Does Bipolar Disorder Exist? Or Was It Created by the Drug Companies?

Every once in a while you read something that leaves you absolutely dumbstruck—it takes some time to grapple with the reality before the appropriate emotions appear. After absorbing the article I am about to describe I was left with a mixture of anger, disgust, and wonder at the audacity of greed.



Mikkel Borch-Jacobsen wrote a review of a book authored by David Healy titled “Mania: a Short History of Bipolar Disorder” in the London Review of Books, October 7, 2010. The book was published in 2008. When I use the term “the author,” it will refer to Borch-Jacobsen.


The author begins with a story guaranteed to grab your attention.

“Early in the morning on 13 December 2006, police officers from the small town of Hull, Massachusetts, near Boston, arrived at the house of Michael and Carolyn Riley in response to an emergency call. Their four-year-old daughter, Rebecca, had been diagnosed with bipolar disorder two years earlier. When the officers reached the house, they found Rebecca sprawled on the floor next to her teddy bear. She had died from an overdose of the medication cocktail prescribed by her psychiatrist, Kayoko Kifuji. At the time of her death, she was taking Seroquel, a powerful antipsychotic drug, Depakote, a no less powerful anticonvulsant and mood-stabilising drug, and Clonidine, a hypotensive drug used as a sedative.”

The parents of the child were charged with first-degree murder, and ultimately convicted. However, the actions of the doctor who prescribed the medications were deemed not prosecutable. In fact, the medical community came to her defense.

“Yet the medical centre where Rebecca had been treated issued a statement describing Dr Kifuji’s treatment as ‘appropriate and within responsible professional standards’. In an interview with the Boston Globe, Janet Wozniak, director of the paediatric bipolar programme at Massachusetts General Hospital, went even further: ‘We support early diagnosis and treatment because the symptoms of [bipolar] disorder are extremely debilitating and impairing … It’s incumbent on us as a field to understand more which pre-schoolers need to be identified and treated in an aggressive way.’”

This prompts the author to ask a reasonable question.

"How could she have prescribed a two-year-old psychotropic medications normally intended for adults suffering from psychotic mania?”

Healy asked himself the same question and set out to deliver the answer. Healy is a well-regarded—albeit occasionally controversial—psychiatrist who is currently a professor of Psychological Medicine at Cardiff University School of Medicine, Wales. One of his recurring topics is the influence of the pharmaceutical industry on medicine and academic research.


It appears that if you let psychiatrists and psychologists work long enough they will eventually come up with a condition that needs their professional help. Bipolar disorder was virtually unknown before the 1980s. Since then it has become one of the commonest—dare we say most popular?— diagnoses. Healy was suspicious of the scientific justification. If the condition is so common now, then the logical conclusion is that the condition was always with us and we were just not smart enough to recognize it. To address this issue, Healy evaluated data on mental patients prior to the discovery of this diagnosis in search of cases exhibiting the related symptoms.

“One thing, however, seems clear: whatever this illness was, it was relatively rare. On the basis of 3872 admission charts from the asylum at Denbigh, North Wales, between the years 1875 and 1924, Healy arrives at a figure of ten cases per million each year, that is 0.001 per cent of the general population. This figure is striking, as today the incidence of bipolar disorder is supposed to be much higher. In 1994, for example, the US National Comorbidity Survey estimated that 1.3 per cent of the American population suffered from bipolar disorder. Four years later, the psychiatrist Jules Angst upped the figure to 5 per cent: 5000 times higher than the figure suggested by Healy.”

Not only was bipolar disorder becoming more common, it was also becoming more nuanced. The more nuance, the more papers that can be written, the more research proposals that can be funded—and the more drugs that are required to treat it.

“First, a distinction was made between ‘bipolar I’, which applied to patients hospitalised for both depressive and manic episodes, and a brand new ‘bipolar II’, which referred to patients hospitalised solely for a depressive episode. In other words, any person hospitalised for depression could now be diagnosed as bipolar. Then the reference to hospitalisation was dropped from the description of bipolar disorder II, which meant it could now include less severe forms of depression and hyperactivity, as well as all sorts of neurotic disorders that Kraepelin would never have dreamed of calling manic-depressive insanity. One now speaks of a ‘bipolar spectrum’, which includes, along with bipolar disorders I and II, cyclothymia (a mild form of bipolar II) and bipolar disorder ‘not otherwise specified’ (an all-purpose category in which practically any affective instability can be placed). The spectrum also includes bipolar disorders II1⁄2, III, III1⁄2, IV, V, VI, and even a very accommodating ‘subthreshold bipolar disorder’.”

“The category has expanded so much that it would be difficult to find anyone who couldn’t be described as ‘bipolar’, especially now that the diagnosis is liberally applied to people of all ages. Conventional wisdom once had it that manic depression burns out with age, but geriatric bipolar disorder is now the talk of psychiatric congresses. Elderly people who are depressed or agitated find themselves diagnosed with bipolar disorder for the first time in their lives and are prescribed antipsychotics or anticonvulsants that have the potential to drastically shorten their life expectancy: according to David Graham, an expert from the Food and Drug Administration, these psycho-tropic medications are responsible for the deaths of some 15,000 elderly people each year in the United States.”

How did a rare and previously unknown condition suddenly flare up and become a threat to two-year olds? Healy has an answer.

“Healy has another, more cynical explanation: the never-ending expansion of the category of bipolar disorder benefits large pharmaceutical companies eager to sell medications marketed with the disorder in mind. Psychiatric research doesn’t evolve in a vacuum. Behind the psychiatrists’ constant redrawing of the map of mental illness in a sincere effort at better understanding, there are enormous financial and industrial interests that steer research in one direction rather than another. For researchers, mental illnesses are realities whose contours they attempt to define; for pharmaceutical companies, they are markets that can be redefined, divided up and extended in order to make them ever more lucrative. The uncertainties of the psychiatric field present a magnificent commercial opportunity, since illnesses can always be tailored to sell a particular molecule under a particular patent. This is what industry insiders call ‘condition branding’.”

“In the case of bipolar disorder, this conceptual gerrymandering has involved stretching and diluting the definition of what used to be called manic-depressive illness so that it might include depression and other mood disorders, thus creating a market for antipsychotic or anticonvulsant medications that were initially approved only for the treatment of manic states.”

Apparently there is a procedure one follows when one wants to create a medical condition.

“Healy tells the story of the launch of bipolar disorder at the end of the 1990s. A specialised journal, Bipolar Disorder, was established, along with the International Society for Bipolar Disorders and the European Bipolar Forum; conferences were inundated with papers commissioned by the industry; a swarm of publications appeared, many of them signed by important names in the psychiatric field but actually ghost-written by PR agencies. Once the medical elites were bought and sold on the new disease, armies of industry representatives descended on clinicians, to ‘educate’ them and teach them how to recognise the symptoms of bipolar disorder. Bipolar patient advocacy groups sprang up, generously supported by pharmaceutical companies; freelance journalists were hired to write magazine articles on the latest advances in psychiatric science; websites were created, such as IsItReallyDepression.com (sponsored by AstraZeneca), where you can fill out a ‘mood assessment questionnaire’ at the end of which you’ll inevitably be dispatched to the nearest doctor. As a British blogger noticed recently, the Wikipedia entries ‘Bipolar Disorder’ and ‘Bipolar Spectrum’ were edited from a computer belonging to AstraZeneca, ensuring that everyone is on the same diagnostic page as the industry.”

Don’t you begin to wonder about how many other “conditions” were concocted in the same manner?


The drugs being prescribed for bipolar disorder are powerful, with the potential for serious side effects. They should not be administered casually, and as the author states, they should not be used as a “prophylactic to be given to depressed pensioners and hyperactive children.”

“A series of prominent lawsuits has been brought over the past few years in the United States against the manufacturers of anticonvulsants and atypical antipsychotics for having hidden their side effects and for having marketed them ‘off label’ towards patient populations not approved by the FDA. The sums paid out in fines or settlements by the pharmaceutical companies involved are staggering, and they give an idea of how disastrous the effects of their medications have been: Warner-Lambert/Parke-Davis (now Pfizer) has paid more than $430 million for marketing Neurontin for bipolar disorder; Lilly had to pay a total of $2.6 billion for the illegal marketing of Zyprexa; Pfizer was forced to pay $301 million for the illegal marketing of the atypical antipsychotic Geodon. AstraZeneca has agreed to pay $520 million to settle federal investigations into its marketing of Seroquel and has already spent $593 million in legal fees defending itself against the 10,381 individual lawsuits brought by patients for the side effects caused by the drug. Johnson & Johnson and its subsidiary Janssen have been sued by nine American states for the off-label marketing of Risperdal.”

The fact that the drug companies can absorb these expenses and still make large profits gives an indication of how much money is in play, and of how little incentive there is for them to change their ways.


The author has a better finish for this tale than any I could come up with.

“The marketing of bipolar disorder itself has not been put on trial, and probably never will be. This is the perfect crime. Bipolar disorder I, II, III etc remain on the books and doctors continue to exercise their freedom of judgment in prescribing Zyprexa and Seroquel off label to their ‘bipolar’ patients. An extended release version of Seroquel, Seroquel XR, was approved in December 2009 by the FDA for the treatment of depression. As for the sales of Zyprexa, they are up 2 per cent compared to 2007, when the medication generated $4.8 billion in sales. Who remembers Rebecca Riley now?”