Bipolar disorder in young people is often a misdiagnosis

By Peter C Gøtzsche

The first sentence in a BMJ article about drug monitoring for bipolar disorder is: “Bipolar disorder often affects a younger population (peak onset between 15 and 19 years)” (1).

How is this possible when bipolar disorder in children and young people was virtually unknown 50 years ago? Because bipolar disorder in young people is mainly a misdiagnosis that stems from confusing the harms of stimulants with the disorder.

The harms of stimulants are very similar to the symptoms doctors use when diagnosing bipolar. In the United States, many ADHD children are diagnosed also with bipolar disorder, which I consider a medical error, as one cannot diagnose an additional disorder reliably in a drugged person. The most prominent American child psychiatrist, Joseph Biederman, invented the diagnosis juvenile bipolar disorder, and he and his co-workers made a diagnosis of bipolar in 23% of 128 children with ADHD (2). This condition was virtually unknown before Biederman stepped into the scene, but in just eight years, from 1994-95 to 2002-03, the number of medical visits in the United States for children diagnosed with bipolar disorder increased 40-fold (an increase of 3900%) (3).

Before a diagnosis of bipolar is made in any patient, doctors should ensure that the patient is not in treatment with a drug whose adverse effects mimics the diagnostic criteria.

1 Zaidi S, Heald AH, Belgamwar RB, Fryer AA. Monitoring drug interventions in people with bipolar disorder. BMJ. 2023;380:e070678.

2 Biederman J, Faraone S, Mick E, et al. Attention-deficit hyperactivity disorder and juvenile mania: an overlooked comorbidity? J Am Acad Child Adolesc Psychiatry 1996;35:997-1008.

3 Moreno C, Laje G, Blanco C, Jiang H, Schmidt AB, Olfson M. National trends in the outpatient diagnosis and treatment of bipolar disorder in youth. Arch Gen Psychiatry 2007;64:1032-9.