Bipolar Disorder in Children and Teens

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Bipolar Disorder in Children and Teens

Topic Overview

What is bipolar disorder?

Bipolar disorder causes mood swings with extreme ups (mania) and downs (depression). When people with this problem are up, they have brief, intense outbursts or feel irritable or extremely happy (mania) several times almost every day. They have a lot of energy and a high activity level. When they are down, they feel depressed and sad.

In the past, experts thought bipolar disorder was the same in children and adults. But symptoms in children and teens are different from those in adults, and they need different treatment.

What causes bipolar disorder?

Experts don't fully understand what causes bipolar disorder.

It seems to run in families. Your child has a greater risk of having it if a close family member such as a parent, grandparent, brother, or sister has it. Parents may wonder what they did to cause their child to have bipolar disorder. But there is nothing a parent can do to cause or prevent it.

What are the symptoms?

In children and teens, moods quickly change from one extreme to another without a clear reason. Some children may briefly return to a normal mood between extremes. Many children change continuously between mania and depression, sometimes several times in the same day. Sometimes children with bipolar disorder have symptoms of both mania and depression at the same time.

Times of mania (ups) or depression (downs) may be less obvious in children and teens than in adults.

  • During a time of mania, children and teens may:
    • Feel irritable and throw violent temper tantrums.
    • Seem extremely happy and have high energy levels.
    • Touch their genitals, use sexual language, and approach others in a sexual way.
    • Not sleep much and go about the house late at night looking for things to do.
    • Talk very fast.
  • During a time of depression, children and teens may:
    • Say they feel empty, sad, bored, or down.
    • Complain of headaches, muscle aches, stomachaches, or fatigue.
    • Often spend time alone and may easily feel rejected or criticized.
    • Move very slowly.

How is bipolar disorder diagnosed in children and teens?

This disorder can be hard to diagnose in children and teens. The symptoms can look a lot like the symptoms of other problems, such as:

Bipolar disorder can often occur along with these problems.

If your doctor thinks your child or teen may have bipolar disorder, he or she may ask questions about your child’s feelings and behaviour. Your doctor may also give you and your child written tests to find out how severe the mania or depression is.

The doctor may do other tests (such as a blood test) to rule out other health problems. He or she may ask if your family has any history of mental illness or problems with drugs or alcohol. Any of these problems can be linked to bipolar disorder.

Why is early diagnosis of bipolar disorder important?

Children with this disorder are more likely to have other problems. These include alcohol and drug abuse, trouble in school, running away from home, fighting, and even suicide. Treating the disorder as early as possible may keep your child from having these problems.

Watch for the warning signs of suicide, which change with age. Warning signs of suicide in children and teens may include thinking too much about death or suicide. Watch also for things that can trigger a suicide attempt such as a recent breakup of a relationship or the loss of a parent or close family member through death or divorce.

How is it treated?

The mood changes that come with bipolar disorder can be a challenge. But with the right treatment, they can be managed well. Treatment usually includes both medicine (such as mood stabilizers) and counselling.

An important part of treatment is making 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, their symptoms usually come back.

Medicines for bipolar disorder in adults have been well studied. But not much research has been completed about how the medicines work and if they are safe for children and teens.

Accepting that your child has bipolar disorder can be hard. The disorder can be a serious, lifelong problem. Your child will need long-term treatment and will need to be watched carefully. By working with your child's doctor, you can find a treatment that works for your child.

Frequently Asked Questions

Learning about bipolar disorder in children and teens:

Being diagnosed:

Getting treatment:

Ongoing concerns:

Living with child bipolar disorder:

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  Bipolar Disorder in Children: Helping Your Child Prevent Manic Episodes

Cause

The cause of bipolar disorder is not well understood.

It seems to run in families. Your child is at greater risk of having bipolar disorder if a close family member such as a parent, grandparent, brother, or sister has it.

Stressful or traumatic events may trigger episodes of mania or depression in a child with bipolar disorder. While it is normal for such events to cause mood changes, these reactions are much more extreme for children with bipolar disorder.

Sometimes symptoms of mania occur as a result of another medical condition, such as an overactive thyroid gland (hyperthyroidism) or multiple sclerosis. Symptoms can also develop as a side effect of some medicines, such as corticosteroids or antidepressants. Using drugs or alcohol, consuming too much caffeine, or not getting enough sleep can also trigger a manic episode.

Symptoms

Bipolar disorder causes cycles of mania (or hypomania, a less severe form of mania) and depression. The different types of bipolar disorder are based on whether a person has more severe symptoms of mania or depression.

  • With bipolar I disorder, moods swing between mania and depression, sometimes with periods of normal mood between extremes. Some children with this disorder have episodes of mania and are hardly ever depressed.
  • With bipolar II disorder, depression is more prominent than mania, and manic episodes may be less common and less severe.
  • With cyclothymia, the high and low mood swings are not as severe as mania and depression seen in bipolar I or bipolar II disorders.
  • Bipolar, NOS (not otherwise specified), is diagnosed when symptoms of mania and depression are not frequent or severe enough for the above diagnoses.

In children and younger teens, bipolar disorder tends to be rapid-cycling or mixed cycling:

  • Rapid-cycling means that the shifts between depression and mania occur quickly, sometimes within the same day. Often the mood shifts are continuous, rarely returning to a normal mood between extremes.
  • Mixed-cycling means that symptoms of both mania and depression occur at the same time.

Following are some common symptoms of bipolar disorder in children and teens.1

Symptoms of depression

  • Continuous sad or irritable mood
  • Loss of interest in activities that the child enjoyed in the past, such as hobbies, sports, games, or friends
  • Significant changes in appetite or body weight (weight loss or gain)
  • Sleeping too much or too little or having trouble falling asleep
  • Slowed body movements or restlessness
  • No energy, or loss of energy
  • Inappropriate feelings of guilt or worthlessness
  • Problems concentrating
  • Recurrent thoughts or talk of death or suicide
  • Headaches, muscle aches, or stomachaches

Manic symptoms

  • Severe changes in mood from being extremely irritable to overly silly and elated
  • Too much energy, such as the ability to keep going without tiring while the child's peers are tiring
  • Decreased need for sleep, such as going for days with very little sleep and not being tired
  • Talking too much or too fast, changing topics too quickly, and not allowing interruptions
  • Increased distraction and constantly moving from one thing to another
  • Grandiosity, such as inflated self-esteem or a belief in unrealistic abilities or powers
  • Increased sexual thoughts, feelings, activity, and use of sexual language (hypersexuality)
  • Increased obsession with reaching goals or becoming involved in too many activities
  • Risky, wild, thrill-seeking behaviour

During severe episodes of mania, your child may suffer from symptoms of psychosis, such as having hallucinations or delusions of grandeur (for example, telling people that a rock band is coming to his or her birthday party).

Bipolar disorder frequently occurs along with other conditions, such as conduct disorder. And each condition needs treatment.

Untreated bipolar disorder can lead to suicide. Warning signs of suicide in children and teens may include preoccupation with death or suicide or a recent breakup of a relationship.

People sometimes confuse bipolar disorder in children with other conditions with similar symptoms, such as attention deficit hyperactivity disorder (ADHD). Although there is some evidence of a link between ADHD and bipolar disorder, the conditions have distinct features that you can usually identify.

In young children, the symptoms of mania are more than just being a bother to adults and other children now and then. For example, many children can be silly and giggly to a point that it bothers their parents sometimes. This is not considered to be a sign of mania. But if a child is silly and giggly for several hours, several times almost every day, and this is interrupting the family's usual routine, then it may be a symptom of mania.

What Happens

Often the first signs of bipolar disorder are severe moodiness, unhappiness, or other symptoms of depression. It is common for children with bipolar disorder to be diagnosed first with only depression and then later to be diagnosed with bipolar disorder.

A first manic or hypomanic episode can be triggered by a stressful situation or by certain medicines, or it may occur without an obvious 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 and overly sensitive to any kind of rejection or criticism.
  • Behave irresponsibly, take risks and not think about the consequences, or have trouble making and keeping friends.

Young children

Children may have severe, seizure-like temper tantrums when they are told "no." A bipolar child may kick, bite, hit, and make hateful comments, including threats and curses. During tantrums, which may last for hours, a child may destroy property or become increasingly violent.

Young children with bipolar disorder may have more extreme happy or silly moods than most children have.

Teens

Manic behaviour 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 behaviour.

During depressive episodes, a teen may do poorly in school and may stop participating in activities he or she enjoyed in the past, such as a sports team.

Watch for warning signs of suicide, which can include preoccupation with death or suicide or a recent breakup of a relationship.

Substance abuse is common. Your child's doctor may recommend an evaluation for both substance abuse problems and bipolar disorder if your child appears to suffer from either condition.

Treating other conditions

Sometimes treatment for other conditions can make your child's bipolar disorder worse. For example:

  • Treating depression with antidepressants can trigger a manic episode or make one worse.
  • Treating attention deficit hyperactivity disorder (ADHD) with stimulants may also trigger severe mania, depression, and even psychosis (loss of touch with reality).
  • Treatment with corticosteroids for conditions such as asthma may also trigger a manic or depressive episode.

Medicines that intensify bipolar symptoms may need to be stopped or changed to a different dose or medicine. Sometimes an additional medicine (such as a mood stabilizer) can solve the problem. But each child responds to medicines differently. And it may take several tries before your doctor can identify an effective medicine or combination of medicines for your child's conditions.

What Increases Your Risk

Your child's risk of developing 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.
  • Has had several episodes of major depression. For every 100 teens with recurring depression, at least 15 are later diagnosed with bipolar disorder.1

When To Call a Doctor

Call 911 or other emergency services immediately if:

  • Your child makes threats or attempts to harm himself or herself or another person, or shows warning signs of suicide.
  • Your child hears voices (has auditory hallucinations).
  • You are a young person and you feel you cannot stop from harming yourself or someone else.

Call your doctor if:

  • Your child's depressive or manic mood symptoms have not improved in 1 to 2 weeks.

Watchful Waiting

Watchful waiting is a wait-and-see approach. If you think your child may have bipolar disorder, watchful waiting is not appropriate. Schedule an appointment with your child's doctor for evaluation.

Who To See

Your family doctor, general practitioner, or your child's pediatrician can diagnose and treat bipolar disorder. It is best to establish a long-term relationship with your child's care providers so that when a depressive or manic episode occurs, the care providers can recognize the changes in the child's behaviour and provide quick treatment advice.

You may wish to find a doctor who has special training in children's mental health conditions or experience treating bipolar disorder in young people.

Your child may also benefit from professional counselling to help deal with mood changes and the effects bipolar disorder has on your child's life. A counsellor with special training in child mood disorders or experience treating child bipolar disorder may be most helpful. Counselling for bipolar disorder can be provided by a:

Other health professionals who also may be trained in counselling include:

Who to see for family member support

If you are a family member of a child with bipolar disorder, it is very important to get the support and help you need. Living with or caring for someone who has bipolar disorder can be very disruptive to your own life. Manic episodes can be particularly difficult. It may be helpful to seek your own counsellor or therapist to help you.

Also, some national support organizations may have a local chapter in your area or provide information on the Internet. Examples of such groups include the Canadian Mental Health Association and the Mood Disorders Society of Canada.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Examinations and Tests

There is no lab test that can diagnose bipolar disorder. Doctors make the diagnosis through a combination of:

  • A medical history, asking questions to help identify other past and present health conditions that could cause the symptoms.
  • A family history to 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 examination, which can rule out other conditions with similar symptoms.
  • A mental health assessment, which can help identify your child's current mental state and the severity of depression or mania.
  • Other written or verbal mental health tests.

Before prescribing medicine to treat bipolar disorder, your doctor will check your child for possible suicidal behaviour by asking a few questions. See a list of questions your doctor may ask your child.

Treatment Overview

Mood changes and other symptoms of bipolar disorder are challenging, but they can be managed effectively. Treatment usually includes medicines (such as mood stabilizers) and counselling. Often a combination of both is needed.

Medicine

An important part of treatment is making sure your child takes his or her bipolar medicine. Often people who feel better after taking their medicine for a while think they are cured and no longer need treatment. But when a person stops taking medicine, symptoms usually return, so it is important that your child follow the treatment plan.

For information about the types of medicines used to treat bipolar disorder, see Medications.

Counselling

Counselling works best when symptoms of bipolar disorder are controlled with medicines. For more information on the types of counselling used to treat bipolar disorder, see Other Treatment.

Home treatment includes helping your child get regular exercise, eat a balanced diet, and get enough sleep. For more information, see Home Treatment.

Hospital treatment

If your child's behaviour is suicidal, aggressive, reckless, or dangerous, or if he or she is out of touch with reality (psychotic) or unable to function, the child may need to go into the hospital for a while. Also, many medicines can make the symptoms of bipolar disorder worse. If your child is taking one of these, he or she may need to taper off and stop the medicine. This should only be done under the supervision of a doctor.

Impact on the family

Bipolar disorder has a big impact on both the child and his or her family. Successful treatment requires that the child and family members know what happens in bipolar disorder and that the family members help make sure that the child follows the treatment.

It can take time for you and your child to accept that the child has a serious, long-term condition that requires ongoing treatment and constant monitoring. But keep in mind that by working with your child's doctor, you and your child can find treatment that works.

Prevention

Bipolar disorder can't be prevented. But there are ways to help manage or prevent mood changes.

The first and most important preventive measure is to make sure that your child takes his or her medicines as directed. Bipolar disorder is a long-term condition and often requires lifelong treatment with medicines.

Reducing stress, getting regular sleep and exercise, and staying on a daily routine may help prevent mood swings and can help with the symptoms of depression and mania.

Home Treatment

Learning as much as you can about bipolar disorder may help you recognize mood changes in your child as they begin 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.

There are steps you can take at home to reduce your child's symptoms.

  • 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 seek ways to help your child reduce academic requirements during severe mood swings.
  • Learn to recognize the early warning signs of your child's manic and depressive mood episodes.

Steps your child can take to help control moods include:

  • Getting enough exercise. During a depressive episode, your child may feel like doing only gentle exercises, such as taking a walk or swimming.
  • Getting enough sleep and keeping a consistent sleep schedule.
  • Eating a balanced diet.
  • Avoiding the use of alcohol or drugs. Substance abuse makes bipolar disorder worse.
  • Avoiding beverages that contain caffeine, including coffee, tea, colas, and energy drinks.
  • Learning to recognize the early warning signs of manic and depressive mood episodes.
  • Asking for help from friends and family when needed.
Click here to view an Actionset. Bipolar Disorder in Children: Helping Your Child Prevent Manic Episodes

For some children with bipolar disorder, depression can cause debilitating symptoms. For information about managing childhood depression, see the topic Depression in Children and Teens.

Medications

Medicines for bipolar disorder in adults have been well studied. But not much research has been completed about how well the medicines work and if they are safe for children and teens.

When you and your child's doctor are deciding which types of medicines to use, consider:

  • The side effects of each medicine and how well your child can tolerate them.
  • How often your child will need to take the medicines.
  • Whether your child is being treated for other illnesses or disorders and how those medicines will interact with medicines for bipolar disorder.
  • Whether your child has used any of the medicines before and whether they worked.

Before prescribing medicine, your doctor will check your child for possible suicidal behaviour by asking a few questions. See a list of questions your doctor may ask your child.

Be sure to use all medicines exactly as your child's doctor has prescribed them. If your child has intolerable side effects from any medicine, call your doctor immediately.

Medication Choices

Medicines most often used to treat bipolar disorder in children and teens include:

While antidepressants can be helpful for some children with bipolar disorder, they can also trigger mania. Doctors usually prescribe antidepressants along with mood stabilizers or antipsychotics to help prevent a manic episode. And the doctor needs to carefully monitor the child for mood changes. Antipsychotics can be used alone, or they may be combined with mood stabilizers for more effective control of manic episodes.

Side effects

Medicines for bipolar disorder have side effects that need to be managed. Some things you cannot change, such as increased urination (common with lithium). But you can deal with some side effects like weight gain (common with several medicines used to treat bipolar disorder) by increasing exercise and reducing calorie intake.

You can work with your child and his or her doctor to find ways of coping with side effects. If side effects from a medicine are intolerable, the doctor may have to change the dose or the medicine.

Advisories. Health Canada and the U.S. Food and Drug Administration (FDA) have issued advisories on antidepressant medicines and the risk of suicide. Health Canada and the FDA do not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when the doses are changed.

Other Treatment

Most children who have bipolar disorder need medicine. But other forms of treatment used along with medicine play an important role in balancing mood and improving quality of life. Counselling, education about the disorder, and stress reduction can help.

Other Treatment Choices

Counselling along with medicine has been used effectively to manage bipolar disorder. Types of therapy that counsellors use to treat bipolar disorder include:

In some cases, electroconvulsive therapy (ECT) may be an option. In this procedure, brief electrical stimulation to the brain is given through electrodes placed on the head. The stimulation produces a short seizure that is thought to balance brain chemicals.

Complementary therapy

Complementary medicine is a term used for a wide variety of health care practices that may be used along with standard medical treatment. Omega-3 fatty acids found in fish oils have been getting some attention as a possible complementary treatment of bipolar disorder. But more research is needed to prove the effectiveness of omega-3 fatty acids in treating this condition in children, teens, and adults.

Other Places To Get Help

Organizations

Canadian Mental Health Association
595 Montreal Road
Suite 303
Ottawa, ON  K1K 4L2
Phone: (613) 745-7750
Fax: (613) 745-5522
Email: info@cmha.ca
Web Address: www.cmha.ca
 

The Canadian Mental Health Association (CMHA) promotes mental health and focuses on combatting mental health problems and emotional disorders. The organization offers workshops, pamphlets, newsletters, and other educational materials.


Canadian Psychiatric Association
141 Laurier Avenue West
Suite 701
Ottawa, ON  K1P 5J3
Phone: (613) 234-2815
Fax: (613) 234-9857
Email: cpa@cpa-apc.org
Web Address: www.cpa-apc.org

Kids Help Phone
300-439 University Avenue
Toronto, ON  M5G 1Y8
Phone: 1-800-668-6868 (hotline number for kids and youth)
(416) 586-5437 (national office)
Fax: (416) 586-0651
Email: info@kidshelp.sympatico.ca
Web Address: www.kidshelpphone.ca
 

Kids Help Phone provides children and teens access to counsellors 24 hours a day, seven days a week. Counsellors also respond to questions posted online. At the Web site, visitors can find information on issues specific to children and teens, such as on bullying, dating, girls' and boys' health, and violence and abuse.


Mood Disorders Society of Canada
3-304 Stone Road West
Suite 736
Guelph, ON  N1G 4W4
Phone: (519) 824-5565
Fax: (519) 824-9569
Email: info@mooddisorderscanada.ca
Web Address: www.mooddisorderscanada.ca

References

Citations

  1. American Psychiatric Association (2000). Bipolar disorders. In Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev., pp. 382–397. Washington, DC: American Psychiatric Association.

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Credits

By Healthwise Staff
Primary Medical Reviewer John Pope, MD - Pediatrics
Primary Medical Reviewer Donald Sproule, MD, CM, CCFP, FCFP - Family Medicine
Specialist Medical Reviewer David A. Axelson, MD - Child and Adolescent Psychiatry
Last Revised June 7, 2011

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