Vincent van Gogh, The Starry Night. Oil on canvas, 73×92 cm, 28¾×36¼ in. (Photo credit: Wikipedia)

Excerpted from the National Institute of Mental Health (NIMH) Publication Bipolar Disorder in Children and Adolescents, 2012.

What is bipolar disorder?

All parents can relate to the many changes their kids go through as they grow up. But sometimes it’s hard to tell if a child is just going through a “phase,” or showing signs of something more serious. In the last decade, the number of children receiving the diagnosis of bipolar disorder, sometimes, called manic-depressive illness, has grown substantially. But what does the diagnosis really mean for a child?

Bipolar disorder is a brain disorder that causes unusual shifts in mood, energy, and activity levels. It can also make it hard to carry out day-to-day tasks, such as going to school or hanging out with friends. Symptoms of bipolar disorder can be severe. They are different from the normal ups and downs that everyone goes through from time to time. Bipolar disorder symptoms can result in damaged relationships, poor school performance, and even suicide. But bipolar disorder can be treated, and many people with this illness can lead full and productive lives.

Symptoms of bipolar disorder often develop in the late teens or early adult years, but some people have their first symptoms during childhood. At least half of all cases start before age 25.

Bipolar disorder tends to run in families. Children with a parent or sibling who has bipolar disorder are up to six times more likely to develop the illness, compared with children who do not have a family history of bipolar disorder. However, most children with a family history of bipolar disorder will not develop the illness.

What are the signs and symptoms of bipolar disorder in children and adolescents?

Youth with bipolar disorder experience unusually intense emotional states that occur in distinct periods called “mood episodes.” The extreme highs and lows of mood are accompanied by extreme changes in energy, activity, sleep, and behavior. Each mood episode represents a drastic change from a person’s usual mood and behavior.

An overly joyful or overexcited state is called a manic episode. An extremely sad or hopeless state is called a depressive episode. Sometimes, a mood episode includes symptoms of both mania and depression. This is called a mixed state. People with bipolar disorder also may be explosive and irritable during a mood episode.

Symptoms of mania include:

Mood Changes
• Being in an overly silly or joyful mood that is unusual for the child. It is different from times when he or she is just being silly and having fun
• Having an extremely short temper and unusual irritability

Behavioral Changes
• Sleeping little but not feeling tired
• Talking a lot and having racing thoughts
• Having trouble concentrating or paying attention, jumping from one thing to the next in an unusual way
• Talking and thinking about sex more often than usual
• Behaving in risky ways more often, seeking pleasure a lot, and doing more activities than usual.

Symptoms of depression include:

Mood Changes
• Being in a sad mood that lasts a long time
• Losing interest in activities once enjoyed
• Feeling worthless or guilty

Behavioral Changes
• Complaining about pain more often, such as headaches, stomach aches, and muscle pains
• Eating a lot more or less than usual and gaining or losing a lot of weight
• Sleeping or oversleeping when these were not problems before
• Losing energy
• Recurring thoughts of death or suicide

It’s normal for almost every child or teen to show some of these behaviors sometimes. These passing changes should not be confused with bipolar disorder.

Symptoms of bipolar disorder are not like the normal changes in mood and energy that everyone has. Bipolar symptoms are more extreme and tend to last for most of the day, nearly every day, for at least one week. Also, depressive or manic episodes include moods very different from a child’s normal mood, and the behaviors generally all come on at the same time. Sometimes the symptoms of bipolar disorder are so severe that the child needs to be treated in a hospital.

Bipolar disorder can be present even when mood swings are less extreme. For example, sometimes a child may have more energy and be more active than normal, but not show the severe signs of a full-blown manic episode. This is called hypomania. It generally lasts for at least four days in a row. Hypomania causes noticeable changes in behavior, but does not harm a child’s ability to function in the same way that mania does.

How does bipolar disorder affect children and adolescents differently than adults?

Bipolar disorder that starts during childhood or the early teen years is called early-onset bipolar disorder, and seems to be more severe than the forms that first appear in older teens and adults. Youth with bipolar disorder are different from adults with bipolar disorder. Young people with the illness appear to have more frequent mood switches, are sick more often, and have more mixed episodes.

It is important to watch out for any sign of suicidal thinking or behaviors. Take these signs seriously. On average, people with early-onset bipolar disorder are at greater risk for attempting suicide than those whose symptoms start in adulthood. One large study on bipolar disorder in children and teens found that more than one-third of study participants made at least one serious suicide attempt. Some suicide attempts are carefully planned and others are not. Either way, it is important to understand that suicidal feelings and actions are symptoms of an illness that must be treated.

What treatments are available for children and adolescents with bipolar disorder?

Currently, there is no cure for bipolar disorder. However, treatment with medications, psychotherapy, or both may help people recover from their episodes, and may help to prevent future episodes.

To treat children and teens with bipolar disorder, doctors often rely on information about treating adults. This is because there haven’t been many studies on treating young people with the illness.

One large study with adults funded by NIMH was the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). This study found that treating adults with medications and intensive psychotherapy for about nine months helped them get better. These adults got better faster and stayed well longer than adults treated with less intensive psychotherapy for 6 weeks. Combining medication treatment and psychotherapies may help young people with early-onset bipolar disorder as well. However, children sometimes respond differently to psychiatric medications than adults.

Medications

Before starting medication, your doctor will want to determine a child’s physical and mental health. This is called a “baseline” assessment. The child will need regular follow-up visits to monitor treatment progress and side effects. Most children with bipolar disorder will also need long-term or even lifelong medication treatment. This is often the best way to manage symptoms and prevent relapse, or a return of symptoms.

It’s better to limit the number and dose of medications. A good way to remember this is to “start low, go slow.” Talk to the doctor about using the smallest amount of medication that helps relieve the child’s symptoms. To judge a medication’s effectiveness, the child may need to take a medication for several weeks or months. The doctor or specialist needs this time to decide whether the medication is working or if they need to switch to a different medication. Because children’s symptoms are usually complex, they commonly need more than one type of medication.

Keeping a daily log of the child’s most troublesome symptoms can make it easier for the doctor to determine whether a medication is helpful. Also, be sure to tell the doctor about all other prescription drugs, over-the-counter medications, or natural supplements the child is taking. Combining certain medications and supplements may cause unwanted or dangerous side effects.

Psychotherapy

In addition to medication, psychotherapy can be an effective treatment for bipolar disorder. When treating bipolar disorder, psychotherapy is usually prescribed in combination with medication. Studies in adults show that it can provide support, education, and guidance to people with bipolar disorder and their families. Psychotherapy may also help children continue taking their medications to stay healthy and prevent relapse.

If you would like the full text of this publication, it is in the public domain and available at no cost at http://www.nimh.nih.gov/health/publications/bipolar-disorder-in-children-and-adolescents/index.shtml

If you would like to read this entire booklet and receive one hour of continuing education credit, visit Professional Development Resources at https://pdresources.org/course/index/6/1176/Bipolar-Disorder-in-Children-and-Adolescents

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