Health Library

Bipolar Disorder / Manic Depression

It is a serious but treatable disorder that occurs in all age groups.

Early intervention and treatment offer the best chance for children with bipolar disorder to have stable moods and develop normally. Proper treatment can lower the adverse effects of this disorder on the lives of these children and their families.

Helping a Child with Bipolar Disorder

Parents concerned about their child's behavior—especially severe mood swings that happen often, depression, periods of hyperactivity along with the need for less sleep, and high-risk behaviors—should have the child evaluated by a psychiatrist familiar with the symptoms and treatment of pediatric bipolar disorders. There is no blood test, genetic test or brain scan that can diagnose bipolar disorder.

Incidence of Bipolar Disorder in Children and Teenagers

Studies suggest that roughly 4% of people under 18 may have symptoms of bipolar disorder, including children as young as 5.

What are the Signs and Symptoms of Bipolar Disorder?

What are the Signs and Symptoms in Children?

Symptoms may be present since infancy or early childhood, or symptoms may suddenly begin as a teenager or an adult. Child psychiatrists now recognize and treat bipolar disorder in young children.

Bipolar disorder involves obvious changes in mood and energy. In most adults with the disorder, states of extreme happiness and agitation accompanied by high energy are called mania. States of extreme sadness and low energy are called depression. Episodes of extreme irritability can accompany episodes of both mania and depression.

The disorder can look different in children than it does in adults. Children often have an ongoing, continuous mood disturbance that is a mix of mania and depression. This rapid and severe cycling between moods produces chronic irritability and few clear periods of wellness between episodes.

Symptoms may include:

• An expansive, elated, depressed, sad or irritable mood
• Rapidly changing moods lasting minutes to days
• Explosive, lengthy and often destructive rages
• Sleeping little or sleeping too much
• Excessive involvement in multiple projects and activities
• Impaired judgment, impulsiveness, racing thoughts and pressured speech
• Inappropriate or precocious sexual behavior
• Grandiose belief in own abilities that may defy logic or physical laws (ability to fly, for example)

What are the Signs and Symptoms in Teenagers?

In teens, bipolar disorder may look like any of the following classical adult presentations of the disorder.

Bipolar I

In this form of the disorder, the teen has episodes of intense mania. About 80% to 90% of people who have Bipolar I also have depressive episodes. In cases of Bipolar I, episodes of mania and depression are so severe that they significantly impair a person’s ability to function.

Symptoms of mania include:

• Elevated, expansive or irritable mood
• Decreased need for sleep
• Racing speech and pressure to keep talking
• Grandiosity
• Excessive involvement in pleasurable but risky activities
• Increased energy or activity
• Poor judgment
• In severe cases, hallucinations

Symptoms of depression include:

• Pervasive sadness and crying spells
• Sleeping too much or inability to sleep
• Agitation and irritability
• Withdrawal from activities formerly enjoyed
• Drop in grades and inability to concentrate
• Thoughts of death and suicide
• Low energy
• Significant change in appetite

Periods of relative or complete wellness may occur between the episodes.

Bipolar II

In this form of the disorder, the teen has episodes of hypomania and depression. Hypomania is a period of increased energy or activity accompanied by constant marked elated, expansive or irritable mood that lasts three to four days. Bipolar II disorder is five to 10 times more common than Bipolar I disorder.

Cyclothymia
• Teens with this form of the disorder have many periods of hypomanic symptoms and depressive symptoms.

Other or Unspecified Bipolar and Related Disorder
• Significant mood symptoms are suggestive of Bipolar I, II or Cyclothymia but are not long enough or severe enough to meet criteria for these disorders.

For some teens, a stressful life event may trigger a first episode of depression or mania. Later episodes may occur without any obvious stresses, or they may worsen with stress. Puberty is a time of risk. In females, the onset of menses may trigger the disorder, and symptoms often vary in severity with the monthly cycle.

How is Bipolar Disorder Diagnosed?

This condition is most often diagnosed in the late teens to early adult years. Diagnosis is important because it guides treatment decisions and allows the family to put a name to the condition that affects their child.

Mental health professionals diagnose bipolar depression by conducting a detailed psychological evaluation, including assessment of the child or teen’s mood patterns, behaviors and symptom history. Information is also gathered about the mental health history of the child’s family, since bipolar disorder can have a genetic component.

Proper diagnosis and treatment are incredibly important. Untreated or improperly treated bipolar disorder can lead to negative behaviors and health outcomes, including:

• An unnecessary increase in symptomatic behaviors leading to removal from school, psychiatric hospitalization or worsening of the disorder due to incorrect medications
• Drug abuse, accidents (caused by impulsivity and / or reckless behavior) and suicide

Many children who develop early-onset bipolar disorder have a family history of drug or alcohol use disorders and / or mood disorders (often undiagnosed). If you are concerned about your child’s behaviors, get a full psychiatric evaluation. Mental health professionals are available to give information about diagnosis and treatment options. They will also support you as you care for your child.

Genetics and Family History

The disorder tends to run in families. There are also environmental factors that influence whether the disorder will occur in a particular child. Bipolar disorder can skip generations and take different forms in different people.

The studies that have been done vary in the estimate of risk to a given person:

• For the general population, a conservative estimate of a person’s risk of having full-blown bipolar disorder is 1%. Disorders in the bipolar spectrum may affect 4%-6%.
• When one parent has bipolar disorder, the risk to each child is 15%-30%.
• When one parent has bipolar disorder and the other parent has a mood disorder, the risk of developing bipolar disorder is 50%-75% for each child.
• When both parents have bipolar disorder, the risk increases to about 80%.

Seeking a Bipolar Disorder Evaluation

Knowing when to seek a bipolar disorder evaluation in children can be hard, but some behaviors should raise a red flag. These include:

• Frequent, severe and prolonged mood swings that impair functioning and that are developmentally inappropriate
• Frequent talk of wanting to die or kill themselves
• Trying to jump out of a moving car
• Rages lasting for hours
• Increased risk-taking behaviors, including spending money they do not have or risky sexual behavior

Bipolar Disorder Versus Other Conditions

Correct diagnosis of bipolar disorder remains challenging. Bipolar disorder is often accompanied by symptoms of other psychiatric disorders. In some children, proper treatment for bipolar disorder clears up the troublesome symptoms thought to indicate another diagnosis. In other children, bipolar disorder may explain only part of a more complicated case that includes neurological, developmental and other components.

Diagnoses that mask or sometimes occur along (comorbid) with bipolar disorder include:

• Depression
• Conduct disorder (CD)
• Oppositional-defiant disorder (ODD)
• Attention-deficit / hyperactivity disorder (ADHD)
• Panic disorder
• Generalized anxiety disorder (GAD)
• Obsessive-compulsive disorder (OCD)
• Tourette syndrome (TS)
• Substance use disorders

What are the Treatment Options for Bipolar Disorder?

Treatment for bipolar disorders typically involves a combination of medication and psychotherapy. Healthy lifestyle interventions, including an emphasis on healthy eating, getting enough sleep, and exercise, have also been shown to reduce the severity and frequency of bipolar disorder episodes.

Therapy

Children and teens with bipolar disorder can benefit from many types of psychotherapy, including:

• Supportive psychotherapy: therapy that focuses on encouragement and validation
• Cognitive behavioral therapy: therapy that addresses positive coping strategies to replace unhelpful ways of thinking and behaving
• Family-focused therapy: therapy that involves both children and their parents to improve family functioning and communication
• Focused counseling on substance use risk: one-on-one guidance about the increased risk for substance abuse in patients diagnosed with bipolar disorder

Drug and Alcohol Use and Addiction Treatment

For teens with bipolar disorders, recreational drug and alcohol use may turn into overuse. If drug or alcohol addiction occurs in youth with bipolar disorders, it is essential to treat both the bipolar disorder and drug use disorder at the same time.

Without simultaneous treatment for both conditions, children may face a cycle of worsening symptoms. Bipolar disorder can increase vulnerability to substance use disorders, while substance abuse can intensify mood swings, depression and risk taking caused by bipolar disorder. By addressing both issues at the same time, mental health specialists can support children and teens experiencing both conditions to achieve better overall treatment outcomes.

Medications

Antipsychotic medications such quetiapine, risperidone or aripiprazole, taken alone or in combination with a mood stabilizer, such as lithium, may effectively treat the symptoms of bipolar disorders. The Food and Drug Administration has approved the use of some antipsychotic medications in patients as young as 10 years old for bipolar disorder. It has approved lithium in patients as young as 7 years old.

Many people may have co-occurring disorders, such as ADHD, along with their bipolar disorder symptoms. Clinicians will first work to help stabilize the person’s mood before moving on to treat other coexisting symptoms, such as inattention.

Some antipsychotic medications typically prescribed for bipolar disorders can cause weight gain as a side effect. Providers may recommend other medications to help offset or prevent the potential for weight gain during treatment.

What is the Long-Term Outlook for a Child with Bipolar Disorder?

Most people will recover from their first mood episode of bipolar disorder. But most will also have a later episode. Over time, episodes of mania and depression may become more frequent.

Initially, stressful life events may trigger mood episodes, but eventually they may happen spontaneously. Some people may go months or years between episodes.

Patients can limit how often and how severe their episodes are by taking their medications, going to therapy, and avoiding alcohol and other drugs. Lifestyle modifications like getting exercise and enough sleep can also help offset bipolar disorder mood episode frequency and severity.