Bipolar Disorder in Adolescents

Bipolar disorder, also known as manic depression, is a mood disorder. It is a serious mental health condition that causes a person to experience a distinct period of abnormal mood and energy level. It persists for several days and represents a notable change from the person’s usual mood, energy, and functioning. Youth with bipolar disorder often experience episodes of depression as well.

It is developmentally appropriate and expected for healthy children to experience shifts in mood and energy. However, children with Bipolar disorder experience episodes of severe mood states including periods of extreme euphoria, irritability, or depression that are different from their normal mood. In Bipolar disorder, these abnormal mood states last for several days and affect the child’s behavior, sleep, energy level, and the ability to think clearly. Chronic or persistent elevations in energy, irritability, or disruptive behaviors are usually associated with other disorders (including depression, oppositional defiant disorder, or attention deficit hyperactivity disorder), rather than bipolar disorder.

It is difficult to diagnose bipolar disorder in children because there are differences in diagnostic criteria, symptoms overlap with other psychiatric disorders, and the symptoms must be interpreted within the context of the child’s chronologic age, intellectual capabilities, and environmental factors. The prevalence of Bipolar disorder in children and adolescents is not well established, but the overall rate of Bipolar disorder in youth ages 7 to 21 has been estimated to be 1.8%. 

Each child may experience symptoms of bipolar disorder differently. However, these are common symptoms associated with depressive and manic states: 

Depressive symptoms:

• Feeling hopeless or helpless

• Having low self-esteem

• Feeling inadequate

• Excessive guilt

• Difficulty with relationships or social withdrawal

• Sleep disturbances, whether sleeping too much or too little

• Changes in appetite or weight

• Decreased energy

• Difficulty concentrating or a decline in school performance

• Increased sensitivity to failure or rejection

• Indecision

• Frequent physical complaints, such as a headache, stomachache, or fatigue

• Thoughts of wishing to be dead

• Suicidal thoughts or attempts

Manic symptoms:

• Increased energy or activity level that is unusual for your child

• Increased distractibility or disorganized thinking that is unusual for your child

• Sleeping several hours less than usual without feeling tired the next day

• Excessive silliness or euphoria that is unusual for your child and not appropriate to the situation

• Increased irritability, rage, or mood shifts that are unusual for your child

• Increased self-esteem or grandiosity that is unusual for your child

• Increased involvement in pleasurable and/or high-risk activities that is unusual for your child

• Increased talkativeness that is unusual for your child

• Worsening in judgment or increased impulsivity that is unusual for your child

• Hallucinations, delusional beliefs, or bizarre behaviors that are unusual for your child

• Suicidal thoughts or attempts

Bipolar disorder often results from a combination of causes, including genetics, environment, and psychological factors. Research suggests that bipolar disorder has a strong genetic component. If a parent or a sibling has Bipolar disorder, the child is at increased risk of also developing the illness, as compared to children without a family history of Bipolar disorder.  Children of parents with Bipolar disorder are also at higher risk of developing depression, anxiety, ADHD, and behavioral problems.  Still, most children with a family history of bipolar disorder will not develop the illness.

If you believe your child experiences abnormal mood states, you can ask your child’s pediatrician for a referral to either a therapist or psychiatrist who specializes in children and adolescents. An accurate diagnosis and early treatment are keys to success in managing Bipolar disorder. With the level of complexity often involved in diagnosing and treating Bipolar disorder, finding a highly trained professional, such as a licensed clinical social worker, a child psychologist, or a child and adolescent psychiatrist is important. At Children’s Hospital of Philadelphia, a specialist will perform a comprehensive psychiatric evaluation. The evaluation may assess: 

• Your child's age, overall health, and medical history

• Extent of your child's current symptoms, behaviors, and functioning

• Expectations for the course of the condition

• Family dynamics and environmental stressors

• Family psychiatric and medical history

• Input from teachers and other care providers

Early treatment is key to reducing distress, improving functioning, and preventing future episodes. Without treatment, your child’s disorder could persist for longer and become increasingly more severe, leading to significant impairment in school, at home, and with friends and family. 

At Children’s Hospital of Philadelphia, a specialist will design a personalized treatment plan based on your child’s symptoms and other factors. The treatment plan may include: 

• Medication (for example, mood-stabilizing medications and/or antidepressants)

• Psychotherapy

• Family therapy

• Consultation with your child's school

Although Bipolar disorder is considered to be a chronic or lifelong illness, the symptoms can be managed if your child receives proper treatment, including medication and psychotherapy.

Continuing to work closely with your child’s treatment team will help to minimize your child’s illness and suffering. You and your child can work together to keep a journal of his/her moods, sleep patterns, and daily events. This will be a helpful resource to track the illness and to help you healthcare team know whether current interventions are working optimally.

Bipolar is a serious mood disorder, but it doesn’t have to interfere with a child’s success in life and in relationships. To promote that success, the experts at Children’s Hospital of Philadelphia can work with your family to design a personalized treatment plan that combines psychotherapy, medication, and an ongoing team approach that minimizes your child’s illness and prevents relapses.

Reviewed by O'Nisha Lawrence, MD on November 11, 2016.