December 26, 2008
NIH Podcast Episode #0074
Balintfy: Welcome to the 74th episode of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health—the nation's medical research agency. I'm your host Joe Balintfy. I'm your host Joe Balintfy and I hope you’ve been having some happy holidays. Coming up in this episode, topics all about medical research. Later in the program, we’ll have an in-depth interview about bipolar disorder. But first, two reports about the safety of medications used to treat ADHD. That's next on NIH Research Radio.
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ADHD Medications Do Not Cause Genetic Damage in Children – Part 1
Balintfy: Two of the most common medications used to treat attention deficit hyperactivity disorder, also known as ADHD, do not appear to cause genetic damage in children who take them as prescribed. We have two stories about this recent study. It provides new evidence that therapeutic doses of stimulant medications, such as methylphenidate and amphetamine, do not cause chromosomal damage in humans. Kristine L. Witt, a genetic toxicologist at the National Institute of Environmental Health Sciences, says this is good news for parents of children with ADHD.
Witt: Our current study was able to detect no evidence of any changes in three very standard measures of chromosomal damage in children who were treated with two of the most commonly prescribed stimulant medications for treatment of ADHD.
Balintfy: A previously published paper reported methylphenidate-induced chromosomal changes in children with ADHD. That paper from 2005 raised concern for the medical community and parents, given that some of the changes have been associated with an increased risk of cancer.
Witt: The earlier reported finding of chromosomal changes associated with cancer were not replicated in our study. And in fact our results do add to what is a growing body of evidence that therapeutic levels of methylphenidate do not induce chromosomal damage in humans.
Balintfy: ADHD is a disorder characterized by attention problems, impulsivity, and hyperactivity. About 3 to 5 percent of children in the United States have been diagnosed with the disorder, although several studies suggest 7 to 12 percent of children may be affected. We’ll have more on this story in just a moment.
ADHD Medications Do Not Cause Genetic Damage in Children – Part 2
Balintfy: With funding through the Best Pharmaceuticals for Children Act by two NIH institutes, this study has fairly clear safety indications.
Mattison: Continuing use of these drugs as prescribed is safe in terms of genetic damage.
Balintfy: Dr. Donald Mattison is senior advisor to the director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
Mattison: Which I think gives parents and practitioners substantial comfort that the drug that they’re using for treating ADHD is extremely unlikely to produce genetic alterations in their children.
Balintfy: The drugs studied were stimulant medications, such as methylphenidate and amphetamine. Dr. Mattison comments, that there are still some questions about how these drugs treat ADHD.
Mattison: But it seems to work by stimulating the executive areas of the brains so the kind of things a child might do on impulse, are less likely to occur.
Balintfy: This current study was designed to determine if findings from a previously published paper that reported drug-induced chromosomal changes in children with ADHD, could be reproduced. The current study was not able to replicate those earlier findings. Dr. Mattison says these results add to a growing body of evidence that therapeutic levels of these medications do not damage chromosomes. For parents he still offers this reminder:
Mattison: It’s always important to watch for something that’s unusual or unexpected while your children are being treated with a drug, any drug, and to keep in close contact with the pediatrician or health care provider that’s involved in prescribing medications for your children.
Balintfy: Funding for the Best Pharmaceuticals for Children Act comes from 17 different institutes and centers at the NIH. For more on the results of this study and ADHD, visit www.nichd.nih.gov. And coming up next on NIH Research Radio, an in-depth interview about bipolar disorder. Stay tuned.
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Balintfy: We’re back and we’re turning to the National Institute of Mental Health to talk about bipolar disorder. Our conversation is with Dr. Ellen Leibenluft (LEE-bin-loft), director of the pediatric bipolar research unit, and we started by asking for a definition of bipolar disorder.
Leibenluft: Bipolar disorder is characterized by mood swings, and in particular, by episodes of dysfunctional mood, and those episodes are episodes of mania, and episodes of depression. So people with bipolar disorder experience both these kinds of mood swings. During mania, people tend to be euphoric, extremely over-the-top happy. They can also be very irritable. And at the same time that they have that change in mood, they also have a change in how fast they talk, they talk much more rapidly, they move much more rapidly, their thoughts race, and they don’t need very much sleep. When people with bipolar disorder are depressed, they of course feel very sad, tearful, can feel very guilty. They either sleep too much or sleep too little, eat too much or eat too little, basically have all the symptoms that people with depression have. So what characterizes bipolar disorder is the ability to switch between these different kinds of mood states.
Balintfy: How common is bipolar disorder?
Leibenluft: The prevalence of bipolar disorder in the general population is somewhere in the vicinity of two to three percent. It is equally -- it impacts equally on men and women, so there’s no gender difference in that. And there’s been an increased recognition of the fact that it can affect children. Although the usual age of onset is late adolescence or early adulthood.
Balintfy: Are there risk factors for bipolar disorder?
Leibenluft: There very definitely are risk factors for bipolar disorder; we do know that bipolar disorder does tend to run in families. It is one of the more heritable psychiatric illnesses. And one of the things that we’re doing is we’re studying children who are at risk for bipolar disorder, children who either have a parent or a sibling with the illness, so that we can see if there are very early signs, so we can see if we can predict who will develop the illness and who won’t. Because ultimately, we want to not just treat the illness and of course cure the illness, but we also want to be able to prevent it.
Balintfy: Currently, what treatments are available for bipolar disorder?
Leibenluft: There are a number of treatments available for bipolar disorder. Some of the mainstays of treatment include the so-called mood stabilizers, lithium being the one that was first identified. Also, valproate is another important mood stabilizer. In addition, some of the so-called atypical antipsychotics are often used to treat both mania and sometimes, now there’s some evidence that they can even help with the depression that goes along with bipolar disorder. And then the antidepressants, the so-called serotonergic antidepressants can also be used to treat the depression part of bipolar disorder. But really, the mainstay of it is the mood stabilizers.
Balintfy: In addition to mood stabilizers, are there also non-pharmaceutical treatments?
Leibenluft: In addition, some specific forms of psychotherapy have been used to help with bipolar disorder. They’re always used in addition to medication, not instead of. For example, psychoeducation, teaching people about their illness, so that they can identify early on when they’re getting into a mood state, and can take certain actions to head it off, either stabilizing their sleep/wake cycle, for example, or shifting around their medications. Also, certain kinds of family therapies have been used, again to help stabilize the situation, particularly when the patient is a young adult, or an adolescent.
Balintfy: Dr. Leibenluft, can you explain if there are some special concerns when it comes to diagnosing bipolar disorder in adolescents and children?
Leibenluft: Sure. The issue that’s arisen is the question of whether bipolar disorder looks similar in children as it does in adults. Early on, I had mentioned that bipolar disorder in adults is characterized by episodes of mania and depression, and the question that has been raised is whether children who get very, very severely irritable, but don’t have those specific episodes, whether that’s also bipolar disorder or not. We know that some children do have classic episodes, so you can find children who look very similar to what adults with bipolar look like, but that’s relatively rare. So the more complex and problematic issue, in a certain sense, is how to think of children who don’t have episodes like that, but are very, very irritable.
Balintfy: Is this Sever Mood Disregulation, and what’s its connection to bipolar disorder?
Leibenluft: There are a few things that we know about these children with severe mood disregulation. They are at risk to grow up, not so much to be bipolar, as to have depression. So it seems that that’s what they are particularly at risk for, so the question is this an early manifestation of depression, is it a risk of depression, but it seems to be related to depression in early adulthood. We also know that these severely mood disregulated children are less likely to have a family history of bipolar disorder, compared to children that have bipolar disorder. And we also know that when we look at what’s going on in the brain when they get frustrated, because we’ve done these studies where we bring children into the lab, and have them play a very frustrating game, and look at what’s happening with their brainwaves, we see differences between the two groups. On the other hand, both the children with severe mood disregulation, these chronically irritable children, and the bipolar children, have a great deal of difficulty identifying face emotions. So they look at somebody’s face, and they both have a lot of difficulty saying what emotion is that person experiencing, and that makes them both different from children who are depressed but not very irritable, children with ADHD. So it looks like these severely mood disregulated children aren’t exactly bipolar, you can differentiate them in many ways, but on the other hand, there are some things that they do have in common. So maybe there’s a spectrum, and they’re somewhere along the line of the spectrum, something like that.
Balintfy: Thanks to Dr. Ellen Leibenluft at the National Institute of Mental Health. For more information about her and bipolar disorder, visit the NIMH website at www.nimh.nih.gov. And keep an eye on the NIH vodcast, “I on NIH” – we’ll have portions of this interview available there as well.
Balintfy: For now, that's it for this episode of NIH Research Radio. Please join us again on January 5th when our next edition will be available for download. I'm your host, Joe Balintfy. Thanks for listening. NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland, an agency of the US Department of Health and Human Services.