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What is 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 children to make bad decisions and do things that are very risky. Bipolar is also called manic-depressive disorder.

Bipolar usually begins when children are in their mid-to-late teens. Some younger children are diagnosed with the disorder.

What are the symptoms of bipolar disorder?

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
  • Not being able to pay attention
  • 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
  • Needing a lot more or much less sleep
  • Feeling very sad for a long period of time
  • Not being able to sit still
  • Not wanting to move
  • Being extremely tired
  • Thinking they cannot do anything well
  • Feeling very guilty
  • Refusing to go to school
  • Not seeing or talking to friends
  • Not thinking clearly
  • Focusing on death or killing themselves, or trying to kill themselves
  • 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 is manic or depressive will vary.

How is bipolar disorder diagnosed?

Bipolar disorder is diagnosed by a medical professional. To get a diagnosis, the child has to have manic episodes. 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.

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

Bipolar I disorder is the more serious diagnosis. Kids can also be diagnosed with bipolar II disorder, which is the same except that the manic episodes are less intense.

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).

What are the risk factors for bipolar disorder?

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

How is bipolar disorder treated?

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 therapy: Family therapy teaches parents and other family members how to keep track of the child’s symptoms. They also learn how to manage stress at home to prevent manic and depressive episodes.
  • 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.
  • Electroconvulsive therapy (ECT): ECT is rarely used with teenagers and not used in younger children. ECT is only done if medication and therapy aren’t working well. This is not like “shock therapy” was in the past. Now, the patient is given medication so they are asleep. They are also given a medication to relax their muscles. Then, an electrical current is passed through a part of their brain. This causes a seizure, but it’s not dangerous.

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.

Risk for other disorders

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 at 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.