Mood swings are often considered a normal part of adolescence – just ask any parent with one or more teenagers at home. However, the so-called “normal” teenage mood swings are actually quite different from the intense mood swings of bipolar disorder. Formerly referred to as “manic-depressive disorder”, bipolar disorder is a serious, lifelong psychiatric illness. Although onset frequently occurs in early adulthood, it can also develop in childhood or adolescence.
As a parent, it can be challenging to determine what’s normal and what’s not when it comes to your teen’s emotional health. This brief guide is designed to help you know the signs to watch for and the steps to take if you believe your teen may have bipolar disorder.
Adolescent Bipolar Disorder Statistics
Some people have the misperception that bipolar disorder only affects adults, not an illness that can develop in childhood or adolescence. However, symptoms can and often do first appear during the teen years. Following are a few statistics and survey results regarding adolescent bipolar disorder:
- Approximately 1 in 5 teens who have major depression will develop bipolar disorder within 5 years (of the onset of their depressive episode)
- A 2012 NIMH-funded survey of over 10,000 teens between the ages of 13 and 18 found that 2.2% met the criteria for bipolar disorder within a given year
- The rate of bipolar symptoms increase with age, with symptoms reported by approximately 2% of early adolescents and 3.1% of older adolescents
- Nearly 6 out of 10 teens who developed bipolar disorder during adolescence are also diagnosed with ADHD
- In the U.S., as many as 33% of children and teens with depression may actually have early onset bipolar disorder
Types of Bipolar Disorder
Although “bipolar disorder” is often used as a catch-all phrase, it actually includes four distinct disorders. Each one involves some degree or combination of manic, hypomanic (similar to but less intense than mania), and depressive episodes. The different types of bipolar disorder are:
- Bipolar I Disorder – periods of mania and major depression (mania alone is sufficient for a bipolar I diagnosis)
- Bipolar II Disorder – periods of hypomania and major depression
- Cyclothymic Disorder – numerous periods of depressive symptoms and hypomanic symptoms, but no full hypomanic or major depressive episodes
- Bipolar Disorder NOS (not otherwise specified) – this diagnosis occurs when the mood symptoms don’t clearly fit any of the above
Looking for and Recognizing the Signs of Bipolar Disorder
Knowing what to look for and how to recognize symptoms of bipolar disorder in your teen will enable you to intervene sooner than later. There are two main things to remember:
- Watch for and pay close attention to any changes from your teen’s normal mood, personality, and behavior.
- Symptoms of mania and depression don’t always look the same in teens as they do in adults.
Signs to watch for may include:
Mania (and hypomania) – Manic episodes or moods can cause elation, euphoria, or extreme irritability. In children and teens, irritability is more common than elation. Another hallmark symptom of mania is a limited need for sleep, often for days on end.
During a manic episode, adolescents have a high risk for becoming destructive and engaging in very risky behavior.
Other signs of mania may include:
- Short fuse / anger outbursts
- Pressured or rapid speech
- Racing thoughts
- Very high energy levels
- Difficulties sleeping
- Difficulties with concentration
- Unusually high level of optimism
- Taking on multiple projects at once
- Grandiosity – an exaggerated sense of self-importance
- Reckless behavior
- Hypersexuality / risky sexual behavior
- Recklessness, such as driving erratically or going on spending sprees
- Having lots of exciting, new ideas
- Hallucinations, such as hearing voices
- Delusions (fixed beliefs that are irrational, false, or illogical)
It’s not uncommon for individuals experiencing their first manic or hypomanic episode to think everything is fine, even though others do notice. Don’t be surprised if your teen gets very annoyed with you if you or another family member mentions your concerns that something seems “off”.
Depression – Depressive episodes or moods are often marked by irritability, negativity or pessimism, persistent sadness or feeling “down”, somatic complaints (e.g. headaches or stomachaches), low energy or fatigue, and increased withdrawal from family and friends. Other symptoms may include:
- Feelings of worthlessness
- Heightened sensitivity to rejection
- Feelings of hopelessness
- Frequent tearfulness
- Feeling empty
- Drop in self-confidence or self-esteem
- Sleeping excessively or difficulties falling or staying asleep
- Changes in appetite
- Anger outbursts
- Apathy / an “I don’t care” attitude
- Agitation or restlessness
- Difficulty getting started or completing tasks
- Lack of motivation (which may look like laziness)
- Loss of interest in activities they once enjoyed
- Trouble concentrating or making decisions
- Low frustration tolerance / easily annoyed
- Struggles with excessive guilt or self-blame
- Decline in academic performance
- Neglecting personal hygiene
- Talking and / or writing about death or suicide*
- Giving away prized possessions*
- Suicide attempts*
*Even if there are no other signs of depression (although there almost always are), suicidal thoughts or behaviors should never be ignored. Don’t assume this is just your teen being “dramatic” or manipulative.
It’s not uncommon to observe many, if not most, of the above symptoms in teens at one time or another. The intense mood swings of bipolar disorder, however, persist for several days or even weeks at a time and will include many symptoms at once, not just one or two. For a teen predisposed to bipolar disorder, stress or over-stimulation can trigger a manic episode, while a significant loss or disappointment in your child’s life may trigger a major depressive episode.
Knowing the First Steps to Take
If you think your teen is starting to exhibit signs of bipolar disorder (or any mood disorder), there are three crucial initial steps you must take to help him or her*:
1 – Talk to your teen. Sit down and have a candid, compassionate talk with your teen. Express your concerns about the various symptoms you’ve been noticing.
Ask your teen if there’s anything going on that’s bothering him or her. Teens aren’t always very forthcoming with parents, especially if they’re experiencing something confusing, uncomfortable, or embarrassing for them. Don’t pressure, and don’t over-react. Let your teen know that you want to help in any way you can, and that you are willing and available to listen.
2 – Set up an appointment for an evaluation. Your child’s pediatrician or your family doctor is one option for an initial evaluation, but he or she isn’t a mental health professional. Your doctor can do a physical examination to rule out any medical issues that may be causing your teen’s mood symptoms, and make an initial diagnosis.
It’s preferable to have your teen initially evaluated by a child and adolescent psychologist or psychiatrist. These professionals have the specialized training and experience to identify and understand the more challenging and often subtle nuances of bipolar disorder in this age group.
Since both talk therapy and medication are usually recommended for managing bipolar disorder, a psychiatrist may choose to manage only the medication aspect of treatment, while a psychologist (or other experienced licensed therapist) provides therapy.
3 – Get your teen into treatment. Once your child has been evaluated, treatment recommendations will be discussed with you. As mentioned above, treatment for bipolar disorder in teens typically involves a combination of medication and psychotherapy (talk therapy).
- Medication – Medication is usually necessary to manage the various types of bipolar disorder, particularly in the case of bipolar I disorder in which the mood episodes are the most extreme. Medication for bipolar disorder in teens usually include mood stabilizers (e.g. lithium or Depakote) and / or atypical antipsychotics (e.g. Risperdal). Medication can help prevent depressive episodes and decrease the frequency and severity of manic episodes.
- Psychotherapy or “talk therapy” – Psychotherapy can help your teen understand bipolar disorder, including the challenges it creates and how to manage it more effectively. It can also help him or her with the difficult relationship and self-esteem issues that often accompany it.
*If your teen is already experiencing a full-blown manic episode, the very first step you’ll need to take is to get him or her to the nearest hospital ER for an evaluation and likely admission to a psychiatric inpatient unit. Attempting to have a conversation while he or she is manic usually won’t be productive and may cause your teen to become increasingly agitated.
Supporting and Encouraging Your Child
Bipolar disorder can be very challenging for both you and your child. You can encourage and support him or her in the following ways:
- Educate yourself about bipolar disorder so you can have greater empathy for and understanding about what your teen is going through
- Be patient and understanding
- Pay attention to mood patterns over time so you can recognize the warning signs and help your teen more effectively manage his or her bipolar disorder (a chart or calendar can be helpful to track sleep, behavior, and other patterns)
- Minimize stress and over-stimulation in the home environment as much as possible, and help your teen find ways to effectively manage his or her stress
- Be available and willing to listen to your teen
- Actively participate in your child’s treatment, including family therapy if possible
- Spend quality 1:1 time with your teen
- Don’t ridicule, shame, or minimize what your child is experiencing
- Keep weapons, alcohol, and medications locked in a safe place
- Respect your teen’s privacy and dignity; the whole world doesn’t need to know about his or her mental health issues
- Avoid nagging or lecturing your child; if you have concerns, talk to your teen in an open, honest, and respectful manner
- Respect what your teen is experiencing, even though you may not understand it
- Strive to stay calm even if you’re feeling frustrated or scared
- Frequently check-in with your teen to see how things are going, if treatment is helping, and to find out if there’s anything you can do that may be helpful.
- Ask your teen about any medication side effects and make sure these are conveyed to his or her psychiatrist or other treatment provider.
What to Do When Things Escalate
The extreme moods of bipolar disorder can be very unpredictable. During a severe mood episode, your teen’s judgment will be seriously impaired. With a manic episode, he or she may go on a sexual or spending spree that can have serious consequences, go several days with little to no sleep, or become very hostile and possibly even violent, increasingly disorganized, or psychotic. These erratic behaviors can put your teen, your family, and others at risk. During a severe bout of depression your teen may become actively suicidal. There’s also a greater risk of drug or alcohol abuse during these episodes.
When things start spiraling out of control you’ll need to take steps to ensure everyone’s safety. A brief hospital stay may be necessary to keep your teen safe and get manic or depressive symptoms under control. Don’t hesitate to reach out for help. You can:
- Contact your child’s treatment provider asap
- Enlist the help of a close family member or friend
- Call an emergency hotline (some mental health agencies have a mobile unit that can assist you)
- Take your child to the nearest hospital emergency room (if you can do so safely)
- Call 911
When Individual Therapy isn’t Enough
Sometimes treatment with medication and / or individual therapy simply aren’t enough to adequately treat your child’s bipolar disorder. If your child is:
- Experiencing mania and / or depression even with medication
- Becoming increasingly sleep deprived
- Threatening or actively planning suicide, or making suicide gestures or attempts
- Unable to function at all or without frequent assistance
then it’s time to consider a more intensive level of treatment. This may involve:
- Intensive outpatient treatment (IOP) / Psychiatric day treatment
- Residential treatment
- Inpatient psychiatric treatment
Intensive outpatient treatment or psychiatric day treatment can vary in terms of the amount of time spent in treatment and how often (e.g. twice a week, 5 days a week) your child is required to go. These programs are the next step up from regular outpatient treatment (i.e. an hour of therapy once or twice a week).
Residential treatment involves having your child stay at a non-hospital treatment facility that specializes in treating adolescents with mental health disorders. Residential treatment typically lasts between 30 to 180 days, depending on the severity of symptoms and rate of progress.
Inpatient psychiatric treatment is the highest and most intensive level of treatment for adolescents with bipolar disorder. It involves admitting your child to an adolescent psychiatric hospital unit where medical staff is on hand to monitor patients 24/7. This level of treatment may last for a few days to a few weeks, and is particularly beneficial for teens who are a danger to themselves or others due to mania, suicidal behavior, or severe depression.
Each of these intensive levels of treatment typically provides daily or bi-weekly visits with a psychiatrist and daily therapy (often both group and individual, and a combination of different types, such as psychotherapy, art therapy, music therapy, etc.).
Taking Care of Yourself
Helping a loved one with bipolar disorder is hard. The extreme mood swings can take quite a toll over time. Also, your teen will be looking to you for guidance, emotional support, and reassurance so it’s important that you take care of yourself in order to be there for him or her. Several things you can do include:
- Get support for yourself – an online or local support group (e.g. through your local NAMI – National Alliance on Mental Illness – chapter), a therapist, your church, and family and friends
- Get sufficient rest
- Make time for yourself
- Find effective ways to manage your stress (e.g. yoga, meditation, or regular exercise)
Most of all, don’t lose hope. Bipolar disorder is a serious illness, but it’s not a death sentence. With proper treatment and support your teen can have a bright, fulfilling future.