Bipolar: What to Look For

Adolescents with bipolar disorder will show signs of both depression (prolonged sadness, lack of affect and interest in things they previously enjoyed, sleeping too much) and mania (periods of excitability or irritability, exaggerated self-confidence, even recklessness). For some, the onset of bipolar disorder is marked by a depressive episode; in others, it is a manic episode. Onset can also be a less severe, chronic form of depression called dysthymia or a milder form of mania called hypomania. The duration of and intervals between depressive and manic episodes are highly variable, particularly in younger people.

A young person might be having a manic episode if his personality seems to change drastically, he develops an inflated sense of his abilities, he displays grandiose thinking, he starts sleeping much less than he normally does, or he becomes extremely energetic, foolhardy, and voluble. Psychotic episodes—breaks from reality—can occur during both manic episodes and severe depressive episodes. During a manic episode, these can include impossible assessments—I can fly—or delusional thinking. For some, a psychotic episode is the first sign of the disorder.

Being on the lookout for symptoms of mania is particularly important if someone already has depressive symptoms. Bipolar disorder with an unnoticed manic component can be misdiagnosed as major depressive disorder, as people are much more likely to seek professional help when gripped by a depressive episode. When a manic episode hits, a sufferer is often elated, displays poor judgment, and cannot realize that his behavior is irrational. But depression and bipolar disorder are not the same thing and should be treated differently.