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 behavior. 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
counseling.
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:
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
Depression symptoms
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 behavior
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).
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 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 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.
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, the national suicide hotline at 1-800-273-TALK (1-800-273-8255), or other emergency services right away if:
Your child is thinking seriously of committing suicide or has recently tried to commit suicide. Serious signs include these thoughts:
Has decided how to kill himself or herself, such as with a weapon or medicines.
Has set a time and place to do it.
Thinks there is no other way to solve the problem or end the pain.
Your child feels he cannot stop from hurting himself or someone else.
Call a doctor right away if:
Your child hears voices.
Your child has been thinking about death or suicide a lot but does not have a plan to commit suicide.
Your child is worried a lot that the feelings of depression or thoughts of suicide are not going away.
Seek care soon if:
Your child has symptoms of depression, such as:
Feeling sad or hopeless.
Not enjoying anything.
Having trouble with sleep.
Feeling guilty.
Feeling anxious or worried.
Your child has been treated for depression for more than 3 weeks but is not getting better.
Who to see
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 behavior 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. Bipolar
disorder can be diagnosed and treated by a health professional such as
a:
Your child may also benefit from professional
counseling to help deal with mood changes and the
effects bipolar disorder has on your child's life. A counselor with special
training in child mood disorders or experience treating child bipolar disorder
may be most helpful. Counseling for bipolar disorder can be provided by
a:
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 counselor 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 National Alliance for the Mentally Ill
(NAMI) and the Child and Adolescent Bipolar Foundation.
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.)
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 counseling. 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.
Counseling
Counseling works best when symptoms of bipolar
disorder are controlled with medicines. For more information on the types of counseling used to treat bipolar disorder, see Other Treatment.
Home treatment
Home treatment includes helping your child get regular exercise, eat a balanced diet, and get enough sleep.
Hospital treatment
If your child's behavior 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.
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.
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.
FDA advisory
The U.S. Food and Drug Administration (FDA) has issued an advisory on antidepressant medicines and the risk of suicide. Talk to your doctor about possible side effects and the warning signs of suicide.
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. Counseling, education about the disorder, and stress
reduction can help.
Other treatment choices
Counseling along with medicine has been
used effectively to manage bipolar disorder. Types of therapy that counselors
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
Child and Adolescent Bipolar
Foundation
1000 Skokie Boulevard
Suite 570
Wilmette, IL 60091
Phone:
(847) 256-8525
Fax:
(847) 920-9498
Email:
cabf@bpkids.org
Web Address:
www.bpkids.org
The Child and Adolescent Bipolar Foundation (CABF) is a parent-led,
nonprofit, Web-based membership organization of families raising children
diagnosed with, or at risk for, early-onset bipolar disorder. This organization
provides resources to help families better understand childhood and adolescent
bipolar disorder.
Depression and Bipolar Support
Alliance
730 North Franklin Street
Suite 501
Chicago, IL 60654-7225
Phone:
1-800-826-3632 includes a hotline for help with depression and bipolar disorder (312) 642-0049
Fax:
(312) 642-7243
Web Address:
www.dbsalliance.org
The Depression and Bipolar Support Alliance publishes
brochures, books, and videotapes about the treatment of mood disorders, all
available free of charge or for a nominal fee. It also has an information and
referral line, and its website contains helpful information.
Mental Health America
2000 North Beauregard Street, 6th Floor
Alexandria, VA 22311
Phone:
1-800-969-NMHA (1-800-969-6642) referral service for help with depression (703) 684-7722
Fax:
(703) 684-5968
TDD:
1-800-969-6642
Web Address:
www.mentalhealthamerica.net
Mental Health America (formerly known as the National
Mental Health Association) is a nonprofit agency devoted to helping people of
all ages live mentally healthier lives. Its Web site has information about
mental health conditions. It also addresses issues such as grief, stress,
bullying, and more. It includes a confidential depression screening test for
anyone who would like to take it. The short test may help you decide whether
your symptoms are related to depression.
National Alliance on Mental Illness
(NAMI)
3803 North Fairfax Drive
Suite 100
Arlington, VA 22203
Phone:
1-800-950-NAMI (1-800-950-6264) hotline for help with depression (703) 524-7600
Fax:
(703) 524-9094
Email:
info@nami.org
Web Address:
www.nami.org
The National Alliance on Mental Illness is a national
self-help and family advocacy organization dedicated solely to improving the
lives of people who have severe mental illnesses such as schizophrenia, bipolar
disorder (manic depression), major depression, obsessive-compulsive disorder,
and panic disorder. NAMI focuses on support, education, advocacy, and research.
The mission of the organization is to "eradicate mental illness and improve the
quality of life of those affected by these diseases."
National Institute of Mental Health
(NIMH)
6001 Executive Boulevard
Room 8184, MSC 9663
Bethesda, MD 20892-9663
Phone:
1-866-615-6464 toll-free (301) 443-4513
Fax:
(301) 443-4279
TDD:
1-866-415-8051 toll-free
Email:
nimhinfo@nih.gov
Web Address:
www.nimh.nih.gov
The National Institute of Mental Health (NIMH) provides
information to help people better understand mental health, mental disorders,
and behavioral problems. NIMH does not provide referrals to mental health
professionals or treatment for mental health problems.
The National Suicide Prevention Lifeline is a 24-hour,
toll-free suicide prevention service. Crisis centers are located in 130
locations across the United States. Callers are routed to the closest provider
of mental health and suicide prevention services.
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.
Other Works Consulted
Akiskal HS (2009). Bipolar disorders section of Mood
disorders. In BJ Sadock, VA
Sadock, eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 9th ed., vol. 1, pp. 1629–1653. Philadelphia: Lippincott
Williams and Wilkins.
American Academy of Child and Adolescent Psychiatry (2009). Practice parameter on the use of psychotropic
medication in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 48(9): 961–973.
American Academy of Child and Adolescent Psychiatry
(2007). Practice parameter for the assessment and treatment of children and
adolescents with bipolar disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 46(1): 107–125. Available
online:
www.aacap.org/galleries/PracticeParameters/JAACAP_Bipolar_2007.pdf.
Ascherman LI, et al. (2006). Mental development and
behavioral disorders. In FD Burg et al., eds., Current Pediatric Therapy, 18th ed., pp. 1213–1219. Philadelphia: W.B.
Saunders.
Baloch HA, Soares JC (2010). Mood disorders. In EG Nabel, ed., ACP Medicine, section 13, chap. 2. Hamilton, ON: BC Decker.
Birmaher B, et al. (2006). Clinical course of children and adolescents with bipolar spectrum disorders. Archives of General Psychiatry, 63(2): 175–183.
Birmaher B, et al. (2007). Bipolar disorder. In A
Martin, FR Volkmar, eds., Lewis's Child and Adolescent Psychiatry, 4th ed., pp. 513–528. Philadelphia: Lippincott Williams and
Wilkins.
Carlson GA, Meyer SE (2009). Early-onset bipolar disorder. In BJ Sadock et al., eds., Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, 9th ed., vol. 2, pp. 3663–3670. Philadelphia: Lippincott Williams and Wilkins.
Correll CU, et al. (2009). Cardiometabolic risk of second-generation antipsychotic medications during first-time use in children and adolescents. JAMA, 309(16): 1765–1773.
Geddes J, Briess D (2008). Bipolar disorder, search
date July 2006. Online version of Clinical Evidence:
http://www.clinicalevidence.com.
Geller B, et al. (2008). Child bipolar I disorder: Prospective continuity with adult bipolar I disorder; Characteristics of second and third episodes; Predictors of 8-year outcome. Archives of General Psychiatry, 65(10): 1125–1133.
Goldstein TR, et al. (2007). Dialectical behavior therapy for adolescents with bipolar disorder: A 1-year open trial. Journal of the American Academy of Child and Adolescent Psychiatry, 46(7): 820–830.
Miklowitz DJ, et al. (2008). Family-focused treatment for adolescents
with bipolar disorder. Archives of General Psychiatry, 65(9): 1053–1061.
Mondimore FM (2007). Mood disorders. In NH Fiebach et
al., eds., Principles of Ambulatory Medicine, 7th ed.,
pp. 329–349. Philadelphia: Lippincott Williams and Wilkins.
National Institute of Mental Health (2008).
Bipolar Disorder in Children and Teens. Available
online:
http://www.nimh.nih.gov/health/publications/bipolar-disorder-in-children-and-teens-brochure.pdf.
Post RM, Altshuler LL (2009). Mood disorders: Treatment of bipolar disorders. In BJ Sadock et al., eds., Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, 9th ed., vol. 1, pp. 1744–1813. Philadelphia: Lippincott Williams and Wilkins.
Sass AE, Kaplan DW (2011). Depression section of Adolescence. In WW Hay et al., eds., Current Diagnosis and Treatment: Pediatrics, 20th ed., pp. 116–118. New York: McGraw-Hill.
Wagner KD, Brent DA (2009). Depressive disorders and suicide. In BJ Sadock et al., eds., Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, 9th ed., vol. 2, pp. 3652–3663. Philadelphia: Lippincott Williams and Wilkins.
Credits
By
Healthwise Staff
Primary Medical Reviewer
John Pope, MD - Pediatrics
Specialist Medical Reviewer
David A. Axelson, MD - Child and Adolescent Psychiatry
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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