Are We Making Our Children Sicker?

SSRI activation in children and the misdiagnosis of Bipolar Disorder

Texas mental health attorneyDid you have a good day today? Are you filled with energy, enthusiasm and motivation one day, only to crash the next? These mood shifts are normal for many. The bipolar person experiences them too, but on a more extreme scale. Spending money irresponsibly, delusions of grandeur and engaging in risky or unsafe behavior is a bipolar person’s true manic Monday, one that could last for weeks while they survive on barely any food, sleep or quiet escape from loud, racing thoughts. Depression may quickly follow, confining the sufferer to a shuttered life where even getting out of bed is almost physically impossible.

Bipolar disorder is a devastating mental illness that affects over 5 million adult Americans every year. This mood disorder has been found to run in families, suggesting a possible genetic link and leaving children predisposed to what is often a violent onset of a manic or depressive episode. Many manic episodes require hospitalization, and the disorder’s extreme highs and lows are often the culprit for people losing jobs, relationships, homes and overall stability.

A misdiagnosis of bipolar, however, can be devastating. Medication can backfire. Diagnosis can be made too soon. While the adult and senior mentally ill population are at risk, children carrying a misdiagnosis are vulnerable brains in vulnerable bodies, and the medication they’re prescribed can do more harm than good. SSRI’s in particular can cause symptoms of hypomanic or manic states, leading to a bipolar diagnosis. This is called “SSRI-activation” and is not healthy for a child’s brain.

The Law Offices of Skip Simpson strives to protect the rights to proper care for mentally ill people, and we know how damaging a misdiagnosis can be, especially to children.

Diagnosing Bipolar Disorder

Bipolar disorder is actually somewhat difficult to diagnose correctly. Diagnostic criteria often involve noting the occurrences of episodes over a long period. These “episodes” are characterized by extreme “highs” and “lows” and usually come with a host of behaviors just as extreme, erratic and dangerous as their hosting moods. While lifelong and without a cure, bipolar disorder can thankfully be treated with medication and therapeutic methods.

In adults, bipolar disorder in one of its varying forms (as the disorder exists on a spectrum) typically reaches a full diagnosis in late adolescence into the mid-twenties. Due to a developing brain, it should be cautioned against to diagnose children with such a severe mental illness, though pediatric bipolar exists. Criteria fall into two categories, one for “manic” symptoms, and the other for “depressive” – the two “poles” of the illness. To be diagnosed, these two distinct mood states need to exist for certain lengths of time. These criteria are cited from the Juvenile Bipolar Research Foundation:

Symptoms of a Depressive Episode:

  • Depressed mood most of the day, nearly every day
  • Diminished interest in hobbies or activities
  • Speech may become slow, delayed and even slurred
  • Physical symptoms such as pain, hypersomnia or extreme fatigue
  • Reoccurring thoughts of death or suicide
  • These symptoms must occur every day for at least a week

Symptoms of a Manic Episode:

  • At least one week of abnormal and persistent elevation in mood, including irritability.
  • Decreased need for sleep
  • Delusions of grandeur
  • Potential psychotic symptoms-hallucinations and disconnect from reality
  • Racing thoughts, sometimes to where a sufferer may feel like their head is “crowded” or “loud”
  • Speaking so rapidly that others cannot understand them and speech may not even follow a coherent train of thought
  • Inability to focus or sit still
  • Excessive spending, substance abuse, irresponsible sexual activity or unsafe driving

Bipolar disorder is separated into Bipolar I and Bipolar II, based on the severity and duration of episodes. In addition, there are other criteria that must be met, making bipolar disorder something a professional should not diagnose lightly in a child.

The right medication for the wrong diagnosis

The absence of mania or hypomania is often overlooked when children complain of depressive symptoms and are prescribed selective serotonin reuptake inhibitors, or SSRI’s. Commonly known as antidepressants, when given to children they can relieve symptoms of unipolar depression. However, SSRI’s “activate” roughly 10% of children, meaning they can cause symptoms eerily similar to hypomania or mania. Irritability, fast speech, hyperactivity and even suicidal ideations can occur. Children with ADHD and anxiety are often given SSRI’s, and their “activated” effects can easily lead to a bipolar diagnosis.

Children with developmental disabilities are particularly at risk. Someone who is a “slow metabolizer” of SSRI’s will see problems even on the lowest dosage. Parents often panic when their child reacts to medications, or seems treatment resistant. Being the legal guardian, they can easily misdirect therapy and medication, sometimes demanding a higher dose for a child that seems unresponsive.

Medication should be carefully monitored, as should the child’s symptoms. Parents who believe their children are treatment resistant may simply not be treating the proper condition, such as ADHD or anxiety, which responds better to an atypical antipsychotic drug. Making “one change at a time” in a child’s medication is heavily stressed, according to Dr. Birmaher of the Western Psychiatric Institute and Clinic in Pittsburgh. The brain is a delicate instrument, and providers who switch multiple drugs at once are putting children at risk.

The risks of a misdiagnosis

Suicide in our youth is no new statistic. One suicide every five days is the current standing rate, a 40-year high, for suicide rates in children under 13. Medication may alleviate symptoms but can also put child patients at risk. In 2004, the FDA issued a public warning of an increased risk of suicidal thoughts or behavior in children being treated with SSRI’s. The SSRI’s reviewed included:

  • Fluoxetine (Prozac)
  • Zoloft
  • Paxil
  • Celexa
  • Lexapro
  • Luvox

The black box warning noted that children should be monitored closely. Bipolar disorder is often treated with a “cocktail” of medications. SSRI’s, mood stabilizers and antipsychotics are popular, and all carry warnings. Even so, the use of SSRI’s in children over 10 has increased considerably over time, and those medications persist in their popularity. We can take no chances when treating our youth for psychiatric conditions. We cannot afford to lose any more sisters, brothers, daughters, sons and friends.

We help protect their rights

Every child has the right to be treated with dignity and respect when addressing potential psychiatric concerns, and this includes adhering to the same strict evaluation that adults must endure to properly diagnose a serious mental illness. Combining therapy with medication and lifestyle changes can be particularly effective, whereas prescribing potentially dangerous medication for a condition that is, in fact, something else can be devastating.

If you or a loved one have suffered the terrible consequences of a child misdiagnosed and mistreated, contact us. We may help.

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