Bipolar Disorder in Children and Teens

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KEY POINTS

• Bipolar disorder causes episodes of extreme changes in mood, energy, thinking, and behavior. Your child may have high energy and be very active, and then feel sad and hopeless and have low energy.
• Treatment may include medicines and several kinds of therapy. In severe cases, your child may need to be treated in the hospital.
• Get emergency care if your child has thoughts of suicide or self-harm, violence, or harming others, or if manic behavior endangers your child or others.

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What is bipolar disorder?

Bipolar disorder is a condition that causes episodes of extreme changes in mood, energy, thinking, and behavior. There are usually two mood phases, a manic phase and a depressed phase. In the manic phase, your child may have high energy and be very active. In the depressed phase, your child may feel sad and hopeless and have low energy.

Episodes of bipolar disorder may continue over a lifetime. Episodes tend to get worse and more frequent if not treated. Bipolar disorder can be managed even if it is not cured.

What is the cause?

The exact cause of the disorder is not known.

• The brain makes chemicals that affect thoughts, emotions, and actions. Without the right balance of these chemicals, there may be problems with the way your child thinks, feels, or acts. Children with this disorder may have too little or too much of some of these chemicals. What causes the switch between moods is not known.
• Bipolar disorder tends to run in families. Stress also plays a part.
• Children with this disorder may have physical changes in their brain. These changes may mean that some parts of the brain are more active or less active than in other children.
• Some medicines can cause depression or manic symptoms. These include some antidepressants, stimulants, blood pressure medicines, diet pills, and steroids such as prednisone.
• Alcohol and drug use can trigger symptoms.

Bipolar disorder is not very common in children. It is usually not diagnosed until the late teen years.

What are the symptoms?

BPD is different in children and teens than in adults. In adults, there are often clear episodes of mania or depression that last a week or longer. In children and teens, the phases may be less clear and changes from one mood to the other may happen faster. Children may have more than one depressed or manic mood in a single day.

In the manic phase, symptoms may include:

• Having bursts of energy and being very active
• Throwing tantrums often or seeming more irritable
• Being unusually silly compared to others of the same age
• Being defiant and destructive, and not following rules
• Being more interested in sex or having unsafe sex
• Going for days with little or no sleep and not feeling tired
• Being impatient and unable to wait for things to happen
• Talking very fast, not allowing others to talk, and changing topics very quickly
• Being distracted, having trouble concentrating, and jumping between different ideas
• Acting recklessly such as running into traffic, wild skateboarding, stealing, or spending all of his or her money

During a period of depression, symptoms may include:

• Appearing not interested in things your child used to enjoy
• Being irritable
• Having trouble falling asleep, waking up very early, or sleeping too much
• Having low energy and being bored or restless
• Losing interest in friends or classmates
• Having trouble concentrating or remembering things
• Eating very little, being a very picky eater, or overeating
• Saying negative things such as "I'm stupid" or "I hate myself"
• Talking about death and suicide and wishing he or she was dead

Teens may be less likely than adults to admit that they are sad and depressed.

Your child may also have mania with depressed symptoms at the same time. Your child may be overly active, have racing thoughts, withdraw from others, feel worthless or be irritable, and cry often.

How is it diagnosed?

Your healthcare provider or therapist will ask about your child’s symptoms. The provider will check for a medical illness or drug or alcohol problem that could cause the symptoms. Many symptoms are also symptoms of other disorders. A mental health therapist who specializes in working with children and teens is best qualified to diagnose bipolar disorder. Children and teens may also have other disorders in addition to a bipolar disorder such as:

• Anxiety disorders
• Attention deficit/hyperactivity disorder (ADHD)
• Substance abuse

How is it treated?

Bipolar disorder can be treated with therapy, medicines, or both. Most of the time, your child will feel better after a few weeks of treatment.

Bipolar disorder tends to get worse if not treated. The manic and depressive episodes can get more severe and happen more often. In severe cases, your child may need to be treated in the hospital.

Medicines

Several types of medicines can help treat bipolar disorder. Your child’s healthcare provider will work with you to select the best medicine. If your child also has ADHD, medicines for ADHD may be prescribed. However, in some cases the medicines for ADHD can trigger manic symptoms or mood swings in children with bipolar disorder. Medicines to treat depression can also bring on bipolar symptoms in children.

Therapy

Combining medicines with therapy is often the best approach. Several kinds of therapy may help:

• Psychoeducational therapy. This type of therapy involves the therapist teaching instead of the client talking. Your child may learn about mental health problems, treatment options, and how to cope with symptoms. Therapists may provide your child with useful information or may help your child learn different skills. They work with individuals and groups.
• Chronotherapy. This therapy helps your child establish a steady sleep routine. Your child learns to go to bed at the same time and rise at the same time every day.
• Interpersonal social rhythm therapy. This therapy help your child keep regular daily routines such as waking up and going to sleep at the same time, eating at the same time, and doing other daily activities at regular times. Your child learns that regular routines help even out moods, even when facing stressful life events such as the loss of a loved one, moving, or troubled relationships.
• Dialectical behavior therapy. This type of therapy helps your child be aware of his or her thoughts and behavior, learn how to express needs, deal with stressful situations, and manage emotions.
• Family focused therapy. All family members learn about bipolar disorder, treatment, and ways that family members can best support your child. Family members learn communication and problem-solving skills to reduce conflict and help resolve family problems.
• Cognitive behavioral therapy (CBT). CBT is a way to help your child identify and change views of self, the world, and the future. CBT can make your child aware of unhealthy ways of thinking. It can also help your child learn new ways to think and act.

Other treatments

Learning ways to relax may help. Yoga and meditation may also be helpful. You may want to talk with your child’s healthcare provider about using these methods along with medicines and therapy.

Claims have been made that certain herbal and dietary products help control depression symptoms. No known herbal or natural remedies are effective in treating bipolar disorder. Supplements are not tested or standardized and may vary in strengths and effects. They may have side effects and are not always safe.

How can I take care of my child?

• Support your child. Encourage your child to talk about whatever your child wants to talk about. Be a good listener. This helps your child realize that feelings and thoughts really do matter, that you truly care about your child, and that you never stopped caring. If your child shuts you out, don't walk away. Let your child know that you are there whenever your child needs you. Remind your child of this often. Even children raised in a loving and nurturing home need to hear it a lot because they may feel unworthy of love and attention for other reasons.

  Stay in touch with teachers, babysitters, and other people who care for your child to share information about symptoms your child may be having.

• Be consistent. Be firm and consistent with rules and consequences. Your child needs to know that the rules still apply. It does not help to teach children that they can avoid consequences if they’re depressed or if they act out.
• Help your child learn to manage stress. Teach children and teens to practice deep breathing or other relaxation techniques when feeling stressed. Help your child find ways to relax such as by taking up a hobby, listening to music, watching movies, or taking walks.
• Take care of your child’s health. Make sure your child eats a variety of healthy foods and gets enough sleep and physical activity every day. Teach children and teens to avoid alcohol, caffeine, nicotine, and drugs.
• Check your child’s medicines. Tell all healthcare providers who treat your child about all the medicines your child takes. Make sure your child takes prescribed medicines every day, even if feeling and thinking well. Stopping medicines when your child feels well may start the problems again.
• Keep a symptom diary to track your child’s moods. Share what you learn with your child’s healthcare provider or counselor.
• Contact your healthcare provider or therapist if you have any questions or if your child’s symptoms seem to be getting worse.

Get emergency care if your child has thoughts of suicide or self-harm, violence, or harming others, or if manic behavior endangers your child or others.

For more information, contact:

• Depression and Bipolar Support Alliance
  800-826-3632
  https://www.dbsalliance.org/
• National Institute of Mental Health
  866-615-6464
  https://www.nimh.nih.gov/