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.
What causes bipolar disorder?
Experts don't fully understand what causes
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. But for a child to have bipolar disorder,
these mood changes must be different from the child's usual moods and must happen
with other symptoms or changes in behavior. These distinct periods of time with changes
in mood and behavior are called mood episodes. People with bipolar disorder have manic
and depressive mood episodes.
Times of mania (ups) or depression (downs) may
be less obvious in children and teens than in adults.
A manic episode lasts
at least a week. It is a period of extremely happy, aggressive, and/or angry mood
that occurs with some of the following symptoms. The child or teen may:
little need for sleep.
Have high energy levels.
Have extreme confidence
Talk very fast.
Have many thoughts at once.
very distracted and unable to focus.
Touch his or her genitals, use sexual
language, and approach others in a sexual way.
Act inappropriate or are intrusive
in social settings.
A depressive episode is a period of
sad, low, or cranky mood that occurs with some of the following symptoms. The child
or teen may:
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 more research is being done on how the medicines
work and if they are safe for children and teens.
Keeping a consistent sleep-wake
schedule is an important first step in managing bipolar disorder. Set a regular sleep-wake
schedule for your child, to make sure they go to bed and wake up the same time every
day, even on weekends.
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.
Health Tools help you make wise health decisions or take action to improve
Actionsets are designed to help people take an active role in managing a health
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 who has 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.
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.
bipolar I disorder, moods swing between mania and depression, sometimes with periods
of normal mood between extremes. All children with this disorder have episodes of
mania, but episodes of depression vary. For example, some children do experience depression,
and others rarely are depressed.
With bipolar II disorder, depression
is more severe than mania. And manic episodes may last for fewer days and be less
With cyclothymia, the high and low mood swings are not as
severe as the mania and depression seen in bipolar I or bipolar II disorders.
NOS (not otherwise specified), is diagnosed when symptoms of mania and depression
are not frequent or severe enough for the above diagnoses.
and younger teens, bipolar disorder tends to be rapid-cycling or mixed cycling:
that there have been at least four shifts between depression and mania over the past
12 months. These shifts occur quickly, sometimes within the same day. Often the shifts
happen without a return to a normal mood in between the extremes.
(also known as mixed-features) 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.footnote 1
Continuous sad or irritable mood
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
Sleeping too much or too little or having trouble falling asleep
body movements or restlessness
No energy, or loss of energy
feelings of guilt or worthlessness
thoughts or talk of death or suicide
Headaches, muscle aches, or stomachaches
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
need for sleep, such as going for days with very little sleep and not being tired
too much or too fast, changing topics too quickly, and not allowing interruptions
distraction and constantly moving from one thing to another
as inflated self-esteem or a belief in unrealistic abilities or powers
sexual thoughts, feelings, activity, and use of sexual language (hypersexuality)
obsession with reaching goals or becoming involved in too many activities
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).
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.
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.
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
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.
socially isolated and overly sensitive to any kind of rejection or criticism.
irresponsibly, take risks and not think about the consequences, or have trouble making
and keeping friends.
addition to having manic symptoms, children may have severe, seizure-like temper tantrums
when they are told "no." A child with bipolar disorder 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.
with bipolar disorder may have more extreme happy or silly moods than most children
Manic behavior by a teen with
bipolar disorder may result in such problems as:
Suspension from school.
as a result of fighting or drug use.
An unwanted pregnancy.
transmitted infection (STI) from unsafe sexual behavior.
episodes, a teen may do poorly in school and may stop taking part 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.
with corticosteroids for conditions such as asthma may also trigger a manic or depressive
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, dose, or combination of medicines for your child's conditions.
Increases Your Risk
Your child's risk for 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.
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:
child is thinking seriously of suicide or has recently tried 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 has a plan.
there is no other way to solve the problem or end the pain.
child feels he cannot stop from hurting himself or someone else.
a doctor right away if:
Your child hears voices.
has been thinking about death or suicide a lot but does not have a suicide plan.
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.
trouble with sleep.
Feeling anxious or worried.
child has been treated for depression for more than 3 weeks but is not getting better.
Who to see
It is best to build 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
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
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 help to seek
your own counselor or therapist to support 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 on Mental Illness
(NAMI) and the Child and Adolescent Bipolar Foundation.
Exams and Tests
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.
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.)
physical exam, which can rule out other conditions with similar symptoms.
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.
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 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.
treatment includes helping your child get regular exercise, eat a balanced diet, and
have a regular sleep schedule. For more information, see Home Treatment.
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
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.
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
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
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.
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
There are steps you can take at home to reduce your child's symptoms.
your child's room quiet, and have your child go to bed at the same time every night.
Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs),
like fluoxetine (Prozac, for example).
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.
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 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.
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.
Counseling along with medicine has been used
effectively to manage bipolar disorder. Types of therapy that counselors use to treat
bipolar disorder include:
Interpersonal and social rhythm therapy. This
focuses on social and family relationships and related problems. It teaches family
members about the disorder. They learn how to recognize signs of relapse and how to
manage what creates stress in each family member. This therapy also helps with setting
and keeping a regular social and sleep schedule.
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
medicine is a term used for a wide variety of health care practices that may be used
along with standard medical treatment. A few studies suggest that adding omega-3 fatty acids to medicine (such as lithium) can help reduce the depressive
symptoms of bipolar disorder in some people. Omega-3 fatty acids don't seem to have
an effect on the manic symptoms of bipolar disorder. And omega-3 fatty acids alone
are not a good treatment for bipolar disorder. They are not a replacement for medicine
or other therapy used to treat bipolar disorder.footnote 2, footnote 3
American Psychiatric Association (2013).
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Sarris J, et al. (2012). Omega-3 for bipolar disorder: Meta-analyses
of use in mania and bipolar depression. Journal of Clinical Psychiatry, 73(1):
Montgomery P, Richardson AJ (2009). Omega-3 fatty
acids for bipolar disorder. Cochrane Database of Systematic Reviews (1).
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Staff Primary Medical ReviewerJohn
Pope, MD, MPH - Pediatrics Kathleen Romito, MD
- Family Medicine Elizabeth T. Russo, MD - Internal
Medicine David A. Brent, MD - Child and Adolescent
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This information does not replace the advice of a doctor.
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