Mania Worsens Antidepressants 16/02/2009 England Young Boy's Mania Worsens on Antidepressants Summary:

Paragraph 11 reads:  "One trigger was living in Reykjavik, when Titus was aged 10 to 13, where the light summers and dark winters fuelled an addiction to manic highs. When they moved from there to the US, he was put on medication but antidepressants made the mania worse and, combined with the vodka, the pills were a disaster."

The boy whose gift became a curse

How does a child genius from a loving family fall into a spiral of mental illness, addiction and finally suicide?


By Cassandra Jardine
Last Updated: 1:30PM GMT 16 Feb 2009
Clare Dickens, with a photograph of her son Titus Photo: CLARA MOLDEN

Titus Dickens used to entertain his grandfather by wandering around his Mayfair flat, quoting Winston Churchill's speeches. An impressive feat at any age, but truly remarkable at 18 months. He was an intensely curious child, his mother Clare remembers, constantly asking questions, able to express himself with a sophistication far beyond his years. He was also unusually talented at singing, art and acting. "The only sign of trouble ahead," she says, "was his absolute refusal to go to bed."

His primary school teachers had high expectations. Having a photographic memory, he always did well in exams, but essays that would have earned his classmates an A, were marked D by teachers who thought he could do even better. After a psychologist assessed his IQ as the highest he had ever encountered, he was accused of not trying. Socially, too, his brilliance created problems. "I discovered that being so smart distanced me from my peers," he said, "so I began making compromises, dumbing myself down."

If only his family had stayed in the "idyllic" Suffolk cottage where he was a carefree toddler, Titus thought his life would have been far happier. Instead, his English mother and American diplomat father were frequently on the move, so Titus and his younger brother, Max, moved with them, constantly having to make new friends. Concentration problems and mood swings led him to take drugs – legal, illegal and prescribed – which exacerbated his condition and brought on a host of new problems.

Titus was unable to do anything in moderation. When he discovered coffee, he could drink 20 espressos at a sitting, until he shook. Once he started to smoke, aged 14, he would do so non-stop. "He would make himself ill with cigarettes," says his mother Clare. The following year he became addicted to the drug Ritalin, prescribed to help him concentrate.

"He was fine when I gave him the Ritalin pill and watched him take it," says Clare. "It helped him focus and his schoolwork improved. But when he went to boarding school and was in charge of his own medication, he would cut up the pills and snort the drug to get a high." Titus described his Ritalin misuse as an "insane compulsion" because it didn't even give him much of a high. In search of the elusive buzz and increasingly aware of letting others down, he also began to drink vodka, smoke cannabis and even sniff Glade air freshener. As he said: "The search for the manic high is as addictive as a junkie's next fix."

Titus may have been predisposed to addictions because both Clare's parents had problems with alcohol, but the pattern seems horribly predictable after reading Teenagers: a Natural History by David Bainbridge, a zoologist who takes a scientific look at the developments that take place during the second decade of life.

The teenage stage is unique to humans. Other species reach maturity much earlier, but our pre-frontal cortex – the thinking part of the brain – needs an extra decade to create and streamline the complex connections that give homo sapiens pre-eminence. The difficulty with this sophistication is that, as Bainbridge puts it, our brains are "evolved to the very limits of instability". Epilepsy and schizophrenia, depression and anxiety – conditions limited to humans – all emerge during the teens when numerous developmental and chemical changes take place in the brain.

To make things still more perilous for teenagers, the time of life when their tendency to experiment is not yet fully controlled by the frontal cortex is also the time when most damage can be done. Any number of toxic substances can permanently damage dopamine receptors in the brain, which determine the ability to derive pleasure from normal life.

The reason why drugs are so terribly addictive, according to Bainbridge, is that they stimulate the nerve connections deep in the brain that drive us to seek out pleasure. These nerves run from the brain stem to the "accumbens nuclei" at the core of the cerebral hemispheres where they secrete dopamine. "Huge drug-induced surges of dopamine in the accumbens cause a long-term reduction in the number of dopamine receptors on those cells," he says, "The drug-taker needs ever increasing doses and the accumbens is less able to respond to sensible things such as food, sex and achievement."

No wonder Titus got worse. His moods swung so violently between hyperactive mania and deep depression that, aged 16, he was diagnosed bipolar (manic depressive). The disorder can be diagnosed in children, but Clare feels Titus wasn't born bipolar, he became so. She says. "His disorder was triggered by environmental factors, although he probably had a genetic predisposition – there is bipolarity on both sides of our family."

One trigger was living in Reykjavik, when Titus was aged 10 to 13, where the light summers and dark winters fuelled an addiction to manic highs. When they moved from there to the US, he was put on medication but antidepressants made the mania worse and, combined with the vodka, the pills were a disaster.

Expelled from his American school, he went to Hurtwood House, a boarding school in Surrey. From there he won a place at the London Academy of Dramatic Art – a triumph – but his condition was increasingly alarming. A British doctor prescribed Haldol, an anti-psychotic that prevents the over-activity of dopamine, which gave him the symptoms of Parkinson's Disease. Other drugs doped him so much that he wet his bed at night, put on four stone and found it hard to get up in the morning.

The key to keeping him well, Clare Dickens knew, was making sure that he didn't become over-tired or stressed. Outside her control in London, he would stay awake for days on end. By the age of 22 he was psychotic, having hallucinations and hearing voices. It was on her 50th birthday that Clare suggested they write a book together, describing his life from their individual points of view. She thought that his unusual ability to describe his own thought processes might help others. Titus agreed to the plan, he said in his introduction, because: "I have to find a reason for why my life has been so abominably chaotic."

Titus did want to get better. In 2006, he spent eight months in rehab in Michigan, where he seemed to be almost back to his old self. Clare and Ed, Titus's father, were exhausted by worrying about their son, impoverished by paying his debts and the cost of rehab, and fearful that his voices were driving him to violence. But Clare was never angry, only sad that her son couldn't sustain the good resolutions with which he left rehab. Sick of feeling doped, he stopped the medication, and his voices returned.

On December 16, 2006, as his parents were driving across a bridge into Manhattan, he opened the back door of the car, dashed out and jumped to his death. His psychiatrist told Clare that he probably jumped in order to save her because the voices were urging him to kill.

As a tribute to Titus, Clare has finished the book they were writing together, which she has entitled A Dangerous Gift. It has been published in Iceland, where the high rate of bipolar disorder has led to rehab programmes with a 70 per cent success rate. Sufferers are shown how to look after themselves and avoid the addictions that lead one in four to commit suicide.

But most of all, she wants to alert parents and teenagers to the devastating effects drugs can have on the developing brain. "Titus hoped that when he got better he could stop others making the same mistakes." For him, wisdom came too late, but through his death she hopes he may save others.