2004N-0330 - Joint Meeting of the Psychopharmacologic Drugs Advisory Committee and the Pediatric Advisory Committee

  


  

  


  

  


  

  


  

  
FDA Comment Number : 
  

  
EC7
  



  

  

  



  

  
Submitter : 
  

  
Dr. Jeffry Klugman
  

  
Date & Time: 
  

  
08/30/2004 02:08:26
  



  

  
Organization : 
  

  
Dr. Jeffry Klugman
  



  

  
Health Professional
  


  

  
Category : 
  


  

  
Issue Areas/Comments 
  


  

  



  

  
GENERAL
  


  

  



  

  
GENERAL
  


  

  



  

  
      I am a psychiatrist specializing in psychoppharmacology, treating adults and adolescents.  I have been especially interested in bipolar disorder since 1995, before most of my colleagues became aware of bipolar's prevalence. I currently treat hundreds of patients with this illness, as well as a comparable number with other diagnoses:  depression, anxiety disorders, substance abuse, etc.  Bipolar is about half my practice.



     According to a study by Geller, now at Washington U, 48% of children and adolescents with depression will be rediagnosed as bipolar by the age of 20.  Another study by Todd, who also happens to be from Washington U, followed a cohort of pre-adolescent children with depression, having eliminated any children with bipolar features or a family history of bipolar.  Two years later, one third of those children had been rediagnosed bipolar.



     In general, the younger the person with a mood disorder, the more likely it is or will become bipolar disorder.  I'll overgeneralize and say that bipolar is an illness of 14 year olds, and depression an illness of 40 year olds.  Of course that's a distortion, but it contains an important grain of truth.



       Administering an antidepressant to a patient with bipolar disorder may induce mania, agitation, anxiety, worsened depression, cycling or even psychosis.  Although between one fifth and one third of bipolar patients will ultimately need antidepressants, treaters who know bipolar try to avoid antidepressants, and certainly will only prescribe them to patients already on mood stabilizers.



        Psychiatrists in general have done a bad job diagnosing bipolar.  A study in the '90s said that the average patient with bipolar had been in psychiatric treatment for 8 years before getting the right diagnosis.  There are many more similarly horrifying statistics.  The most common misdiagnosis is to say a bipolar patient has a major (unipolar) depression.



        To pull this together then, kids with mood disorders tend to have bipolar.  Bipolar is often misdiagnosed as depression.  Also kids with depression tend to become bipolar at some later date.  Giving an antidepressant to someone with actual or latent bipolar disorder, in the absence of mood stabilizers, will often make them feel WORSE!



         In conclusion, a lot of the children and adolescents being given antidepressants have bipolar illness or a bipolar diathesis. No wonder some of them feel worse and have increased suicidal ideation.



         It is important that treaters be made aware of this possibility.  To restrict the use of antidepressants in children and adolescents, however, is throwing out the baby (and the children and the adolescents) with the bathwater.  Many kids need those drugs!  Don't do anything foolish, please.