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Bipolar Disorder (Children and Adolescents)

What is Pediatric Bipolar Disorder?

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood and energy. It can also make it hard for someone to carry out day-to-day tasks, such as going to school or hanging out with friends. Symptoms of bipolar disorder are severe. They are different from the normal ups and downs that everyone goes through from time to time. They can result in damaged relationships, poor school performance, and even suicide. But bipolar disorder can be treated, and people with this illness can lead full and productive lives. Bipolar disorder often develops in a person's late teens or early adult years, but some people have their first symptoms during childhood.

 

Symptoms

Youth with bipolar disorder experience unusually intense emotional states that occur in distinct periods called "mood episodes." An overly joyful or overexcited state is called a manic episode, and 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. Extreme changes in energy, activity, sleep, and behavior go along with these changes in mood. Symptoms of bipolar disorder are described below:

Symptoms of Mania Include Symptoms of Depression Include

Mood Changes

Being in an overly silly or joyful mood that's unusual for your child. It is different from times when he or she might usually get silly and have fun. Having an extremely short temper. This is an irritable mood that is unusual.

Mood Changes

Being in a sad mood that lasts a long time Losing interest in activities they once enjoyed Feeling worthless or guilty.

Behavioral Changes

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

Behavioral Changes

Complaining about pain more often, such as headaches, stomach aches, and muscle pains. 

Eating a lot more or less 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.

Symptoms of bipolar disorder are not like the normal changes in mood and energy that everyone has now and then. 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 described in the chart above may start at the same time. Sometimes the symptoms of bipolar disorder are so severe that the child needs to be treated in a hospital.

 

Types of Bipolar

adolescent boy lying on stomach smiling

Doctors usually diagnose mental disorders using guidelines from the Diagnostic and Statistical Manual of Mental Disorders, or DSM. According to the DSM, there are four basic types of bipolar disorder:

Bipolar I Disorder is mainly defined by manic or mixed episodes that last at least seven days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, the person also has depressive episodes, typically lasting at least two weeks. The symptoms of mania or depression must be a major change from the person's normal behavior.

Bipolar II Disorder is defined by a pattern of depressive episodes shifting back and forth with hypomanic episodes, but no full-blown manic or mixed episodes.

Bipolar Disorder Not Otherwise Specified (BP-NOS) is diagnosed when a person has symptoms of the illness that do not meet diagnostic criteria for either bipolar I or II. The symptoms may not last long enough, or the person may have too few symptoms, to be diagnosed with bipolar I or II. However, the symptoms are clearly out of the person's normal range of behavior.

Cyclothymic Disorder, or Cyclothymia, is a mild form of bipolar disorder. People who have cyclothymia have episodes of hypomania that shift back and forth with mild depression for at least two years (one year for children and adolescents). However, the symptoms do not meet the diagnostic requirements for any other type of bipolar disorder.

 

Diagnosis

No blood tests or brain scans can diagnose bipolar disorder. However, a doctor may use tests like these to help rule out other possible causes for your child's symptoms. Doctors who have experience with diagnosing early-onset bipolar disorder, such as psychiatrists, psychologists, or other mental health specialists, will ask questions about changes in your child's mood. They will also ask about sleep patterns, activity or energy levels, and if your child has had any other mood or behavioral disorders. The doctor may also ask whether there is a family history of bipolar disorder or other psychiatric illnesses, such as depression or alcoholism.

Your insurance company can provide you a list of mental health professionals. Other resources for information and referrals include:

FDA Warning on Antidepressants

Antidepressants are safe and popular, but some studies have suggested that they may have unintentional effects on some people, especially in adolescents and young adults. The FDA warning says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment.

Possible side effects to look for are

  • Depression that gets worse
  • Suicidal thinking or behavior
  • Any unusual changes in behavior such as trouble sleeping, agitation, or withdrawal from normal social situations.

Families and caregivers should report any changes to the doctor. The latest information from the FDA website.

Treatment

Medication

Before starting medication, the doctor will want to determine your child's physical and mental health. This is called a "baseline" assessment. Your 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.

Mood Stabilizers - To date, lithium (sometimes known as Eskalith), risperidone (Risperdal), and aripiprazole (Abilify) are the only medications approved by the U.S. Food and Drug Administration (FDA) to treat bipolar disorder in young people.

Atypical antipsychotic medications are sometimes used to treat symptoms of bipolar disorder in children. These medications are called "atypical" to set them apart from earlier types of medications, called conventional or first-generation antipsychotics. In addition to risperidone and aripiprazole, atypical antipsychotic medications include, Olanzapine (Zyprexa), Quetiapine (Seroquel), Ziprasidone (Geodon).

Antidepressant medications are sometimes used to treat symptoms of depression in bipolar disorder. Doctors who prescribe antidepressants for bipolar disorder usually prescribe a mood stabilizer or anticonvulsant medication at the same time. Fluoxetine (Prozac), Paroxetine (Paxil), Sertraline (Zoloft).

Psychotherapy

In addition to medication, psychotherapy ("talk" therapy) can be an effective treatment for bipolar disorder. 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 keep taking their medications to stay healthy and prevent relapse.

 

Other Disorders

Children with bipolar disorder often have other diagnoses as well. Common illnesses include ADD/ADHD, anxiety disorders, oppositional defiant disorder, conduct disorder and substance abuse. Because some of these disorders have symptoms that appear similar cross-sectionally to those of bipolar disorder, it is important to complete a very careful and thorough diagnostic process.

 

Where to Get Help

If you suspect that your child may be experiencing symptoms of bipolar disorder, your family doctor is a good place to start. Other helpful resources can be found at Where can I go for help?

 

References and Resources:
Bipolar Disorder in Children and Teens: A Parent's Guide

For more information:

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This article is a NetWellness exclusive.

Last Reviewed: Aug 22, 2013