Can a Diagnosis Be Epidemic, With Therapeutic Efforts the Catastrophe?

The diagnosis of bipolar spectrum disorders (BSD) given for office visits has risen 40-fold for children and has risen dramatically for adults as well. Some of the growth may have been fueled by recategorization of individuals who would previously have received diagnoses of major depression along with the widening of diagnostic criteria for BSD. Concomitant with the rise in BSD diagnoses, the number of adults and children receiving atypical antipsychotics has increased dramatically. Recent evidence finds that atypical antipsychotics cause considerable reduction in brain volume. It is thus imperative to ensure that those with diagnoses comprising BSD—bipolar I, bipolar II, and bipolar not otherwise specified (BP-NOS)—actually share a common etiology and are being appropriately treated. This article reviews the history, evidentiary support, and implications associated with the expansion of the bipolar spectrum.