Illness & Conditions - Health Conditions
Bipolar Disorder in Children and Teens
What is bipolar disorder?
Bipolar disorder causes mood swings with extreme ups (mania) and downs (depression). When people with this problem are up, they have brief, intense outbursts or feel irritable or extremely happy ( mania ) several times almost every day. They have a lot of energy and a high activity level. When they are down, they feel depressed and sad.
In the past, experts thought bipolar disorder was the same in children and adults. But symptoms in children and teens are different from those in adults, and they need different treatment.
What causes bipolar disorder?
Experts don't fully understand what causes bipolar disorder.
It seems to run in families. Your child has a greater risk of having it if a close family member such as a parent, grandparent, brother, or sister has it. Parents may wonder what they did to cause their child to have bipolar disorder. But there is nothing a parent can do to cause or prevent it.
What are the symptoms?
In children and teens, moods quickly change from one extreme to another without a clear reason. Some children may briefly return to a normal mood between extremes. Many children change continuously between mania and depression, sometimes several times in the same day. Sometimes children with bipolar disorder have symptoms of both mania and depression at the same time.
Times of mania (ups) or depression (downs) may be less obvious in children and teens than in adults.
How is bipolar disorder diagnosed in children and teens?
This disorder can be hard to diagnose in children and teens. The symptoms can look a lot like the symptoms of other problems, such as:
Bipolar disorder can often occur along with these problems.
If your doctor thinks your child or teen may have bipolar disorder, he or she may ask questions about your child's feelings and behavior. Your doctor may also give you and your child written tests to find out how severe the mania or depression is.
The doctor may do other tests (such as a blood test) to rule out other health problems. He or she may ask if your family has any history of mental illness or problems with drugs or alcohol. Any of these problems can be linked to bipolar disorder.
Why is early diagnosis of bipolar disorder important?
Children with this disorder are more likely to have other problems. These include alcohol and drug abuse , trouble in school, running away from home, fighting, and even suicide. Treating the disorder as early as possible may keep your child from having these problems.
Watch for the warning signs of suicide, which change with age. Warning signs of suicide in children and teens may include thinking too much about death or suicide. Watch also for things that can trigger a suicide attempt such as a recent breakup of a relationship or the loss of a parent or close family member through death or divorce.
How is it treated?
The mood changes that come with bipolar disorder can be a challenge. But with the right treatment, they can be managed well. Treatment usually includes both medicine (such as mood stabilizers) and counseling .
An important part of treatment is making sure your child takes his or her medicine. Children and teens with this disorder sometimes stop taking their medicines when they feel better. But without medicine, their symptoms usually come back.
Medicines for bipolar disorder in adults have been well studied. But not much research has been completed about how the medicines work and if they are safe for children and teens.
Accepting that your child has bipolar disorder can be hard. The disorder can be a serious, lifelong problem. Your child will need long-term treatment and will need to be watched carefully. By working with your child's doctor, you can find a treatment that works for your child.
Frequently Asked Questions
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The cause of bipolar disorder is not well understood.
It seems to run in families. Your child is at greater risk of having bipolar disorder if a close family member such as a parent, grandparent, brother, or sister has it.
Stressful or traumatic events may trigger episodes of mania or depression in a child with bipolar disorder. While it is normal for such events to cause mood changes, these reactions are much more extreme for children with bipolar disorder.
Sometimes symptoms of mania occur as a result of another medical condition, such as an overactive thyroid gland (hyperthyroidism) or multiple sclerosis . Symptoms can also develop as a side effect of some medicines, such as corticosteroids or antidepressants. Using drugs or alcohol, consuming too much caffeine, or not getting enough sleep can also trigger a manic episode.
Bipolar disorder causes cycles of mania (or hypomania, a less severe form of mania) and depression . The different types of bipolar disorder are based on whether a person has more severe symptoms of mania or depression.
In children and younger teens, bipolar disorder tends to be rapid-cycling or mixed cycling:
Following are some common symptoms of bipolar disorder in children and teens. 1
During severe episodes of mania, your child may suffer from symptoms of psychosis , such as having hallucinations or delusions of grandeur (for example, telling people that a rock band is coming to his or her birthday party).
Untreated bipolar disorder can lead to suicide. Warning signs of suicide in children and teens may include preoccupation with death or suicide or a recent breakup of a relationship.
People sometimes confuse bipolar disorder in children with other conditions with similar symptoms, such as attention deficit hyperactivity disorder (ADHD). Although there is some evidence of a link between ADHD and bipolar disorder, the conditions have distinct features that you can usually identify.
In young children, the symptoms of mania are more than just being a bother to adults and other children now and then. For example, many children can be silly and giggly to a point that it bothers their parents sometimes. This is not considered to be a sign of mania. But if a child is silly and giggly for several hours, several times almost every day, and this is interrupting the family's usual routine, then it may be a symptom of mania.
Often the first signs of bipolar disorder are severe moodiness, unhappiness, or other symptoms of depression. It is common for children with bipolar disorder to be diagnosed first with only depression and then later to be diagnosed with bipolar disorder.
A first manic or hypomanic episode can be triggered by a stressful situation or by certain medicines, or it may occur without an obvious cause.
Children with bipolar disorder may:
Children may have severe, seizure-like temper tantrums when they are told "no." A bipolar child may kick, bite, hit, and make hateful comments, including threats and curses. During tantrums, which may last for hours, a child may destroy property or become increasingly violent.
Young children with bipolar disorder may have more extreme happy or silly moods than most children have.
Manic behavior by a teen with bipolar disorder may result in such problems as:
During depressive episodes, a teen may do poorly in school and may stop participating in activities he or she enjoyed in the past, such as a sports team.
Watch for warning signs of suicide, which can include preoccupation with death or suicide or a recent breakup of a relationship.
Substance abuse is common. Your child's doctor may recommend an evaluation for both substance abuse problems and bipolar disorder if your child appears to suffer from either condition.
Treating other conditions
Sometimes treatment for other conditions can make your child's bipolar disorder worse. For example:
Medicines that intensify bipolar symptoms may need to be stopped or changed to a different dose or medicine. Sometimes an additional medicine (such as a mood stabilizer) can solve the problem. But each child responds to medicines differently. And it may take several tries before your doctor can identify an effective medicine or combination of medicines for your child's conditions.
What Increases Your Risk
Your child's risk of developing bipolar disorder or other mood disorders is higher if the child:
When To Call a Doctor
Call 911, the national suicide hotline at 1-800-273-TALK (1-800-273-8255), or other emergency services right away if:
Call a doctor right away if:
Seek care soon if:
Who to see
It is best to establish a long-term relationship with your child's care providers so that when a depressive or manic episode occurs, the care providers can recognize the changes in the child's behavior and provide quick treatment advice.
You may wish to find a doctor who has special training in children's mental health conditions or experience treating bipolar disorder in young people. Bipolar disorder can be diagnosed and treated by a health professional such as a:
Your child may also benefit from professional counseling to help deal with mood changes and the effects bipolar disorder has on your child's life. A counselor with special training in child mood disorders or experience treating child bipolar disorder may be most helpful. Counseling for bipolar disorder can be provided by a:
Other health professionals who also may be trained in counseling include:
Who to see for family member support
If you are a family member of a child with bipolar disorder, it is very important to get the support and help you need. Living with or caring for someone who has bipolar disorder can be very disruptive to your own life. Manic episodes can be particularly difficult. It may be helpful to seek your own counselor or therapist to help you.
Also, some national support organizations may have a local chapter in your area or provide information on the Internet. Examples of such groups include the National Alliance for the Mentally Ill (NAMI) and the Child and Adolescent Bipolar Foundation.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
There is no lab test that can diagnose bipolar disorder. Doctors make the diagnosis through a combination of:
Before prescribing medicine to treat bipolar disorder, your doctor will ask questions about possible suicidal behavior.
Mood changes and other symptoms of bipolar disorder are challenging, but they can be managed effectively. Treatment usually includes medicines (such as mood stabilizers) and counseling. Often a combination of both is needed.
An important part of treatment is making sure your child takes his or her bipolar medicine. Often people who feel better after taking their medicine for a while think they are cured and no longer need treatment. But when a person stops taking medicine, symptoms usually return, so it is important that your child follow the treatment plan.
Counseling works best when symptoms of bipolar disorder are controlled with medicines. For more information on the types of counseling used to treat bipolar disorder, see Other Treatment.
Home treatment includes helping your child get regular exercise, eat a balanced diet, and get enough sleep.
If your child's behavior is suicidal, aggressive, reckless, or dangerous, or if he or she is out of touch with reality ( psychotic ) or unable to function, the child may need to go into the hospital for a while. Also, many medicines can make the symptoms of bipolar disorder worse. If your child is taking one of these, he or she may need to taper off and stop the medicine. This should only be done under the supervision of a doctor.
Impact on the family
Bipolar disorder has a big impact on both the child and his or her family. Successful treatment requires that the child and family members know what happens in bipolar disorder and that the family members help make sure that the child follows the treatment.
It can take time for you and your child to accept that the child has a serious, long-term condition that requires ongoing treatment and constant monitoring. But keep in mind that by working with your child's doctor, you and your child can find treatment that works.
Bipolar disorder can't be prevented. But there are ways to help manage or prevent mood changes.
The first and most important preventive measure is to make sure that your child takes his or her medicines as directed. Bipolar disorder is a long-term condition and often requires lifelong treatment with medicines.
Reducing stress, getting regular sleep and exercise, and staying on a daily routine may help prevent mood swings and can help with the symptoms of depression and mania.
Learning as much as you can about bipolar disorder may help you recognize mood changes in your child as they begin to occur. Catching and treating these mood changes early may help reduce the length of the manic or depressive episode and improve the quality of your child's life.
There are steps you can take at home to reduce your child's symptoms.
Steps your child can take to help control moods include:
For some children with bipolar disorder, depression can cause debilitating symptoms. For information about managing childhood depression, see the topic Depression in Children and Teens.
Medicines for bipolar disorder in adults have been well studied. But not much research has been completed about how well the medicines work and if they are safe for children and teens.
When you and your child's doctor are deciding which types of medicines to use, consider:
Before prescribing medicine to treat bipolar disorder, your doctor will ask questions about possible suicidal behavior.
Be sure to use all medicines exactly as your child's doctor has prescribed them. If your child has intolerable side effects from any medicine, call your doctor immediately.
Medicines most often used to treat bipolar disorder in children and teens include:
While antidepressants can be helpful for some children with bipolar disorder, they can also trigger mania . Doctors usually prescribe antidepressants along with mood stabilizers or antipsychotics to help prevent a manic episode. And the doctor needs to carefully monitor the child for mood changes. Antipsychotics can be used alone, or they may be combined with mood stabilizers for more effective control of manic episodes.
Medicines for bipolar disorder have side effects that need to be managed. Some things you cannot change, such as increased urination (common with lithium). But you can deal with some side effects like weight gain (common with several medicines used to treat bipolar disorder) by increasing exercise and reducing calorie intake.
You can work with your child and his or her doctor to find ways of coping with side effects. If side effects from a medicine are intolerable, the doctor may have to change the dose or the medicine.
The U.S. Food and Drug Administration (FDA) has issued an advisory on antidepressant medicines and the risk of suicide. Talk to your doctor about possible side effects and the warning signs of suicide.
Most children who have bipolar disorder need medicine. But other forms of treatment used along with medicine play an important role in balancing mood and improving quality of life. Counseling, education about the disorder, and stress reduction can help.
Other treatment choices
Counseling along with medicine has been used effectively to manage bipolar disorder. Types of therapy that counselors use to treat bipolar disorder include:
In some cases, electroconvulsive therapy (ECT) may be an option. In this procedure, brief electrical stimulation to the brain is given through electrodes placed on the head. The stimulation produces a short seizure that is thought to balance brain chemicals.
Complementary medicine is a term used for a wide variety of health care practices that may be used along with standard medical treatment. Omega-3 fatty acids found in fish oils have been getting some attention as a possible complementary treatment of bipolar disorder. But more research is needed to prove the effectiveness of omega-3 fatty acids in treating this condition in children, teens, and adults.
Other Places To Get Help
Last Revised: April 12, 2011
Author: Healthwise Staff
American Psychiatric Association (2000). Bipolar disorders. In Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev., pp. 382–397. Washington, DC: American Psychiatric Association.
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