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Bipolar Disorder in Adolescents

What is bipolar disorder?

Bipolar disorder, previously referred to as manic depression, is classified as a type of affective disorder (also called mood disorder) that goes beyond the day's ordinary ups and downs, and is a serious medical condition and important health concern in this country. Bipolar disorder is characterized by periodic episodes of extreme elation, happiness, elevated mood, or irritability (also called mania) countered by periodic, classic major depressive symptoms, hence there are two "poles" or symptoms of the disorder.

Who is affected by bipolar disorder?

Bipolar disorder affects 2.6 percent of American adults each year. The median age of onset is 25. When symptoms are present before the age of 12, they are often confused with attention-deficit/hyperactivity disorder (ADHD)--a syndrome that is usually characterized by serious and persistent difficulties resulting in inattentiveness or distractibility, impulsivity, and hyperactivity.

Affecting males and females equally (although females are more likely to experience more depressive and less manic symptoms), bipolar disorder often begins in adolescence or early adulthood. Bipolar disorder is beginning to be better recognized in young children, although diagnosis may still be difficult.

Bipolar disorder is likely to run in families and, in some cases, is believed to be hereditary. Researchers are still seeking to identify a gene (or genes) that may be responsible for this disorder.

What are the symptoms of bipolar disorder?

The following are the most common symptoms of bipolar disorder. However, each individual may experience symptoms differently.

Depressive symptoms may include:

  • Persistent feelings of sadness

  • Feeling hopeless or helpless

  • Having low self-esteem

  • Feeling inadequate

  • Excessive guilt

  • Feelings of wanting to die

  • Loss of interest in usual activities or activities once enjoyed

  • Difficulty with relationships

  • Sleep disturbances (for example, insomnia or hypersomnia)

  • Changes in appetite or weight

  • Decreased energy

  • Difficulty concentrating

  • A decrease in the ability to make decisions

  • Suicidal thoughts or attempts

  • Frequent physical complaints (for example, headache, stomachache, or fatigue)

  • Running away or threats of running away from home

  • Hypersensitivity to failure or rejection

  • Irritability, hostility, aggression

Manic symptoms may include:

  • Overly inflated self-esteem

  • Decreased need for rest and sleep

  • Increased distractibility and irritability

  • Excessive involvement in pleasurable and/or high-risk activities that may result in painful consequences; this may include provocative, aggressive, destructive, or antisocial behavior (for example, sexual promiscuity, reckless driving, reckless spending, abuse of alcohol and/or drugs).

  • Increased talkativeness (may include increase in rate of speech, changes topics quickly, cannot be interrupted)

  • Excessive "high" or euphoric feelings, at times grandiose 

  • Severe, unpredictable mood changes including unusually happy or silly, or unusually angry, agitated, or aggressive

  • Increased sex drive

  • Increased energy level

  • Uncharacteristically poor judgment

Some teenagers in a manic phase experience psychotic symptoms including hallucinations and/or delusions.

For a diagnosis of bipolar disorder to be made, an individual must exhibit both depressive and manic symptoms to a varying degree, depending on the severity of the disorder. The symptoms of bipolar disorder, especially in a teenager, may resemble other problems (such as, drug abuse, attention-deficit/hyperactivity disorder, or delinquency). Always consult your adolescent's health care provider for a diagnosis.

How is bipolar disorder diagnosed?

Seeking early diagnosis and treatment is crucial to recovery. A diagnosis is often made after a careful psychiatric examination and medical history performed by a psychiatrist or other mental health professional.

Treatment for bipolar disorder

Specific treatment will be determined by your adolescent's health care provider based on:

  • Your adolescent's age, overall health, and medical history

  • Extent of your adolescent's symptoms

  • Your adolescent's tolerance for specific medications or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

Mood disorders, including bipolar disorder, can often be effectively treated. Treatment should always be based on a comprehensive evaluation of the adolescent and family. Treatment may include one, or more, of the following:

  • Medication (for example, mood-stabilizing medications and/or antidepressants)

  • Psychotherapy (most often cognitive-behavioral, supportive, psychoeducational, and/or interpersonal therapy)

  • Family therapy

  • Consultation with the adolescent's school

Parents play a vital supportive role in any treatment process.

Recognizing the varied and extreme mood swings associated with bipolar disorder is crucial in obtaining effective treatment, and avoiding the potentially painful consequences of the reckless, manic behavior.