Bipolar Disorder in Children and Teens
Bipolar disorder in children: Overview
Bipolar disorder is sometimes called manic depression. It is an illness that causes extreme mood changes. Moods go from times of very high energy (manic episodes) to times of depression. These moods may cause problems with your child's schooling, family life, friendships, and ability to function.
There is no cure for bipolar disorder. But it can be helped with medicines. Counseling may also help. It is important for your child to take his or her medicines exactly as prescribed, even when he or she feels well. Your child may need lifelong treatment.
What causes it?
Experts don't fully understand what causes bipolar disorder. But they believe many factors may be involved. It seems to run in families. Your child has a greater risk of having bipolar disorder if a close family member has it.
What are the symptoms?
Bipolar disorder causes cycles of mania and depression. Mania is a period of extremely happy, aggressive, or angry mood. Your child may need little sleep and talk very fast. During a depressive episode, your child may have a sad, low, or cranky mood. Your child may have low energy.
How is it diagnosed?
There is no lab test that can diagnose bipolar disorder. Doctors make the diagnosis by asking questions about health problems your child and family members have had. The doctor will ask questions about your child's feelings and behavior. Your child will also get a physical exam.
How is bipolar disorder treated?
Bipolar disorder can be managed. Treatment usually includes medicines (such as mood stabilizers) and counseling. Often a combination of both is needed. To help at home, see that your child gets exercise and has a regular sleep schedule. If your child shows dangerous behavior, he or she may need to go to the hospital.
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What Increases Your Risk
Your child's risk for bipolar disorder or other mood disorders is higher if the child:
- Has a close relative such as a parent, sibling, or grandparent with bipolar disorder or another mood disorder.
- Has a family history of problems with alcohol or drugs. Such family members may be using alcohol or drugs as a way to deal with a psychological disorder.
Bipolar disorder causes cycles of mania and depression.
A manic episode lasts at least a week. It's a period of an extremely happy, aggressive, or angry mood. The child or teen may:
- Have little need for sleep.
- Have high energy levels.
- Have extreme self-confidence.
- Talk very fast.
- Have many thoughts at once.
- Seem very distracted and unable to focus.
- Touch his or her genitals, use sexual language, and approach others in a sexual way.
- Act inappropriately or intrude in social settings.
- Show risky, wild, thrill-seeking behavior.
A depressive episode is a period of a sad, low, or cranky mood. The child or teen may:
- Not find pleasure in things that he or she normally enjoys.
- Have low energy or feel "slowed down."
- Have sleep and appetite changes.
- Have low self-esteem.
- Feel guilty or worthless.
- Withdraw from friends or family.
- Have trouble focusing.
- Have thoughts about death or suicide.
Often the first signs of bipolar disorder are being severely moody, unhappy, or depressed. It is common for children with bipolar disorder to be diagnosed first with only depression and then later with bipolar disorder.
A first manic or hypomanic episode can be triggered by a stressful situation or by certain medicines. Or it may occur with no clear cause.
Children with bipolar disorder may:
- Have trouble getting going in the morning but then have intense energy later in the day.
- Miss school often or talk about running away from home.
- Become socially isolated. They may be overly sensitive to any kind of rejection or criticism.
- Behave irresponsibly. They may take risks and not think about the consequences.
- Have trouble making and keeping friends.
In addition to having manic symptoms, children may have severe temper tantrums when they are told "no." A child with bipolar disorder may kick, bite, and hit. They may make hateful comments, including threats and curses. During tantrums, which may last for hours, a child may destroy property or become more and more 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:
- Suspension from school.
- Arrest as a result of fighting or drug use.
- An unwanted pregnancy.
- A sexually transmitted infection (STI) from unsafe sexual behavior.
During depressive episodes, a teen may do poorly in school and may stop taking part in activities he or she enjoyed in the past, such as a sports team.
Watch for warning signs of suicide. This can include preoccupation with death or suicide or a recent breakup of a relationship. If you notice any signs that your child may hurt themselves, get help right away.
Substance use disorder is common. Your child's doctor may recommend an evaluation for both substance use problems and bipolar disorder if your child appears to suffer from either condition.
When to Call a Doctor
Call 911 or other emergency services immediately if:
- Your child is thinking seriously of suicide or has recently tried suicide. Serious signs include these thoughts:
- Deciding how to kill themself, such as with a weapon or medicines.
- Setting a time and having a plan.
- Thinking there is no other way to solve the problem or end the pain.
- Your child feels that they can't stop from hurting themself or someone else.
If your child talks about suicide, self-harm, or feeling hopeless, get help right away. Call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) or text HOME to 741741 to access the Crisis Text Line. Consider saving these numbers in your phone.
Call a doctor now if:
- Your child hears voices.
- Your child has been thinking about death or suicide a lot but doesn't have a suicide plan.
- Your child is worried a lot that the feelings of depression or thoughts of suicide aren't going away.
Seek care soon if:
- Your child has symptoms of depression or mania, such as:
- Feeling sad or hopeless.
- Not enjoying anything.
- Having trouble with sleep.
- Feeling guilty.
- Feeling anxious or worried.
- Feeling extremely happy or very grouchy.
- Talking too fast or more than usual.
- Being more active than usual.
- Having trouble concentrating because of having too many thoughts at the same time (racing thoughts).
- Acting inappropriately or intruding in social settings.
- Touching their genitals, using sexual language, and approaching others in a sexual way.
- Showing risky, wild, thrill-seeking behavior.
- Your child has been treated for depression for more than 3 weeks but is not getting better.
It's best to build a long-term relationship with your child's care providers. Then when a depressive or manic episode occurs, the care providers can recognize the changes in the child's behavior and provide quick treatment advice.
If you are a family member of a child with bipolar disorder, it's very important to get the support and help you need. Living with or caring for someone who has bipolar disorder can really disrupt your own life. Manic episodes can be extra tough. It may help to seek your own counselor or therapist to support you.
Also, some national support organizations may have a local chapter in your area or provide information online. Examples of such groups include the National Alliance on Mental Illness (NAMI) and the Child and Adolescent Bipolar Foundation.
Exams and Tests
There is no lab test that can diagnose bipolar disorder. Doctors make the diagnosis through a combination of:
- A medical history. The doctor will ask questions to help find other past and present health conditions that could cause the symptoms.
- A family history. This can identify bipolar disorder, other mood disorders, or drug or alcohol problems in close relatives. (All of these conditions are linked to bipolar disorder.)
- A physical exam. It can rule out other conditions with similar symptoms.
- A mental health assessment. It can help identify your child's current mental state and the severity of depression or mania.
- Asking questions about your child's feelings and behavior.
- Other written or verbal mental health tests.
The doctor may do other tests (such as a blood test) to rule out other health problems.
The mood changes that come with bipolar disorder can be a challenge. But with the right treatment, they can be managed. Treatment usually includes medicines (such as mood stabilizers) and counseling. Often a combination of both is needed.
Treatment options include:
Make 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, the symptoms usually come back.
Counseling works best when symptoms of bipolar disorder are controlled with medicines.
- Home treatment.
This includes helping your child get regular exercise, eat a balanced diet, and have a regular sleep schedule.
- Hospital treatment.
If your child's behavior is suicidal, aggressive, reckless, or dangerous, or if he or she is out of touch with reality (psychosis) or can't function, your child may need to go into the hospital for a while.
Learning as much as you can about bipolar disorder may help you recognize mood changes in your child as they start 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.
Here are some steps you can take at home to reduce your child's symptoms and control his or her moods.
- Be sure your child gets enough sleep.
Keep your child's room quiet. And have your child go to bed at the same time every night.
- Control the amount of stress in your child's life.
You may need to find ways to help your child reduce school requirements during times of severe mania or depression.
- Recognize early signs of manic and depressive mood episodes.
- Be sure your child gets enough exercise.
During a depressive episode, your child may feel like doing only gentle exercises, such as taking a walk or swimming.
- Be sure your child eats healthy foods and has a balanced diet.
Try to avoid beverages that contain caffeine, including coffee, tea, colas, and energy drinks. The American Academy of Pediatrics recommends that children and teens not drink energy drinks.footnote 1
- Help your child avoid things that may trigger a mood episode.
Don't let your child use alcohol or drugs. Substance use disorder makes bipolar disorder worse.
- Ask for help from friends and family when you need it.
Medicines for bipolar disorder in adults have been well studied. But more research is being done on how well the medicines work and if they are safe for children and teens.
Medicines most often used to treat bipolar disorder in children and teens include mood stabilizers, antipsychotics, and antidepressants.
Before prescribing medicine to treat bipolar disorder, your child's doctor will ask questions about possible suicidal behavior.
When you and the doctor are deciding which types of medicines to use, think about:
- The side effects of each medicine. How well can your child handle them?
- How often your child will need to take the medicines.
- Whether your child is being treated for other illnesses or disorders. How will those medicines interact with medicines for bipolar disorder?
- Whether your child has used any of the medicines before. Did they work?
Counseling along with medicine can work well to manage bipolar disorder. Types of counseling include:
- Cognitive-behavioral therapy. It focuses on changing certain thinking and behavior patterns.
- Interpersonal and social rhythm therapy. This focuses on social and family relationships and related problems. It teaches family members about the disorder. They learn how to recognize signs of relapse. And they learn how to manage what creates stress in each family member. This treatment also helps with setting and keeping a regular social and sleep schedule.
- Problem solving. It helps you find immediate solutions to problems.
- Play therapy. This is for very young children.
- Family therapy. This helps educate and support the entire family.
- Dialectical-behavioral therapy. This focuses on building skills to manage mood swings.
Current as of: February 9, 2022
Author: Healthwise Staff
John Pope MD - Pediatrics
Kathleen Romito MD - Family Medicine
Elizabeth T. Russo MD - Internal Medicine
David A. Brent MD - Child and Adolescent Psychiatry
Current as of: February 9, 2022