This morning I nearly choked on my coffee when I read this headline: “Lithium Safe for Children as Effective Treatment for Bipolar Disorder.” Those three words (lithium, safe, children) were not something that my head could reasonably fit in the same sentence. From what I’ve heard of lithium it’s not even safe in adults. My definition (and I dare say that of most people) of “safe” means a drug that produces few if any adverse effects, and certainly no permanent damage.
I would post the list of the side-effects of lithium here but it’s too long. If you’re interested, click here for a list. Lithium negatively effects at least kidney, thyroid and liver function. Long-term use of lithium (10-29 years) was linked in a recent study to one third of the population developing kidney failure. If you ask me, that’s not completely safe.
Of course it will depend on your luck and genetics and other unknown factors whether you do well on this drug or not. As an adult you will have access to varied information and can make an informed decision about whether it is a good idea in your case to take lithium. But we are not talking about adults here, but children. Children don’t get to decide.
A study performed by Dr. Elizabeth Waller on children under seven years of age with aggressive behavior found that lithium produced central nervous system impairment (evidenced by drowsiness, confusion, poor coordination and tremor) in 50% of the subjects. She says extreme caution is warranted when prescribing this drug to children and that it should only be done by doctors with considerable experience with the drug.
So you may well imagine that this sentence from the Johns Hopkins webpage added to my fury: “doctors can now more confidently add lithium to the armamentarium of available treatments for this vulnerable population.” The researchers add “in the short term” since the study was only eight weeks long, but I’m very much afraid the Chinese telephone some doctors and particularly the media use might easily get rid of that caveat.
There is ongoing controversy over whether pediatric bipolar disorder is even real. Up till very recently, the consensus has been that it either doesn’t exist or is extremely rare. The rates of diagnosed pediatric bipolar disorder have skyrocketed within ten years since the start of this century. Bipolar in children was diagnosed in hospitals forty times as often towards the end of the time period. For argument’s sake, let’s assume for a moment that these doctors are right and there are increasing numbers of these children who genuinely fill the diagnostic criteria (side note: there are no diagnostic criteria for children so kids are diagnosed using the same criteria as adults, which alone is problematic since normal behavior is very different for these populations). Even if that were true, should we put them on lithium?
Genetics and a wide variety of other factors play a role in who develops mental health issues and who doesn’t. But there are several studies showing the risk for developing bipolar disorder is much larger in those who have undergone severe emotional trauma as children. One study found that all the bipolar patients had had more severe traumatic events in their childhood than the healthy controls. So for at least some of these people, it doesn’t actually seem like they just develop this illness out of nowhere because they happen to be genetically disposed. Interestingly, sexual and emotional abuse predict a lower age of onset, which would mean that more children fit into this traumatized population. We can’t infer the causal relationship from these studies, but such a strong correlation is very noteworthy.
The scariest part in this is the fact when we start to treat these suffering kids with powerful drugs that dull their pain, we are not really treating them. We are not using the skills and the knowledge we have to make their lives better. Instead we are branding them with the stigma of an incurable mental health condition, saying that their feelings and sorrows are not real but manifestations of a random illness, and in the process possibly producing serious long-term effects on their health.
It’s possible that many adults with bipolar disorder are so far off on that path that they actually do require treatment with drugs such as lithium to feel better. But children? Children, who strangely didn’t even suffer from this condition until recently? It is every parent’s and doctor’s responsibility to do everything in their power to help the child before resorting to these drugs. If there is anything wrong in the child’s life that needs fixing, such as unresolved traumatic events, bad nutrition, inadequate exercise, learning disabilities, lack of friends, problematic relationship with parents, personality issues, anger control issues… Sort out these issues before putting the kid on lithium. It is not as safe as the drug companies would like you to think.
To wrap it up, some additional, in my mind fairly crucial, information on Dr. Findling, the researcher behind this coffee-spilling study, found at the very bottom of the Johns Hopkins newsletter:
“Relevant disclosures: Findling has consulted for drug manufacturers Bristol-Myers Squibb, Lilly, Merck, Otsuka, Pfizer, Sunovion and Validus, and has received research support from AstraZeneca, Johnson & Johnson, Bristol-Myers Squibb, Lilly, Merck, Otsuka, Pfizer, Sunovion and Validus.”
Was that all the major drug companies? No, there are more.
In this 2014 study, funded by Validus, Findling studied the safety and efficacy of carbamazepine, a drug that may be used as a second line agent in bipolar disorder. They found that the drug “might be safe” in spite of the fact that the majority (83.4%) of the patients reported adverse events, although luckily “no deaths or completed suicides occurred in any subjects.” (the bold is mine).
The disclosure list for this study is considerably longer:
Validus Pharmaceuticals, LLC provided funding for the study.
Dr Findling receives or has received research support, acted as a consultant, received royalties from, and/or served on a speaker’s bureau for Abbott, Addrenex, Alexza, American Psychiatric Press, AstraZeneca, Biovail, Bristol-Myers Squibb, Cognition Group, Dainippon Sumitomo Pharma, Forest, GlaxoSmithKline, Guilford Press, Johns Hopkins University Press, Johnson & Johnson, KemPharm Lilly, Lundbeck, Merck, National Institutes of Health, Neuropharm, Novartis, Noven, Organon, Otsuka, Pfizer, Physicians’ Post-Graduate Press, Rhodes Pharmaceuticals, Roche, Sage, Sanofi-Aventis, Schering-Plough, Seaside Therapeutics, Sepracore, Shionogi, Shire, Solvay, Stanley Medical Research Institute, Sunovion, Supernus Pharmaceuticals, Transcept Pharmaceuticals, Validus, WebMD, and Wyeth.
In the last 12 months, Dr Ginsberg receives or has received research support, acted as a consultant, and/or served on a speaker’s bureau for AstraZeneca, Bristol Myers Squibb, Forest, Jaymac, Merck, Novartis, Noven, Otsuka, Pamlab, Pfizer, Seaside Therapeutics, Shionogi, Shire, Sunovion, and Validus.
The authors report no other conflicts of interest.”
Well, thank God there weren’t any more. I counted 42 for doctor Findling. I suspect there’s some serious money to be had when you have support from 42 drug companies. Is this really the man you want to trust when making decisions about a drug’s safety? Would you truly believe that he has no interest in having the outcome turn out for the drug’s benefit?
I know I wouldn’t.