Parents of teens diagnosed with depression often wonder what steps clinicians in an adolescent treatment center will take, at the beginning of treatment, to balance the extreme moods and other up-and-down emotional symptoms their teen experiences.
For parents of teens diagnosed with bipolar disorder (BD), this is often their main concern. Since BD is characterized by cyclic movement between manic states and depressive states, finding a way to live in a manageable range in between the two states is a primary goal of treatment. For clarification, a manic state is best understood as a high-energy, happy, or active/energetic state. A depressive state, on the other hand, is best understood as a low-mood, unhappy, and often inactive/lethargic state.
That’s one reason diagnosing bipolar in teens can be challenging.
Alternating between giddy and cranky – to vastly oversimplify this for a moment – is typical teen behavior. Parents may arrange a psychological assessment during a depressive phase, because they’re familiar with the symptoms of depressive disorders, and think their teen might need help. Or they may arrange a psychological assessment during a manic phase, because mania often results in risky, impulsive, and irrational/dangerous behavior, which raises obvious concerns.
Sometimes clinicians misdiagnose teens because their assessment is incomplete and does not identify the phase that preceded the assessment. For instance, a teen in a depressive phase may receive a diagnosis for a depressive disorder. A teen in a manic phase may receive a diagnosis for a conduct disorder or other behavioral disorder such as attention-deficit/hyperactivity disorder (ADHD).
For teens with bipolar disorder, this can delay treatment progress. Treatment approaches that are appropriate for depression or ADHD may not be appropriate for bipolar disorder, and in some cases, may be counterproductive.
That’s why it’s important for parents to seek assessments from clinicians experienced in treating adolescents.
An Accurate Diagnosis is Critical
Clinicians who understand the adolescent population know how the features of BD in teens differ from similar features in adults. This knowledge allows them to help teens find balance more quickly and more efficiently than the way treatment for BD in teens often happened in the past, which was, unfortunately, a process of trial and error. Misdiagnosed teens had little real chance of finding the balance they needed.
By balance, in this context, what we mean is mood stabilization, i.e. the phrase in the title of this article.
Mood stabilization is the first step in treating bipolar disorder in adolescents. Mood stabilization, which we describe above as the process of finding a manageable range of mood between extremes, moves a teen out of either a manic or depressive phase and into a physical, psychological, and emotional state that enables them to fully participate in treatment and therapy, and begin the process of recovery.
To ensure an accurate diagnosis, clinicians refer to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which separates depressive disorders from bipolar disorders. It also identifies clear criteria that distinguish BD from psychotic disorders such as schizophrenia and behavioral disorders such as ADHD. To learn more about depressive disorders and treatment for depression in teens, please read our article here:
With regards to bipolar depression the DSM-5 identifies three distinct types:
- Bipolar I Disorder. This type of BD includes periods of mania, major depression, or mixed episodes that:
- Last for at least a week
- Affect sleep and/or typical daily function
- Occur immediately before or after a depressive episode of two weeks or longer
- Bipolar II Disorder. This type of BD includes periods of mania, hypomanic depression, or mixed episodes that are less severe than those common to bipolar 1. The episodes associated with bipolar II are called hypomanic or hypomania.
- Cyclothymic Disorder. This type of BD includes alternation periods of depressive symptoms and hypomanic symptoms. Teens diagnosed with cyclothymic disorder typically do not experience the full hypomanic or major depressive episodes seen in bipolar I or bipolar II.
Here’s what mania, hypomania/hypomanic, and depression mean in the context of a bipolar disorder diagnosis.
- Mania and Hypomania:
- Manic/hypomanic episodes or moods can cause elation, euphoria, or the opposite emotions, such as anger or extreme irritability. In teens, irritability is more common than elation. A common symptom of mania is a limited need for sleep, which may persist for days.
During a manic episode, adolescents are at increased risk of engaging in impulsive, risky behavior.
- Depression (in BD):
- Depressive episodes or moods may include irritability, persistent negativity, persistent pessimism, sadness, physical issues like headaches or stomachaches, low energy/fatigue, and/or withdrawal and/or disinterest in family and friends.
During a depressive episode, adolescents are at increased risk of suicidal ideation and suicide attempts.
The reason mood stabilization is a priority – and the reason it’s used more often as it relates to BD as opposed to depression – is because a teen at one of the two extremes is not capable of engaging in productive therapeutic work.
Which brings us to the question posed in the title of this article:
How do treatment centers accelerate mood stabilization?
We’ll address that question now.
Teenage Depression Treatment for Bipolar Disorder: Mood Stabilization
We keep using the phrase mood stabilization because that’s the goal for a person who displays mania: finding a middle path. Whereas a teen in a depressive state needs help surfacing from that state, and a teen in an anxious, keyed up state needs help coming down from that state, a teen with BD needs help staying in between those two states.
That takes specific treatment, and in some cases, specific medications. A medication that lifts a teen out of a depressive state and/or a medication that brings a teen down from a heightened state may not be effective in keeping a teen in the middle.
In fact, the medications that help depression and anxiety may exacerbate bipolar disorder.
That’s why we reiterate the need for an accurate diagnosis. Once a teen receives an accurate diagnosis, they can begin the process of mood stabilization, which is the first step in treating BD. The best approach to treating BD is the integrated treatment model, which includes a combination of psychotherapy, medication, and lifestyle supports and/or adjustments.
In most cases, the initial phases of treatment for teens who receive a referral for a teen depression treatment center, mood stabilization involves three primary components:
- Removing the teen from their current environment.
- This minimizes triggers, i.e. stimuli that elicit manic or depressive states
- Prescribing and beginning a course of a mood stabilizing medication.
- This balances any dysfunction in brain chemistry that may contribute to manic or depressive states.
- Initiating psychotherapy.
- This enables teens to identify emotions – in BD teens, both manic and depressive emotions – and begin to develop skills to process these emotions to mitigate the pain and disruption they cause.
The American Psychological Association (APA) describes the way talk therapy and medication work together:
“In most cases, medication helps stabilize [teens] so that they can participate effectively in psychotherapy, which then helps with longer-term symptom management and coping strategies. [Therapists] see the two as working in concert.”
Important but often overlooked components of mood stabilization during residential treatment for teens include the lifestyle supports/adjustments we mention above. Among these, three are proven effective:
- Sleep stabilization
- A healthy diet
- Regular physical activity (exercise or anything resembling exercise)
These lifestyle changes and complementary supports accelerate both the recovery and mood stabilization process. One way to think of these lifestyle supports/changes is that they create a healthy and resilient body, which facilitates recovery, and they lay the foundation for the healthy, resilient, and durable daily habits – i.e. coping mechanisms – that form the foundation of sustained recovery.
That’s the basic process of mood stabilization: environment, medication, therapy. We’ll talk about those in more detail now.
Mood Stabilization and the Treatment Process
The first element, the environment, is important, but will not take long to describe. Teens in treatment have a greater chance of success when they’re in a safe, comfortable environment designed to make them feel at home. Small groups of teens paired with high numbers of clinicians and staff, combined with three healthy meals a day and daily activity create an environment where a teen can establish the trust necessary for growth and recovery. Some traditional teenage depression treatment centers create this type of therapeutic environment, but a recent trend toward small treatment homes in residential areas offers teens a choice: rather than a place that feels like a hospital, they can receive treatment in a place that feels like a home.
Next – in most cases of bipolar disorder in teens – comes medication with the use of prescription mood stabilizers. In some cases, teens need antipsychotics or antidepressants: that’s a decision made in a collaboration between the teen, the family, and a psychiatrist and/or therapist/clinician. The following medications are proven effective in treating bipolar disorder in teens.
Treatment for Bipolar Disorder in Teens: Medication
- Mood stabilizers:
- Valporic acid
Once a teen is in a safe and stable physical and emotional space, they can begin the third step in mood stabilization, psychotherapy. The following therapeutic approaches are proven effective in treating teens with bipolar disorder.
Treatment for Bipolar Disorder in Teens: Psychotherapy
- Individual therapy:
- 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:
- CBT groups
- DBT groups
- Family therapy:
- Functional family therapy
- Multi-family groups
- Parenting groups
Research shows that the family component is essential. Teens have a greater chance of success – and families have a greater chance of restoring balance and harmony to their home – when parents, grandparents, siblings, and any other family members relevant to the recovery of the teen participate in the treatment process.
The fourth component, after environment, medication, and psychotherapy, is complementary/lifestyle supports and/or changes. The following complementary/lifestyle supports facilitate the recovery process in teens with bipolar disorder.
Treatment for Bipolar Disorder in Teens: Complementary Supports
- Mindfulness-based stress reduction:
- Mindful walking
- Experiential therapies:
- Equine therapy (horses)
- Expressive therapy:
There’s another element of treatment and recovery for bipolar disorder that we haven’t mentioned. It comes after a teen finishes treatment: community support. The National Alliance on Mental Illness offers information on community groups for families and teens with BD, and the Depression and Bipolar Support Alliance provides a support group finder that can help you or your teen find a support group in your area, after their treatment team discharges from treatment and they return home.
How Teenage Depression Treatment Centers Help
Teens with bipolar disorder and families of teens with bipolar disorder often find themselves caught in the contrasting cycles of the disorder. That’s hard for everyone involved. Teenage depression treatment centers that have specialized programs for adolescents with BD can help break those cycles and help rebuild the family unit and the home environment.
Treatment empowers teens to take control of their lives. The skills they learn help them manage their symptoms, independently, in the moment, so they’re not as disruptive and painful – and so they don’t dominate their lives.
A teen can learn to live with bipolar disorder – and other disorders like depression or anxiety – and turn the tables so that they determine how they spend their days, rather than spending their days in reaction to their emotions and their symptoms.
With appropriate treatment from a teenage depression treatment center, a teen with bipolar disorder can lead a productive, fulfilling life.
We know because we see it happen every day.
Finding Help: Resources
If you’re seeking treatment for your teen, please navigate to our page How to Find the Best Treatment Programs for Teens and download our helpful handbook, A Parent’s Guide to Mental Health Treatment for Teens.
In addition, the American Academy of Child and Adolescent Psychiatry (AACAP) is an excellent resource for locating licensed and qualified psychiatrists, therapists, and counselors in your area. Both the National Institute of Mental Health (NIMH) and the National Alliance on Mental Illness also provide and high-quality online resources, ready and waiting for you right now.