Major Tranquilizers—even atypical ones–
are not Mood Stabilizers!
Lately I have noticed a disturbing trend: more and more patients are referring to an atypical major tranquilizer—Abilify, Seroquel, Geodon, Zyprexa, Risperdol—as a “mood stabilizer.”
What is the difference? and Why is this disturbing? (Continued)
The following article on pharmacology are detailed and technical and may be unnecessarily complex for some visitors to this site.
Nonetheless because the use of multiple medications has become the standard of care for bipolar disorder, both in children and in adults, it may be important for some parents or professionals to master these complexities in order to understand what makes some combinations safe and others dangerous.
In most cases the prescribing physician or the pharmacist can give you a warning about drugs that interact dangerously. Still, some parents want to know for themselves.
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Part I: METABOLISM OF PSYCHIATRIC MEDICATIONS
The CYP-450 System:
For the most part, psychiatric drugs are metabolized in the liver. In order to be psycho-active a drug must have a certain chemical activity and must be partially fat soluble, so it can pass through the blood-brain barrier and on into the central nervous system where it can affect the action of neurons. (Continued)
“CUM GRANO SALIS”
The division between clinical and research psychiatry, especially in children, has been recently emphasized in the controversy about using antidepressants in children and the efficacy of antidepressant treatment in bipolar disorder. In an editorial in the current American Journal of Psychiatry distinguished child psychiatrist, Cynthia Pfeffer—“The FDA Pediatric Advisories and Changes in Diagnosis and Treatment of Pediatric Depression”—observes that research between 1990 and 2000 showed a decrease in suicide among children treated with antidepressants. Click here to read Pfeffer’s editorial Pfeffer goes on to note that a more recent study confirmed the benefits of combined psychotherapeutic and pharmacologic treatment of depressed children. [March J, Silva S, Petrycki S, Curry J, Wells K, Fairbank J, Burns B, Domino M, McNulty S, Vitiello B, Severe J: "Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) Team"JAMA 2004; 292:807–820]. (Continued)
Diagnosis of bipolar disorder in children continues to be controversial. In an article in The New Yorker (April 4, 2007) Jerome Groopman MD, a respected medical writer, raises questions about the over diagnosis of the disorder. He notes that according to one study the diagnosis of bipolar disorder in children under 18 increased fourfold between 1990 and 2000. He quotes former director of The National Institutes of Mental Health (NIMH) Steven Hyman as cautioning: “The diagnosis has spread too broadly, so that powerful drugs are prescribed too widely… We are going to have hell to pay in terms of side effects… You can do more harm than good if you treat the wrong kid.” Hyman goes way too far, however, when he remarks, “Bipolar disorder in children represents the intersection of two great extremes of ignorance: how to best treat bipolar disorder and how to treat children for anything.” [Click here to read "What's Normal? The difficulty of diagnosing bipolar disorder in children" on Dr. Groopman's website.] Psychiatry is not ignorant about treating bipolar disorder, in either children or adults, although the appropriate treatment can vary widely from one person to another. What is more, enormous progress has been made in the diagnosis and treatment of bipolar disorder in children. Progress has also been made in understanding the neurological basis of the disorder. (Continued)
The death of 4-year old Rebecca Riley has raised concern that Bipolar Disorder is being over diagnosed in children and treated routinely with dangerous medications. Of greater concern than the use of medication with children is the lack of appropriate psycho therapeutic care for both these children and their families. Rebecca may well have been properly diagnosed, but she and her parents needed more comprehensive psycho therapeutic care. (Click here to read The Boston Globe story about Rebecca’s case.) (Continued)
COMMENTS ON THE ART WORK
“The Brilliant and At Times Terrifying Imagination of a bipolar 8 y.o. child” (Eric p. 209)
In this drawing in addition to the vivid use of color
[The large realistic—but rather wooden—figure in the middle of the drawing was drawn by me. As I look at Eric's drawing now, his more primitive figures are far more lively and energetic.]
(Continued)