Bipolar Disorder in Children and Teens

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KEY POINTS

• Bipolar disorder causes extreme changes in mood, thinking, and behavior, such as feeling highly energized and very active, and then feeling sad, hopeless, and low energy.
• Treatment may include medicines, therapy, and learning ways to manage stress. In severe cases, your child may need to be treated in the hospital.
• Get emergency care if your child has serious thoughts of suicide or harming others. Also get emergency help if manic behavior becomes so wild that it endangers your child or others.

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What is bipolar disorder?

Bipolar disorder is a condition that causes extreme changes in mood, thinking, and behavior. There are usually two mood phases, a manic phase and a depressed phase. In the manic phase your child has an unusually high amount of energy and is extremely active. In the depressed phase your child is very sad, hopeless, and doesn’t care about anything.

Bipolar disorder may last a lifetime. Symptoms tend to get worse 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.
• 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.
• Bipolar disorder tends to run in families. Stress also plays a part.
• Some medicines can cause depression or manic symptoms. These include some antidepressants, stimulants, blood pressure medicines, diet pills, and steroids such as prednisone.

Bipolar disorder is not very common in children. It is usually not diagnosed until the late teenage 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 are 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:

• 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
• Having bursts of energy and going for days with little or no sleep without 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; for example, running into traffic, wild bicycle or skateboard riding, stealing, or spending all of their money

In the depressed phase, symptoms may include:

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

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

Your child may also have what is called a mixed episode. A mixed episode is mania with depressed symptoms at the same time.

How is it diagnosed?

Your healthcare provider or therapist will ask about your child’s symptoms. He will make sure your child does not have 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 because children and teens may also have other disorders in addition to bipolar disorder, such as:

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

How is it treated?

Bipolar disorder can be successfully treated with therapy, medicines, or both. If bipolar disorder is not treated, it tends to get worse. The mania and depression phases can be more severe and episodes may happen more often. Most of the time, your child will feel better after a few weeks of treatment.

Medicines

Several types of medicines can help treat bipolar disorder. Your 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

Seeing a mental health therapist is helpful. Cognitive behavioral therapy (CBT) is a form of therapy that helps your child identify and change thought processes. Replacing negative thoughts with more positive ones can help your child learn how to manage problem behaviors.

Family therapy is often very helpful. Family therapy treats the family as a whole rather than focusing on just your child.

Interpersonal therapy can help your child work on one or two problem areas, such as relationships with friends and family. Learning about the disorder and how to manage symptoms also helps.

Other treatments

Learning ways to relax may help. Yoga and meditation may also be helpful. You may want to talk with your 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. Omega-3 fatty acids may help to reduce symptoms of depression. 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 children to talk about whatever they want to talk about. Be a good listener. This helps children begin to realize that their feelings and thoughts really do matter, that you truly care about them, and that you never stopped caring. If your child shuts you out, don't walk away. Let children know that you are there for them whenever they need you. Remind children of this over and over again. They may need to hear it a lot because they feel unworthy of love and attention.

  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 to them. 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, for example take up a hobby, listen to music, watch movies, or take walks.
• Take care of your child’s physical health. Make sure your child eats a healthy diet and gets enough sleep and exercise 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 his medicines every day, even if feeling well. Stopping medicines when your child feels well may start the problems again.
• 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 harming others, or if manic behavior puts you, others, or your child in danger.

For more information, contact:

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