youth.”
In the New York Times article, Weill Cornell Medical College psychiatrist Richard Friedman tells of how illicit drugs like cocaine and methamphetamine activate the brain’s reward system by releasing dopamine. However, he notes, the brain then tries to compensate for the drug’s presence, and it does by becoming less sensitive to dopamine release. The brain may end up with a “less responsive reward circuit,” which never fully repairs itself even after the drug use stops, he writes. The result is that the person may then be condemned to “endure a dulled life.”
All of that may be true. But here is what is missing from this article. Ritalin and the other stimulants used to treat ADHD in children also activate the “dopamine system.” Ritalin, in fact, does it in much the same manner that cocaine does, and with equal potency. The difference is that Ritalin is not cleared from the body as quickly as cocaine, and thus a dose of Ritalin has longer-acting effects than cocaine. In response, the stimulant-using brain undergoes changes that make it less sensitive to dopamine release—it is trying to compensate for the drug’s presence. And so now the obvious question. If this process, in those who use cocaine or other illicit drugs, may lead to a “less responsive reward circuit,” which never fully repairs itself even after the drug use stops, isn’t there a similar risk with putting children on Ritalin or other stimulants? Is this treatment that may then lead children to “endure a dulled life” as adults?
It seems like a question that psychiatry—based on this article by Richard Friedman in the New York Times—should ask.
Tuesday, August 31, 2010