Bipolar Disorder in Children and Teens

What is bipolar disorder?

Bipolar disorder (BPD) is a serious mental illness. Children with this disorder have extreme changes in mood and behavior. In the manic phase they are highly energized and very active. In the depressed phase they are sad and have low energy. These moods happen more often and are far more severe than typical for children of the same age. Bipolar disorder used to be called manic-depressive illness.

What is the cause?

The causes of the disorder are unclear. BPD runs in families. If parents have bipolar disorder or depression, children are more likely to have it.

A first episode of mania or depression may be triggered by substance abuse, a death in the family, parents divorcing, breaking up with a boyfriend or girlfriend, or other traumatic events. However, often BPD begins with no specific event.

What are the symptoms?

BPD is different in children and teens than in adults. In adults there are often clear episodes of mania or depression that last a week or longer. In the manic phase the person has very high energy and may do wild, reckless things. This phase is often followed by depression.

In children and teens, the phases are less distinct and the changes between them may be more rapid. Depressed children are more likely to be irritable, cranky, and withdrawn, and less likely to be sad or feel hopeless than depressed adults. Children may cycle between depressive and manic phases as often as once or twice a day. This is called "rapid cycling,"

Many experts believe that children as young as 5 or 6 years old may show signs of BPD. Other experts believe that BPD cannot be diagnosed until the late teenage years. Some children and young teens may show a "mixed state." In a mixed state, depression and mania happen at the same time.

A child in the manic phase may:

• Throw tantrums often.
• Be unusually silly compared to others of the same age.
• Be defiant and destructive, and not follow rules.
• Be more sexual.
• Have bursts of energy and go for days with little or no sleep without feeling tired.
• Be impatient and unable to wait for things to happen.
• Talk very fast, not allow others to talk, and change topics very quickly.
• Be distracted, have trouble concentrating, and jump between different ideas.
• Be too active and act recklessly; for example, engaging in risky sexual activities, running into traffic, or wild bicycle or skateboard riding.

A child in the depressed phase may:

• Appear not to care about anything.
• Have low energy and be bored or restless.
• Lose interest in friends or classmates.
• Have trouble concentrating or remembering things.
• Have trouble falling asleep, wake up very early, or sleep too much.
• Eat very little or be a very picky eater.
• Say negative things like "I'm stupid" or "I hate myself."
• Stop doing activities he or she used to enjoy.
• Talk about death and suicide, such as saying "I wish I was dead."

Teens, when depressed, may:

• be withdrawn
• have trouble concentrating
• have less energy and may sleep more
• be more irritable
• be less likely to admit that they are sad and depressed.

When manic, teens may:

• seem more irritable
• be more impulsive, sexual, and energetic
• be able to function with less sleep than they usually need

How is it diagnosed?

Sometimes it is hard to tell bipolar disorder from other problems such as depression, substance abuse, anxiety, and PTSD. Many symptoms are also symptoms of other disorders. A mental health therapist who specializes in working with children and teens is best qualified to diagnose bipolar disorder.

The therapist will ask about your child's symptoms and behavior, medical and family history, and any medicines the child is taking. Your child may also need some lab tests to rule out medical problems.

Children and teens may also have other disorders in addition to BPD, such as:

• anxiety disorders
• attention deficit/hyperactivity disorder (ADHD)
• conduct disorder (delinquent behavior such as stealing and criminal activity)
• oppositional defiant disorder
• substance abuse

How is it treated?

Both medicines and therapy are usually used to treat BPD.

Your child may need to start taking medicines before therapy can be effective. Several types of medicines can help treat depression. Your healthcare provider will work with you to carefully select the best one for your child.

If your child also has attention deficit/hyperactivity disorder (ADHD), medicines for ADHD may be prescribed. However, in some cases the medicines for ADHD can trigger manic symptoms or mood swings in children with bipolar disorder. Antidepressant medicines can also bring on BPD symptoms in children.

It is important to have an experienced professional working with your child or teen. Your child's therapist will need to check your child's symptoms and medicines often.

Cognitive behavior therapy (CBT) helps children learn how to manage their physical symptoms, negative thoughts, and problem behaviors.

Family therapy is often very helpful. Family therapy treats the family as a whole rather than focusing on just the child. Children often feel very supported when parents and siblings attend therapy with them and work as a group.

Interpersonal therapy and psychoeducation (learning about the disorder and how to lessen symptoms) have also been found to be helpful.

How long will the effects last?

About 10% of teenagers who have a major episode of depression lasting several weeks develop BPD as adults.

Bipolar disorder is a lifelong problem. Without treatment, it may get worse. With medicine and regular therapy, however, it is often well controlled. Many children function normally once a good treatment program is in place.

What can I do to help my child?

If your child is suicidal, get professional help immediately. Without treatment, nearly 1 in 5 people with bipolar disorder commit suicide.

• Learn all you can. Read, join support groups, and network with others who are dealing with bipolar disorder.
• Make sure your child takes his or her medicines every day, even if feeling well. Stopping medicines when he or she feels well may bring about manic or depressive episodes.
• Stick to daily routines like regular bed and meal times.
• Keep activities very structured and predictable for your child.
• Be firm and consistent with rules and consequences. Staying calm and in control while you enforce rules and consequences is important with BPD children.
• Watch your child or teen for the beginning signs of a manic or depressive episode. Stay in touch with teachers, babysitters, and counselors to share information about symptoms your child may have.
• Make sure your child gets enough sleep and exercise every day.
• Teach your child to avoid alcohol, caffeine, nicotine, and drugs.
• Check with the healthcare provider treating your child before your child takes other medicines to make sure there is no conflict with their bipolar medicines.

When should I seek help?

If your child often has the BPD symptoms listed above, seek professional help. Do not try to treat these symptoms by yourself. Your child needs professional treatment.

Get emergency care if your child has thoughts of suicide or harming others, or if manic behavior puts you, others, or your child in danger.

For more information, contact:

Depression and Bipolar Support Alliance
Telephone: 800-826-3632
Web site: http://www.dbsalliance.org

National Alliance for the Mentally Ill
Telephone: 800-950-NAMI (6264)
Web site: http://www.nami.org

National Institute of Mental Health
Telephone: 866-615-NIMH (6464)
Web site: http://www.nimh.nih.gov/

National Mental Health Alliance
Telephone: 800-969-NMHA (6642)
Web site: http://www.nmha.org