Depression, Bipolar Disorder and ADHD in Children By: Michael G. Conner, Psy.D,
There is a health care crisis very few people know about. It involves our children.
According to the US Health Department, nearly 1 in5 children between 11 and 17 have diagnosable mental, emotional or behavioral disorders. About 1 in10 children have severe problems. At least 10% of children between 11 and 17 are depressed. About 3% to 6% have a condition called bipolar disorder. Around 3% to 18% of children are reported to have ADD or ADHD. More children die from suicide than cancer. Professionals argue about the exact numbers but these are good approximations.
The Real Story about Depression in Children
The cause of depression is not what the public has been told during the past few years. First of all, there is absolutely no scientific evidence to prove the idea that depression is caused by a “chemical imbalance.” I’m talking about depression in children and most depression in adults. Pharmaceutical companies and their advertisers just made up the chemical imbalance theory and applied it to everyone. They got caught, that is one reason why you don’t see those cute animated depression commercials that show how drugs correct chemical inbalances on television anymore.
Two identical twins raised apart do not always end up depressed unless they are raised in very similar environments with similar stressors. Nearly all true childhood depression is the result of an inability to deal effectively with stress, anxiety or sadness. Children inherit sensitivity and emotional vulnerability that can result in depression. Children who feel helpless, hopeless and defeated eventually become depressed. Too much stress over time changes a child’s brain. They shut down, stop caring and they stop trying. The biochemical hypothesis behind depression is related to the effect of a variety of stressors on specific genes that alter the production of proteins that are essential in the mood machinery of the brain. It appears that repeated defeat and the inability to make a difference in stressful situations may play an essential role in creating depression. This mechanism is unrelated to a chemical imbalance.
A child is protected against depression when they are not abused, when their needs are met, when they are raised by parents who “make sense.” The well nurtured child has a strong sense of “self-mastery”, and discovers a “good” life that is not just the pursuit of pleasure and stimulation. These qualities protect a child against depression.
Attention Deficits and Hyperactivity: Is it Really a Disorder?
The cause of attention deficits and hyperactivity are more confusing than childhood depression and even more misunderstood by the public. ADD and ADHD are unique because they are considered disorders primarily in the United States and not the rest of the world. Most of what is diagnosed as ADHD in the United States is considered a normal difference among people in other countries. I see children who have a wandering and adventurous mind and high energy who have been told they have a disorder. The reason these disorders are so popular is because drug companies market medications that slow children down. Accelerated children exhaust parents and drugs that slow children down make it easier on teachers and working parents.
Ironically, the drugs most commonly used to slow children down are basically similar or exactly the same as methamphetamines. That’s right… parents are giving children a small amount of “meth” or a drug similar to “meth”. The side effects can be significant and may include weight loss, reduced growth, premature aging of the child’s cardiovascular system, greater risk of future addiction, heart problems, heart attacks, seizures, etc… I can’t even count the number of children who I have treated who came to me with a mistaken diagnosis of ADHD. Too many kids are diagnosed with ADHD.
It turns out that some of these ADHD children were traumatized, abused or neglected and as a result they have problems with attention and hyperactivity that is really anxiety and fear of relationships. Still others have another condition called bipolar disorder that can look like ADHD. Others are merely sensitive, nervous, bored, bright energetic children.
Bipolar Disorder: Looks Like Everything
Bipolar disorder (no longer called manic depression) is a real medical illness, a condition that is caused by a biological problem that is almost certainly genetic. Bipolar disorder is the most highly inherited condition in mental health. We don’t know the real cause but there are medications that help a lot or not at all. Bipolar disorder is actually a very difficult disorder to diagnose. The current diagnostic system is years out of date and many professionals believe there are bipolar disorders, soft bipolar disorders and a broad spectrum of bipolar disorders. I see patients who have symptoms that look like bipolar disorder but their lives are miserable, not out of control. It is not their personality or the result of stress in their life. Their mood, energy and ability to be productive cycle as a consequence of their situation and their nutrition.
At times bipolar disorder can look like depression. Other times it looks like an attention problem or hyperactivity. It can also resemble willfulness, temperamentalness or defiance. Symptoms of bipolar disorder usually start in puberty. Symptoms can be observed in younger children (often hyperactivity) but that is rare and it is hard to know if a child is truly bipolar. Some people experience their first symptoms of bipolar disorder later in their lives, usually before age 30.
Bipolar disorder may be under diagnosed. Physicians and mental health professionals often see the symptoms and conclude it is depression or ADHD. Ironically, drug treatment for depression and ADHD can help a bipolar child focus more and feel a little less depressed. But this does nothing to help children deal with more serious and devastating symptoms of bipolar disorder. Bipolar children taking medications for depression and ADHD can tolerate their suffering and they can get better grades for a while. Over time, they may break down, lose control or become reckless, self-destructive or even dangerous. Failure to recognize and properly treat bipolar disorder is devastating and the consequences can last a life time. Very few children recover from bipolar disorder if it is not diagnosed and treated as soon as possible. It is very difficult or impossible to correct the psychological damage to a child if they have severe bipolar disorder at age 12 and treatment is delayed for 4 or 5 years.
Health Care Crisis
There are approximately 40 million children in the U.S. who are 11 to 17 years old. It is estimated that 8 million of these children have a diagnosable mental health problem or addictive disorder. At the same time there is a scarcity of qualified mental health professionals who can screen and treat these children. According to the US Surgeon General, there are resources to help 1 out of 10 children in need. Schools have resources to help around 1 out of 20 children who need special education support for emotional problems. There are not enough qualified professionals to screen, diagnose and help children between the age of 11 and 17. As many as 5.6 million seriously troubled children are not being identified or receiving any help. Others are getting the wrong kinds of help. The Surgeon General’s office has declared this a “health crisis”.
Challenges of Understanding and Helping Children with Concerns of Depression, ADHD and or Bipolar Disorder
Parents should never assume a given diagnosis is correct or always will be correct even if it seems correct. They must become involved, educated and be empowered to work with mental health professionals to help their children. Parents should not assume everything is fine just because their child seems better for the moment.
Here are some reasons why:
Depressed or anxious children may be bipolar (but usually aren’t).
Young children can look like they have ADHD when they have early symptoms of bipolar disorder.
Many children with ADHD become depressed and anxious because school is hard for them.
ADD is not easy to identify before a child enters second grade unless it is severe from an early age.
Children who are anxious, bored or have learning disabilities can look like they have ADD or ADHD.
A child who becomes suddenly hyperactive may be showing anxiety, or possibly bipolar disorder, or a medical condition such as an over active thyroid gland. They should see a physician.
Children do not catch ADHD. It doesn’t start suddenly. It doesn’t start when children are in middle school.
The first signs of bipolar disorder usually surface when children enter puberty, but some times it can start at a very young age.
Alcohol and drug abuse can look like depression, ADHD or bipolar disorder.
Bipolar disorder can begin at almost any age, but usually after age 10 and before age 30. I have worked with families where everyone is clearly bipolar. More usually only one family member will be bipolar.
Many children with bipolar disorder become depressed or depressed and anxious because life is harder and they are miserable.
A depressed young teen who is very irritable and angry may have bipolar disorder but usually not.
Sexually abused children can look like they have bipolar disorder as they grow older.
A bipolar child can also have ADHD.
Family dysfunction can make children look like they have symptoms of depression, ADHD or bipolar disorder.
Medications Errors and Confusion
Medicating a child without working closely with a psychologist or therapist who really understands these disorders may be very harmful or dangerous.
Depression – In the real world, not a highly controlled study, antidepressants help no more than 1 out of 10 children diagnosed with depression. They do not cure depression and their benefit may not be valued given the side effects. Antidepressants can help a bipolar child when they are depressed but there is a greater chance that a bipolar child may become reckless, self-destructive or dangerous when the depression cycle ends. Giving an antidepressant to a bipolar child, in about15% of cases, will cause them to become impulsive or reckless. There is concern that given an antidepressant to a bipolar child can increase the risk of bipolar disorder or increase the severity.
No antidepressant is much more effective than others – except in rare cases. The real difference among antidepressants is in the severity of side effects. Some medications cause new emotional symptoms and more physical problems than others. The overall effect of antidepressants, in most cases, is to “numb” the patient’s emotional experience. The feel less sad or less nervous but they also fell less joy and happiness. The latter is a common experience among people who take these drugs. Psychotherapy and family interventions with willing and able parents are far more effective. In fact, prescribing antidepressants without therapy first has been recently deemed negligent in some countries. The American Psychiatric Association recommends therapy first in most cases, and medication and therapy second. Therapy alone is probably more effective than medication in most cases.
Just because a medication for depression seems to help a child, it doesn’t not mean your child has depression or even a disorder. It means the drug is helping with some of their symptoms. But, about 85% of children who seem to get better after they start antidepressants actually get better because of the passage of time, positive changes, fortunate events, extra attention or the threat of consequences. In most cases it is not the medication.
Medicating children improperly can be dangerous or harmful. Taking some medications, like Effexor, can increase the risk of violence. Unlike medications such as Prozac, children can take an over dose and die. Children can also have withdrawal symptoms when they stop Effexor. Starting an antidepressant like Paxil can increase risk of suicidal behavior. Medications like Prozac have been shown to increase aggressive behavior in children.
ADD and ADHD – According to the Center for Disease Control (CDC) approximately 4.4 million children are reported to have ADHD in the U.S. Treatment with stimulants, such as amphetamines or methamphetamines, will cause behavior disturbance, thought disorder, psychotic or mixed manic symptoms in 160,000 of these children. Patients should also be monitored for the appearance or worsening of aggressive behavior or hostility during initial therapy. Medications used to treat ADD and ADHD can help some children with bipolar disorder to focus but those drugs are not approved for that use.
Reports of sudden death have been reported with use of Amphetamines and Methamhetamines use to treat children with ADD and ADHD. Normal doses in children with structural heart abnormalities or other serious cardiac conditions; sudden death, stroke, and myocardial infarction have occurred in adults receiving normal doses of the drug. A careful history and physical examination is recommended for all patients prior to initiation of treatment; further evaluation via electrocardiogram and echocardiogram may be indicated. All patients should be monitored for excessive treatment-related increases in blood pressure and heart rate, and caution should be exercised when prescribing amphetamines for patients with conditions, such as preexisting hypertension, heart failure, recent myocardial infarction, or ventricular arrhythmia.
Screening and Getting Help for Adolescents
There is a free, quick and easy way to screen your adolescent. Go to the web site at www.StepOneForParents.org. This is a free resource offered by Mentor Research Institute. Complete the screening questionnaire. Review the StepOne report with a qualified counselor, psychologist or physician. You may discover that you don’t know enough about your child. You may need to become more involved and learn more about potential problems.
Final Comments: Parents should consult with a qualified professional before discontinuing any medication.