Bipolar disorder is a manageable condition.
If you’re the parent of a teen diagnosed with bipolar disorder (BP), then you understand your child faces significant challenges. It’s likely they’ll experience some variation of the cycles of mania and depression that characterize bipolar disorder for the rest of their lives. If you’re unsure what those terms mean in the context of bipolar disorder – mania and depression – we’ll explain below. For now, it’s important to recognize that in order to live with these intense, up-and-down states of emotion, your teen will probably be on some sort of psychiatric medication and participate in some type of psychotherapy to manage those states – also for the rest of their lives.
That may sound scary or intimidating.
However, it’s important to recognize that BD is a manageable condition. Research shows that a teenager who receives a diagnosis for BD as described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) – BD-I, BD-II, or BD-NOS – can respond positively to the appropriate combination of medication, therapy, and lifestyle modifications. With commitment, patience, resilience, and the support of a compassionate, loving family and peer network, your teen can learn to manage their bipolar disorder and live the life they choose, rather than a life defined by their diagnosis or dominated by their symptoms.
With that said, we won’t sugarcoat things. Most people with bipolar disorder experience successes and misses. They go through multiple iterations of the cyclic patterns that mirror the nature of their disorder. They stay on their meds for months or years and then decide to go off their meds. When they do, they’ll probably have a rough time, remember why they were on their meds in the first place, then start taking them again, and do well – until they decide to go off their meds again.
That’s the truth.
Bipolar Depression in Teens
Our article “Hope for Bipolar Teens – Part One” describes one of the primary challenges facing teens who display symptoms of bipolar disorder: an accurate diagnosis. This is crucial for finding treatment for a teen with bipolar depression. If your teen receives their diagnosis from a licensed mental health professional experienced working with adolescents with bipolar disorder, then you, your child, and your family can avoid the problems many people with BD faced in the past: inaccurate diagnoses and courses of treatment that in some cases exacerbate the condition, rather than improving it.
We’ll reiterate something here:
You increase your teen’s chance of sustained recovery when you get than a full evaluation and diagnosis from a licensed mental health professional experienced in working with adolescents with bipolar disorder.
To understand why we repeated that, please read the article we link to above. We also suggest reading part two of that series, “Hope for Bipolar Teens Part II: Silver Linings – Bipolar Disorder and Creativity.”
We think you get the idea: an accurate diagnosis is crucial for sustainable recovery. Here’s what we mean by recovery, both in a general mental health context and specifically for people with bipolar disorder:
“Recovery is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.”
At the risk of making a drastic oversimplification, that’s what all parents want for their children. They want them to live a self-directed life and reach their full potential. We’re sure that’s what you want for your child, too.
That’s why it’s important for you to find the best possible treatment for bipolar depression in teens, and when you seek treatment for a teenager with bipolar disorder, it’s important to understand what that means.
And to understand that, it’s helpful to understand what bipolar disorder is. We’ll help by offering a full definition of BD and the latest statistics on the prevalence of BD in teens. Then we’ll outline the latest, evidence-based treatments for teens with bipolar depression/bipolar disorder, and end with a description of what to look for in a high-quality behavioral health treatment center for teens.
What is Bipolar Disorder, a.k.a Bipolar Depression?
While many people use bipolar disorder as a catch-all phrase, clinically speaking, BD includes three separate disorders. Each involves a combination of manic, hypomanic (similar to, but less intense than mania), and depressive episodes. The different types of bipolar disorder are:
- Bipolar I Disorder. This BD variant includes periods of mania, major depression, or mixed episodes that:
- Last for at least a week
- Are so severe that they affect sleep or typical daily functioning
- Occur immediately before or immediately after a depressive episode that lasts or lasted two weeks or more
- Bipolar II Disorder. This variant includes periods of mania, hypomania depression, or mixed episodes that are less intense than the episodes experienced by adolescents with bipolar 1. The milder manic episodes typical of bipolar II are called hypomanic or hypomania.
- Cyclothymic Disorder. This variant includes numerous periods of depressive symptoms and hypomanic symptoms, but adolescents with cyclothymic disorder do not experience the full hypomanic or major depressive episodes seen in bipolar I or bipolar II.
We’ll expand on that by explaining what mania, hypomania/hypomanic, and depression mean in the context of a bipolar disorder diagnosis.
- Mania and Hypomania:
- Manic episodes or moods can cause elation, euphoria, or the opposite: anger or extreme irritability. In children and teens, irritability is more common than elation. Another hallmark symptom of mania is a limited need for sleep, which can last for days.
During a manic episode, adolescents have a high risk of engaging in destructive and/or risky behavior.
- Depression (in BD):
- Depressive episodes or moods are often characterized by irritability, negativity or pessimism, persistent sadness or feeling down, somatic complaints such as headaches or stomachaches, low energy or fatigue, and increased withdrawal from family and friends.
[Note: for a complete list of signs and symptoms to watch for in an adolescent you suspect may have BD, please read our parent guide on Bipolar Disorder in Adolescents.]
The differences between the typical mood swings of adolescence and the manic and depressive phases of bipolar disorder/bipolar depression are in the frequency, intensity, and duration of the episodes. Teens will go up and down. Teens will be moody. However, BD is not typical teen moodiness. The symptoms of BD persist for several days or weeks at a time and often include more than one symptom at a time.
Bipolar Depression in Teens: Facts and Figures
Here are some important facts and statistics regarding adolescent bipolar disorder:
- Approximately 1 in 5 teens who have major depression develop bipolar disorder within 5 years of the onset of their first depressive episode
- Among U.S. adolescents:
- 2.9% of teens age 13-18 meet the criteria for bipolar disorder each year
- There are gender differences in the rate of bipolar disorder in adolescents:
- 3.3% for females
- 2.6% for males
- Rates of bipolar diagnoses increase with age:
- 1.9% of adolescents age 13-14 are diagnosed with bipolar disorder each year
- 3.1% of adolescents age 15-16 are diagnosed with bipolar disorder each year
- 4.3% of adolescents age 17-18 are diagnosed with bipolar disorder each year
- Close to 60% of teens who develop bipolar disorder also have an ADHD diagnosis
- Experts estimate that as many as 33% of children and teens diagnosed with depression may instead have early onset bipolar disorder
The most important fact for you to know is this last one:
Evidence shows that with the right combination of medication, therapy, and support, the rate of successful treatment for people with bipolar disorder is between 60 and 80 percent.
Treatment for Bipolar Depression in Teens
The latest clinical evidence shows that that the most effective treatment for bipolar disorder in teens follows the integrated treatment model. The best treatment centers for bipolar depression in teens apply this model, which includes a combination of psychotherapy (a.k.a. talk therapy), medication, and complementary supports.
Here’s how an expert from the American Psychological Association (APA) describes the way talk therapy and medication work together:
“In most cases, medication helps stabilize kids so that they can participate effectively in psychotherapy, which then helps with longer-term symptom management and coping strategies. I see the two as working in concert.”
The types of talk therapy used most frequently to treat bipolar disorder in teens, with the best outcomes, include:
- Individual therapy, which may include:
- Dialectical behavior therapy (DBT)
- Cognitive behavioral therapy (CBT)
- Mindfulness based cognitive behavioral therapy (MBCBT)
- Applied Behavioral Analysis (ABA)
- Behavioral Activation (BA)
- Motivational Interviewing (MI)
- Interpersonal Psychotherapy (IPT)
- Group therapy, which may include:
- Group CBT and group DBT
- Family therapy, which may include:
- Functional family therapy
- Multi-family groups
- Parenting groups
The types of medication used frequently to treat bipolar disorder in teens, with the best outcomes, include:
- Mood stabilizers:
- Lithium
- Valporic acid
- Lamotigine
- Carbamazepine
- Oxcarbasepine
- Antipsychotics:
- Quetiapine
- Aripiprazole
- Risperidone
- Olanzapine
- Ziprasidone
- Antidepressants:
- Fluoxetine
- Escilatpram
- Sertraline
The complementary supports used frequently to treat bipolar disorder in teens, with the best outcomes, include:
- Mindfulness-based stress reduction:
- Experiential therapies:
- Exercise
- Equine therapy (horses)
- Hiking
- Expressive therapy:
- Music
- Dance
- Drama
- Art
- Community support:
- The National Alliance on Mental Illness web page offers information on community groups for families and teens with BP
- The Depression and Bipolar Support Alliance web page hosts a support group finder that can help you or your teen find a support group in your area
These therapies, medication, and types of support listed above occur in various combinations across different levels of care. The different levels of care correspond to the specific amount of supervision, monitoring, treatment immersion, and treatment intensity recommended by your teen’s treatment team. Levels of care may include outpatient treatment (OP), intensive outpatient treatment (IOP), partial hospitalization treatment (PHP), and residential treatment (RTC).
How to Find the Best Treatment Center
As the integrated treatment model becomes the standard of care for mental health, substance use, and behavioral disorders among teens, a rapidly expanding body of evidence shows that proactive lifestyle adjustments like a healthy diet, regular exercise, and a mindful awareness of personal triggers contribute to the successful management bipolar disorder, from the mildest cases to the most severe.
If you’re the parent of a teen with bipolar depression, you should understand that your teen’s treatment plan will be specific to their individual needs. The exact combination of therapy, medication, and complementary support will be determined through a collaborative effort including you, your teen, and the professional treatment team.
When you seek treatment for your teen, make sure any treatment center you consider for your teen is committed to including the following nine elements of highly regarded adolescent treatment centers:
The Nine Essential Components of Bipolar Disorder Treatment for Teens
- Full Evaluation and Custom Plans
- Complete, Integrated Treatment
- Family Participation
- Age-Specific Programming
- Involvement and Time-in-Treatment, i.e. clinicians and staff commit to building trust and cooperation with your teen, which increases the chance your teen will complete treatment
- Trained, Licensed, Professional Treatment Team
- Culture- and Gender-Informed
- Full Continuum of Care
- Evaluation of Treatment Outcomes, i.e. clinicians and staff commit to an ongoing evaluation of treatment outcomes
For a full explanation of these nine elements of highly regarded treatment programs for teens, please read our article How to Choose a Teen Rehab Center. These elements were originally specified for the treatment of teens with substance use disorder, but have been recognized by adolescent mental health experts as core elements of treatment for mental health and behavioral disorders as well.
Finally, what we want you to take away from this article is that it’s possible for your teen to live a full and fulfilling life – despite their diagnosis of bipolar disorder. The sooner you get them treatment, the better the outcome will be. And the more you learn to support them unconditionally as they navigate their recovery journey, the more likely their chances of sustained recovery and treatment success.