Understanding Bipolar Disorder in Teens

Upset teen sitting on stairs
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Learning that your teen has bipolar disorder can feel scary and overwhelming—especially if you aren’t familiar with it. Movies and the media often depict people with bipolar disorder unfavorably. But many of those depictions aren’t realistic.

It’s important to educate yourself about the realities of bipolar disorder so you can gain a better understanding of what your teen is experiencing and help him get the best treatment possible.

While bipolar disorder isn’t curable, the symptoms are manageable.

Types

Hormonal shifts, brain development, and teenage drama make mood swings relatively common among adolescents. But in teens with bipolar disorder, mood issues are more serious.

Bipolar disorder is a mental illness that causes serious mood changes that are accompanied by changes in sleep, energy level, and the ability to think clearly.

Teens with bipolar disorder may experience weeks or even months of severe depression and times of elevated moods or irritability. Their unstable moods take a serious toll on their daily functioning. They may struggle to establish and maintain healthy relationships, have a hard time getting an education, or have difficulties keeping a job.

There are two basic types of bipolar:

  • Bipolar I – Teens with bipolar I experience at least one manic episode. Although not required for for the formal diagnosis, the vast majority will also experience major depressive episodes during the course of their lives.
  • Bipolar II – Teens with bipolar II have at least one hypomanic episode (a less serious form of mania) and at least one major depressive episode.

Both types can be very serious conditions in teenagers and require treatment from a mental health professional.

Signs and Symptoms

Up to 65 percent of adults with bipolar disorder experienced symptoms prior to the age of 18.

Childhood-onset bipolar is associated with a more severe course of illness compared to people who don’t begin to experience symptoms until adulthood.

Even if you know an adult with bipolar disorder—or you have been diagnosed with it yourself—it might not look the same in a teenager. Teens tend to more irritable than elated during manic episodes and their depressive episodes may involve more complaints of physical symptoms than sadness.

Manic episodes last at least seven days. A teen experiencing a manic episode may:

  • Engage in risky behavior, like driving at high rates of speed or driving while intoxicated
  • Become irritable easily
  • Talk fast about a lot of different things
  • Feel overly happy or act silly in a way that is unusual for their age
  • Exhibit unusual or excessive concern with sexual activity
  • Have trouble staying focused

A teen experiencing a hypomanic episode exhibits the symptoms of mania but their daily functioning won’t be markedly impaired. Many teens who experience hypomania enjoy the increased energy and decreased need for sleep. Hypomania only has to last for four days, as opposed to the seven or more days that are required for the diagnosis of a manic episode.

A teen experiencing a depressive episode may:

  • Complain about physical aches and pains, like stomachaches and headaches
  • Think about death or suicide
  • Feel guilty, empty, or worthless
  • Sleep too little or too much
  • Feel very sad, hopeless, or helpless
  • Have little energy and no interest in fun activities
  • Struggle to concentrate
  • Overeat or not eat at all

Risks to Consider

Teens are already prone to risky behavior, but that risk is multiplied when the teenager also has bipolar disorder. Keep an eye out for substance abuse, such as drinking or taking drugs, as well as suicidal behavior.

The risk for suicide in people with bipolar disorder is among the highest for all psychiatric disorders.

Studies show that between 25 and 50 percent of adults with bipolar make at least one suicide attempt over the course of their lives and between 8 and 19 percent of individuals with bipolar disorder die from suicide.

Studies have also found that 72 percent of adolescents with bipolar disorder acknowledge thinking about suicide at one point or another. Research shows teens with both bipolar I and bipolar II are at an elevated risk for suicide.

If your teen has been diagnosed with bipolar disorder, take the risk of suicide seriously. Work with your teen’s treatment providers to assess your teen’s risks and to develop a safety plan.

Co-Morbid Conditions

Many adolescents with bipolar disorder have an additional mental illness, addiction, or behavior disorder. Some research has estimated that up to 90 percent of youth with bipolar disorder may have attention deficit hyperactivity disorder as well.

Anxiety disorders, substance use, and disruptive behavior disorders are among the other most common issues teens with bipolar disorder may experience.

Causes

Researchers don’t know the exact cause of bipolar disorder. There is likely a genetic component as well as environmental factors.

A teen who has a parent with bipolar disorder is nine times more likely to develop bipolar than a teen without a family history of bipolar. When both parents have bipolar disorder, the risk is even higher.

Scientists think an imbalance in neurotransmitters (also known as chemical messengers) in the brain is involved in the neurobiology of bipolar disorder.

Diagnosis

If you think your teen may have bipolar disorder (or any other mental health issue), talk to his physician. Schedule an appointment t discuss your concerns.

A physician may refer you to a mental health treatment provider for a complete evaluation. A mental health expert will likely want to interview you and your teen to get a full picture of the signs and symptoms.

There isn’t a lab test that identifies bipolar disorder. And sometimes, other conditions such as depression or ADHD have similar presentations. So it’s important to offer as much information as you can about your child’s mood, sleep patterns, energy level, history, and behavior.

Treatment

Bipolar disorder must be managed throughout a person’s life. Treatment may require adjustments over time. Your teen’s treatment team may recommend:

  • Medication: A psychiatrist may prescribe medication to stabilize your teen’s mood. It’s important to monitor your teen’s medication and be on the lookout for side effects. Finding the right medication and the right dosage may take some time as there isn’t a single medication that works best for everyone with bipolar disorder.
  • Talk therapy: A therapist may educate your child about bipolar and may offer coping strategies to help manage the symptoms. Therapy for teens often includes family members. Family therapy may address relationship issues, behavior management problems, or strategies to help the entire family cope with a teen’s mental illness.

A psychiatric hospitalization may be required at one time or another if a teen poses an acute safety risk. A serious suicide attempt, thoughts of suicide with a clear plan, self-injury, or psychosis are just a few of the possible reasons a teen with bipolar disorder may need to stay in a hospital.

Treatment works best when the teen, parents, doctors, therapists, and other treatment providers work together as a team. So it’s important to attend your teen’s appointments, ask questions, communicate with other treatment providers, and continue to educate yourself about your teen’s mental health needs.

A therapist or psychiatrist may request that you log your teen’s moods, sleep patterns, or behavior. Charting your teen’s progress can help treatment providers determine how well therapy or medications are working to keep your child’s moods stable.

It’s also important for parents to ensure a teen is taking her medication. Some teens quit taking their medication as soon as they’re feeling better (but medication needs to be taken consistently to keep symptoms at bay).

Support Your Teen at School

It’s important to work with your teen’s school if he’s been diagnosed with bipolar disorder. School officials can assist with a plan that will best support your teen’s education.

Your teen’s academic needs will depend on his symptoms and his academic issues. If he exhibits behavior problems at school, the teachers may create a behavior plan that will use appropriate disciplinary action.

If he struggles academically, the school may provide services to help ensure he is able to get an education. The school may be able to offer things such as a modified schedule or a hall pass that lets your teen visit the guidance counselor whenever necessary. Encourage your teen to participate in meetings to talk about how the school could support his education as well.

Support Your Teen at Home

Bipolar disorder affects the entire family so it’s important to work together to help your teen manage the symptoms.

Learn as much as you can about bipolar disorder and the latest treatment options—and make sure other family members learn about it too. It’s important for siblings to understand what to expect, like why a teen may want to stay in bed for weeks at a time or why he may have periods where he doesn’t want to sleep at all.

Hold regular conversations with your teen about treatment and treatment-related issues. There’s a good chance that at some point your teen won’t want to take medication or attend therapy. Validate her feelings and talk about the importance of following doctors’ recommendations.

It’s important to take care of yourself as well. Coping with the challenges of raising a child with bipolar disorder can be stressful. Consider joining a support group for parents with teens with bipolar disorder (or mental illness in general). Connecting with other parents may help you gain emotional support as well as practical advice about how to support your teen.

Sources

Best MW, Bowie CR, Naiberg MR, Newton DF, Goldstein BI. Neurocognition and psychosocial functioning in adolescents with bipolar disorderJournal of Affective Disorders. 2017;207:406-412.

Eisner LR, Johnson SL, Youngstrom EA, Pearlstein JG. Simplifying profiles of comorbidity in bipolar disorderJournal of Affective Disorders. 2017;220:102-107.

HealthyChildren.org: Bipolar Disorder in Children and Teens.

Odonnell LA, Axelson DA, Kowatch RA, Schneck CD, Sugar CA, Miklowitz DJ. Enhancing quality of life among adolescents with bipolar disorder: A randomized trial of two psychosocial interventionsJournal of Affective Disorders. 2017;219:201-208.

Stanley IH, Hom MA, Luby JL, Joshi PT, Wagner KD, Emslie GJ, Walkup JT, Axelson DA, Joiner TE. Comorbid sleep disorders and suicide risk among children and adolescents with bipolar disorderJournal of Psychiatric Research. 2017;95:54-59. 

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