Quick Guide to Bipolar Disorder

Bipolar disorder is a mental health disorder that causes cycles of extreme emotional changes.  

Children and teenagers with bipolar disorder have periods of time where they are extremely happy and energetic, called mania, and other periods where they are very depressed. Mania can cause kids to be highly impulsive and make risky decisions and actions. Some kids experience a less intense form of mania called hypomania. Bipolar disorder used to be called manic-depressive disorder. 

Bipolar usually begins when children are in their mid-to-late teens. Some younger children are diagnosed with the disorder, and sometimes bipolar symptoms do not start until adulthood.

Most children and teenagers with bipolar disorder will go through separate periods of time, called episodes, of both mania and depression. Mania and depression have very different symptoms. 

Signs of mania include: 

• Extreme changes in personality  
• Being very excited  
• Being easily annoyed or aggressive (especially in younger children) 
• Having lots of energy 
• Believing they are much smarter or better than others  
• Doing wild or dangerous things 
• Not needing much sleep 
• Talking too much 
• Having many thoughts racing through their head 
• Significant difficulty paying attention 
• In its most extreme form, losing touch with reality, which is called a psychotic episode or break 

Signs of depression include: 

• Being very sad or easily annoyed  
• Losing interest in things that make them happy  
• Gaining or losing a lot of weight 
• Sleeping more or less than usual 
• Feeling consistently sad for at least 2 weeks
• Not being able to sit still 
• Not wanting to move 
• Being extremely tired 
• Thinking they cannot do anything well 
• Feeling very guilty or hopeless
• Not seeing or talking to friends 
• Not thinking clearly 
• Focusing on death or killing themselves, or trying to kill themselves 
• In its most extreme form, losing touch with reality, which is called a psychotic episode or break 

A child’s first symptoms could be manic or depressive. In the beginning, the symptoms of either mania or depression might also be milder. The length of time that a child experiences symptoms will vary. 

Some experience something called “mixed episodes,” in which they have a depressed mood but racing thoughts and speech, agitation, and anxious preoccupations.

Bipolar disorder is diagnosed by a medical professional. To get a diagnosis, the child has to have at least one hypomanic or manic episode. An episode is a period of time where the child has extreme behaviors that are very different than before. The new behaviors make it difficult for the child to be a part of normal activities like school, work or spending time with friends. Psychotic episodes, where the child loses touch with reality, can also be part of mania at its most severe. 

If a child only has depressive episodes, they will be diagnosed with depression instead of bipolar disorder. 

In addition to bipolar I disorder, Kids can also be diagnosed with bipolar II disorder, in which manic episodes are replaced by the less intense hypomania.  

Until recently, children who were easily annoyed and had lots of tantrums could be diagnosed with bipolar disorder, even if they did not have manic episodes. Now, these children are diagnosed with a different disorder called disruptive mood dysregulation disorder (DMDD). 

A child is more likely to be diagnosed with bipolar disorder if their family members have been diagnosed with it. 

Bipolar disorder is usually treated with a combination of therapy and medication. Even with the right treatments, children with bipolar can have “breakthroughs,” or relapses where their symptoms come back. They need good support from their family, friends and healthcare professionals. 

Therapy 

Bipolar disorder can be treated with several types of therapy: 

• Cognitive behavioral therapy (CBT): CBT is the most common type of therapy for bipolar disorder. In CBT, the therapist helps the child understand what triggers their manic and depressive episodes. Kids also learn how their thoughts can cause their feelings, and how to manage them.  
• Family-focused therapy (FFT) for bipolar disorder:  The treatment consists of sessions for the patient and family members to learn about bipolar disorder, communication enhancement training, and problem-solving skills training.

• Prodrome detection: This therapy helps kids and families to notice symptoms early in an episode of depression or mania. That way, they can prevent or stop the episode. 
• Social rhythm therapy: Social rhythm therapy uses a clear daily schedule to help prevent episodes.   

Medication 

Medication is required to treat bipolar disorder. Children and teenagers with bipolar disorder are often prescribed a mood stabilizer, like lithium. Mood stabilizers help treat symptoms and reduce episodes of depression and mania. People with bipolar disorder often take mood stabilizers for their whole lives.  

If the mood stabilizer doesn’t help the child’s depression, they may be prescribed an antidepressant as well. Kids may also be prescribed drugs to treat other symptoms like psychosis or trouble sleeping.  

When taken together, these medications can have major side effects. To avoid problems, the child should regularly visit their doctor. 

Children with bipolar disorder are more likely to commit suicide. If you think your child or teenager is suicidal, you can call the National Suicide Prevention Lifeline by dialing 988 or 1-800-273-8255, or 911 if there is an emergency. Don’t wait — the risk of suicide in children and teenagers is very real.