You may have read or heard about the recent report in the Archives of General Psychiatry (Vol. 28, No. 3) that while the rate of bipolar illness is 4% in the USA it only averages 2% outside of the USA. Twice as many people with bipolar in America than elsewhere? So, what's up with that?
Why is bipolar being diagnosed at twice the rate in the USA relative to outside of the USA? While I don't know for sure I am amazed at how frequently it is diagnosed in recent years. This is especially true among children and young people. Bipolar I, II, and now even Bipolar III is being used to capture variations on the theme of cycles of depression and mania.
Recently I sent a patient who I considered to have struggles with anxiety to a psychiatrist for potential
medication. The person ended up with a bipolar diagnosis. This lead to medications that created a variety of problematic side effects as well as other unintended consequences for the person. This isn't unusual. I've had this happen before to my patients in recent years. Other psychologists have told me that they have had this experience as well.
My concern is that bipolar has become the diagnosis du jour in America. This worries me because patients are prescribed strong mood stabilizing medications that may or may not be appropriate for them as well as living with a diagnosis that may or may not be truly accurate. I am most concerned when children and young people are medicated in ways that might not be completely safe for their developing brains.
Now, I'm a psychologist and not a psychiatrist. Thus, at the end of the day, I have to trust my physician colleagues to do the right thing when it comes to medication management making decisions based on the very best available science and clinical best practices.
That being said, I am nervous. I can't help but wonder if the frequent diagnosis of bipolar in the USA in recent years truly reflects a better appreciation for and identification of this disorder or might it just be trendy: the diagnosis du jour. For example, when Hollywood stars announce that they have bipolar (e.g., Catherine Zeta Jones) might the publicity increase the diagnosis in the general population too?
On a perhaps more sinister note, could the frequency of bipolar disorder be a by-product of pharmaceutical company interests and efforts to promote their medications for profit? You have to at least wonder.
Certainly bipolar disorder exists but could it really exist at twice the rate in the United States than anywhere else in the world? What explanation seems more reasonable to you? What do you think?
And by the way, you can learn more at http://apa.org/monitor/2011/06/bipolar.aspx.
