Bipolar Disorder Daily News Blog

Frontline recently aired a program that explores the rapid increase in diagnoses of bipolar disorder in children during the past 7-8 years; the program is an update from earlier Frontline pieces which aired in 2001 and 2008. This program offers an overview of the current environment and attitude in the US vis-à-vis diagnosing young children with bipolar disorder and prescribing psychiatric medicines (many of which are "off label" for kids and adolescents). The video asserts that the rapid increase in diagnosis of bipolar disorder for kids is primarily a US phenomenon and conveys the heart wrenching uncertainty for families who wrestle with the counter-intuitive notion of giving young children psychiatric medicines. It also provides updates on kids who were first interviewed in 2001 and 2008 to see how they are progressing and how their bipolar diagnosis affects their lives. It's worthwhile to watch this program as it aptly raises critical issues for families and young kids faced with a bipolar disorder diagnosis (see my Nov. 10, Oct 28 & Oct 13 blogs for additional background on bipolar disorder and children).

I've recently blogged about using Mood Tracking Solutions as a tool for those with bipolar disorder to help manage their lives (see Oct. 27 and Sept. 15 posts). I came across an interesting article which supports this notion. A UK based psychologist and bipolar patient, Dr. Liz Miller, has written a book: "Mood Mapping" which offers a method for bipolar patients to closely monitor their moods as a way to help manage their condition.

Dr. Miller was a successful neurosurgeon when she was diagnosed with biopolar disorder at age 28; a series of personal setbacks associated with the bipolar condition ended her career as a neurosurgeon. Like many people who are diagnosed with bipolar disorder, Dr. Miller sought as much information as possible about the illness and how to best treat it. Over time, she began to track her moods and daily habits. Eventually, she wrote a book which focuses on five main areas of life which affect a person's mood that can be changed: one's surroundings, physical health, relationships, strategies for life, and being yourself.

Thoughts: Dr. Miller's story is reminiscent of Dr. Kay Redford Jamieson's reliance on her own experience with bipolar disorder to create her compelling account in "The Unquiet Mind." That said, I have not yet read this book and I welcome any comments or critiques. Dr. Miller, now 52 years old, has not taken any medication to treat her bipolar disorder for 8 years. This approach flies in the face of a commonly accepted precept about how to manage bipolar disorder over the long term: i.e. taking a mix of meds to stablize mood and protect against depression is generally thought of as a crucial part of of treating bipolar disorder.

I came across an intersting set of Short Stories on the online BBC Health "Secret Life" section. These short clips feature eight people with bipolar disorder who were asked questions about how they first felt when they were diagnosed; their experiences of mania, depression and getting treatment; and whether they'd push a magic button and get rid of the condition if they could. Interestingly, when asked if they could "eliminate their bipolar condition with the magic touch of a button," at least half of them said they wouldn't push that button. Their answers are illuminating and no doubt our readers understand the rationale behind either choice. You need to use RealPlayer to access these stories.

Last Saturday (Nov. 7) the House of Represenatives passed the Health Care Reform bill (H.R. 3962) by a narrow margin of 220-215. The Health Care reform debate has moved over to the Senate side where a similar bill may be brought to the Senate Floor as early as next week. We'll keep you posted on the Senate side developments and monitor the key provisions that impact people with bipolar disorder and other mental illnesses.

The Issue

The steady drum beat of diagnosing kids and adolescents across the U.S. with mental illnesses seems to have quickened during the past few years. Increasingly, parents come out of meetings with school counselors, psychologists, psychiatrists et. al. with a diagnosis of pediatric bipolar disorder, early onset bipolar disorder and/or ADHD and a prescription for psychiatric medicines. These diagnoses can both calm and alarm parents.

Several recent posts from Kimberly Read, a regular contributor to About.com regarding bipolar disorder, caught my eye. She sites a whopping 4,000 percent increase in pediatric bipolar disorder; I was intrigued by this statistic and sought out its source.

Source & Conclusion

Source: A 2007 study published in the Archives of General Psychiatry measured national trends in outpatient visits that resulted in a diagnosis of bipolar disorder, and then compared those trends between two age cohorts: a child/adolescent group (1-19) and an adult group (20 or older). The study compared office visits in the 1994-95 period to office visits in 2002-2003. The increase in office visits between these two periods for the child/adolescent group was 4,000%!

For those of you with young boys, there is additional grist for the mill: the study also showed a disproportionate number of boys (67.6%) coming in for visits and being diagnosed with bipolar disorder.

Conclusion: The study concluded that "there has been a rapid increase in the diagnosis of youth bipolar disorder in office-based medical settings." Why this might be the case is the subject for other studies.

What does it all mean?

While there is a massive increase in the diagnosis of bipolar disorder and other mental illnesses among kids and adolescents, we don't really know why that is the case. It may be that these illnesses were under diagnosed in the mid-90s or over diagnosed in the later period. It seems that terms such as bipolar disorder, ADHD etc. have come into the mainstream lexicon. Books such as The Bipolar Child (first published in 2000) helped increase the general public awareness about pediatric bipolar and probably gave encouragement to tens of thousands of families to seek out professional help for their children.

We will be on the look out for future studies that shed new light on the dramatic increase of diagnoses of bipolar disorder among kids and adolescents, and offer explanations that help families cope with this illness. As always, please feel free to offer your comments or observations on this post.

In yesterday's blog, I indicated that the Health Care Reform Bill is moving toward a vote in the House of Representatives. The expected vote is now being considered for Sunday (Nov 8) or perhaps later. President Obama is planning to go to Capitol Hill on Saturday to lobby key swing vote Representatives who could make the difference in passing the Health Care Reform Bill. There are several important provisions for bipolar patients and people with other mental illnesses (see yesterday's blog for these points). Today and tomorrow are great days to call your Representative's Washington D.C. office and indicate your support for this legislation (H.R. 3962). You can call the U.S. Capital Switchboard at (202) 224-3121 and asked to be transferred to your Representative.

Last week, the House of Representatives created a new bill, H.R. 3962, which combines previous legislation passed by three House committees. This newly created legislation represents the House version of Health Care reform which is scheduled for a House vote this Saturday (Nov 7). During the past two days, two large lobbying groups, the American Association of Retired Persons (AARP) and the American Medical Association (AMA), have thrown their support behind H.R. 3962. A Senate version which combines earlier legislation that passed through two Committees is being drafted and is expected to be introduced in the near term.

H.R. 3962 addresses several key issues for people who suffer from bipolar disorder or other mental illnesses. These provisions include:

1. Medicaid expansion for childless adults who make up to 150% of the federal poverty income level, including people living with serious mental illness who currently do not qualify for Medicaid coverage in their state.

2. Expanded coverage for the uninsured through a newly created health insurance "exchange" which would be required to have mental health benefits.

3. Insurance reforms that would ensure that people with mental illness could not be denied health insurance benefits on the basis of a preexisting condition or could not be dropped from existing coverage due to their medical condition.

These are important provisions and, if you agree with them, we encourage you to call your Representative or send an email between now and Saturday. Representatives' offices do keep track off emails and calls. If you're unsure of how to reach your Representative, you can call the U.S. Capital Switchboard at (202) 224-3121 and ask to be transferred to your Representative. For those of you with a lot of time on their hands, you can go to Health Care Reform Bill and read the actual bill which is nearly 2000 pages long!

During the NAMI 2009 conference we met with representatives of the Social Security Adminstration's TIcket to Work program which provides financial incentives for small businesses to employ people with disabilities. This program has been retooled recently with the objective of making it easier and more lucrative for businesses to hire people who suffer from bipolar disorder, depression and other Mental Illnesses.

Earlier today, we received a note from this program with a schedule of events in 15 states during November. For more information or to sign up for one of these program you can access Ticket to Work.

If you own a small business or are in a situation where you might qualify to work in a small business, you might review this program. The program administrators are actively working to add new businesses and get more people with disabilities back to work.

Also available is a Ticket to Work powerpoint document NAMI Workshop Slides.ppt that offers a more comphrensive overview of this progam. Be forewarned, this is 65 slide document.

Children taking psychiatric medications for bipolar disorder and other mental illnesses can experience rapid weight gain according to a new study published in the Oct. 28 The Journal of the American Medicine Association. The findings also link some of these drugs to metabolic changes such as elevated levels of cholesterol and triglycerides.

The Study monitored 272 children from the Queens, NY area, ages 4-19 (with an average age of 14), over a six year period (2001-2007); these children were receiving atypical antipsychotics such as Abilify, Risperdal, Seroquel, and Zyprexa for the first time. These medicines are considered 2nd generation drugs which improve upon earlier first generation antipsychotics which had numerous unpleasant side effects for patients. It's important to note that while all four of the drugs studied are approved for use on adults by the FDA, only Abilify and Risperdal are currently approved for pediatric use.

While weight gain has long been considered a common side effect for some of these drugs, today's study focuses on the impact of these drugs on young children and teenagers. The study shows weight gains of between 10-19 pounds over a three-month period. This study only reveals the short-term impact of taking these drugs on weight gain; the researchers intend to monitor these patients over a longer period of time.

This study confirms what many patients, doctors and researchers suspected: that taking these drugs can lead to weight gain in children. Parents should be fully aware of this potential side effect when their kids are diagnosed with bipolar disorder, depression etc. and treated with one of these drugs. Of course, many if not most doctors and parents will come to the conclusion that treating and controlling a child's bipolar disorder illness with one of these drugs outweighs the potential side effect of weight gain. That said, patients and their parents should be fully aware of the drugs' side effects.

For more information, review the accompanying JAMA Editorial regarding this study.

MoodTracker.com

Our findings are drawn from conversations with the MoodTracker.com CEO (David Hale), current users of MoodTraker.com, and our independent review of MoodTracker.com. We plan to monitor this software, stay in touch with active users and provide subsequent updates. We use pseudonyms to ensure MoodTracker users' privacy.

What is MoodTracker.com?

MoodTracker.com is a web-based Mood Tracking system which helps people who suffer from bipolar depression or depression track relevant information & data associated with their illness. This information includes: establishing a daily mood chart; charting a patient's "Mood History;" establishing a patient's Medical History; building in Support Alerts which offer users email, text messages etc. to take medicine or some other action step; and recording caregiver information.

MoodTracker.com provides a web-based tool that is easy to use, requires little time for patients to set up, and is easily accessible for patients, family members or Doctors (if patients allow such access to their online accounts). MoodTracker.com also provides an online Forum area for patients to discuss questions about how to use MoodTracker.com;
it also enables users to discussion numerous issues pertaining to bipolar depression and depression.

What do users say about it?

We spoke with Jennifer, a MoodTracker.com user, about her experience with the online tracking system. Jennifer researched various mood tracking systems and choose MoodTracker.com. She considered it essential that the system be web-based; she liked the flexibility of having her account & data on a server which could be accessed from any online source. She views this system has a good way to share relevant information with her Doctor who could easily access her information in advance of their sessions and be "current" on various data points. She also feels the various pie charts and graphs offered a user friendly, helpful way to visualize her moods and relevant data. She also likes the ability to send alerts to herself for various action points including taking medicine. Lastly, she found the Forum section to be user friendly, helpful and relevant to her ongoing issues.

Software tool versus web-based system.

Readers may recall that the Founder/CEO of the bStable product (see Sept. 15 post), researched the software versus web-based issue and came down strongly in favor of building a software tool. David Hale came to the opposite conclusion and decided to build a web-based application. One of the key issues patients that can arise with a web-based system is the security of the data. David points out that MoodTracker.com does not require any personal ID information to create an account; of course, patients are free to use any name/password combination as well as any email address so their use of MoodTracker.com is quite secure.

What does MoodTracker.com cost?

There are two MoodTracker.com versions. The basic version, MoodTracker, is free. An enhanced version, MoodTracker Plus, costs $24.95 annually and includes:

Pie Charts: With Pie Charts you get a summary of your moods by percentage. This can be very helpful for evaluating your moods over time and getting a better feel for the effectiveness of your medications. You can see your pie charts summarized by month, quarter, or year. Each pie chart is also sub-categorized by medication history, and there are different pie charts for mood, sleep, anxiety, and irritability.

Exercise Tracking: You can easily set up any number of exercise records to create a customized exercise plan. Each record specifies the exercise, the date when you started it, and how frequently it's done.

Significant Event Tracking: If a significant event occurs that greatly affects your mood, you can mark it on your chart.

No Advertisements: When you login to your MoodTracker Plus+ account, you won't see any ads. Basic MoodTracker users will see Google Ads on MoodTracker.com

Conclusions

MoodTracker is a good web-based mood tracking tool. It is easy to use and enables users to track relevant data points on a daily basis. MoodTracker Plus offers some nice additional charting, avoids advertising and is inexpensive. All in all we think this is a good system for those who prefer a web-based system versus a software based solution. It's one of a few independent sites (i.e. not affiliated with a pharmaceutical firm) that caters specifically to patients with bipolar disorder. We will continue to monitor MoodTracker.com's progress.

For more information, click here to access MoodTracker.com.

We recently posted a blog (Oct 19) about the increase in bipolar disorder and depression on college campuses. We cited an NPR Story on "Morning Edition" which highlighted actions that Stanford students are taking to educate other students about Mental Illness. We also cited a multi-decade study which surveyed college counseling professionals across the U.S. We've tracked down the survey, a compressive study which offers a look at the intensity and incidence of Mental Illness on colleges dating back to the early 1980s as well as a snapshot of the current state of counseling services on US colleges.

The survey includes 284 counseling centers from a broad range of colleges from small Liberal Arts colleges to large Universities including MIT, Duke, Cornell, Swarthmore, Rhode Island School of Design (RISD), the University of Texas (Austin), the University of Wisconsin (Madison) & the University of California (Davis). .

The survey offers an illuminating look at the current state of Mental Illness within US colleges and the availability or lack thereof of critical counseling and psychiatric services on campuses. A few highlights:

Scope of survey: 284 counseling centers from a broad sample of US colleges and Universities representing approx 3.4 million students.

26% of center clients (students) are on psychiatric medication. This figure is up from 20% in 2003, 17% in 2000, and 9% in 1994.
We encourage you to check out the survey and draw your own conclusions from the plethora of data and information contained in the study. What seems unambiguous is that ever greater numbers of U.S. students are suffering from Mental Illnesses, and they require some form of psychological or psychiatric treatment. It's also clear that many if not a majority of US college counseling centers are under serving students who need serious help.

Why is there a dramatic increase in the incidence and intensity fo Mentall Illnesses on college campuses? This question is beyond the scope of this particular blog post; however, it's an important issue which should concern both students and counseling professionals on college campuses. Please feel free to respond to this blog and offer your own insight into or experience of Mental Illness on your college campus. This is an important issue and your input may be helpful to a fellow student in need of support and understanding.

Additional Information: 2008 College Survey PDF

A new high-profile organization, Bring Change 2 Mind, is being launched today through a series of public service announcements (PSAs). The PSAs address the stigma of Mental Illness and raise awareness of the prevalence of Mental Illness in the U.S.; they are directed by Ron Howard and feature Glenn Close.

Glenn Close is working in concert with several leading organizations to create Bring Change 2 Mind. For more information, see www.bringchange2mind.org. Ms. Close has a sister, Jessie, who suffers from bipolar disorder.

I must admit that I became a bit emotional when watching a few of the clips available at www.bringchange2mind.org/index.php/share-your-story It takes courage for people, like Jessie, to announce to the world that they suffer from bipolar disorder or other Mental Illnesses. However, it's this type of personal courage which will help educate people and chip away at the stigma attached to Illnesses such as bipolar disorder and depression that lingers in society today. By lending her celebrity status to this issue, and personalizing it through an intimate portrayal of her sister's battle with bipolar disorder, Ms. Close is creating a strong platform from which to educate people about Mental Illness. We at pendulum.org applaud her effort!

I believe the creation of Bring Change 2 Mind breaks new ground in the effort to educate people about Illnesses such as bipolar disorder, depression, and schizophrenia. The fact that Ron Howard and Glenn Close have paired up to create these PSAs insures that today's launch will be widely viewed. I encourage our readers to take a look at this campaign to experience its impact. Also, they are actively seeking people who want to share their story with a video clip on this new website.

Here's a partial list of the PSAs that will be part of today's launch:(please note that you need to scroll down the home pages of these websites to find the links to Glenn Close and/or Bring Change 2 Mind).

* Bring Change 2 Mind on ABC's Good Morning
America

* Bring Change 2 Mind on ABC's TheView

* Bring Change 2 Mind on MSNBC's Dr. Nancy Show

Please offer any comments or observations you may have about this new organization and campaign to raise awareness around Mental Illnesses such as bipolar disorder, depression and schizophrenia.

Thank you.