Bipolar disorder (formerly known as manic-depressive illness or manic depression) is a lifelong mood disorder and mental health condition that causes intense shifts in mood, energy levels, thinking patterns and behavior. These shifts can last for hours, days, weeks or months and interrupt your ability to carry out day-to-day tasks.
Most people are diagnosed with bipolar disorder in adolescence or adulthood, but the symptoms can appear earlier in childhood.
There are a few types of bipolar disorder, most of which involve experiencing manic and depressive episodes. However, people with bipolar disorder don’t always experience either manic episodes or depressive episodes. They also experience euthymia, which is a relatively stable mood state in which they are their usual self.
Mania is a condition in which you have a period of abnormally elevated, extreme changes in your mood, emotions, energy level and activity level. People with certain types of bipolar disorder can experience hypomania, which is a less severe form of mania.
During a depressive episode, you experience a low or depressed mood and/or loss of interest in most activities, as well as many other symptoms of depression.
How does bipolar disorder affect children?
Bipolar disorder is different in children and teenagers than in adults. Adults with bipolar disorder often have clear episodes of mania or depression that last a week or longer. In children and teens, the phases may be less clear, and changes from one episode to the other may happen faster. For example, a child may exhibit periods of giddiness and silliness, anger outbursts, and unprovoked crying all in one day.
Bipolar disorder is different from the typical mood swings and ups and downs every child and teenager goes through. The mood changes in bipolar disorder are more extreme, often unprovoked, and also involve:
Changes in sleep patterns.
Changes in energy level.
Issues with focus and the ability to think clearly.
Bipolar disorder symptoms can make it hard for your child to perform well in school or to get along with friends and family members. Some children and teens with bipolar disorder may try to hurt themselves or attempt suicide.
How common is bipolar disorder in children?
Studies show that about 4% of people under the age of 18, including children as young as 5, have bipolar disorder.
To put this in perspective, here are the rates of the most common mental health conditions that affect children:
9.8% of children have attention-deficit/hyperactivity disorder (ADHD).
9.4% of children have an anxiety disorder.
4.4% of children have depression.
What are the symptoms of bipolar disorder in children?
To understand bipolar disorder, it's helpful to know how mental health providers talk about severe mood swings. Mood swings are often termed "mood episodes." Manic episodes describe periods when a child feels overly excited and confident, and they have a lot of energy. These feelings can quickly give way to confusion, irritability and possibly rage.
Depressive episodes describe periods when a child feels very sad (depressed) and has low energy.
Children may not have clear-cut episodes. Instead, they may have "mixed" episodes and exhibit both manic and depressive symptoms. Some children may show "rapid cycling" where they shift quickly between mania or hypomania and depression — sometimes even within the same day.
Depressive, manic or mixed episodes, by definition, are a change in behavior that differs from your child’s baseline state (euthymia).
Signs and symptoms of manic episodes in children
Children with bipolar disorder are more likely to be irritable and prone to destructive outbursts during manic episodes than to be happy or euphoric like adults with bipolar disorder typically are.
During a manic episode, your child may:
Be overly happy, hopeful and excited, which is often inconsistent with external events.
Have bursts of energy and be very active.
Have frequent tantrums or seem more irritable than usual.
Be unusually silly compared to others their age.
Be defiant and destructive and not follow rules as they usually do.
Go for days with little or no sleep without feeling or acting tired.
Be more impatient and restless than usual.
Talk very fast, not allowing others to talk.
Be distracted, have trouble concentrating and jump between different ideas.
Believe they have many unrealistic or grandiose skills and powers and can do things other people can't do (such as believe that they’re in charge instead of adults).
Seem overly interested or involved in pleasurable but risky activities, such as unprotected sex and drinking alcohol.
Do risky or reckless things that show poor judgment.
Signs and symptoms of depressive episodes in children
During a depressive episode, your child may:
Feel frequent and unprovoked sadness.
Be uninterested in things they used to enjoy.
Cry often.
Be irritable.
Have trouble falling asleep, wake up very early or sleep too much.
Have low energy.
Lose interest in friends or classmates and isolate themselves from social interaction.
Be extremely sensitive to rejection or failure.
Have trouble concentrating or remembering things.
Have poor performance in school.
Eat too little or too much.
Say negative things about themselves.
Talk or think about death and suicide.
They may also mention or complain of physical symptoms, including:
Teens may be less likely than adults to admit that they’re sad and depressed. If your child shows signs of suicidal thinking, call your child’s healthcare provider.
If you think your child is in crisis and needs immediate help, call 911 or the Suicide and Crisis Lifeline at 988. It’s confidential, free and available 24/7.
How is bipolar disorder treated in children?
Over the past decade, mental health experts across psychology and psychiatry have helped refine the assessment and treatment of bipolar disorder among children and teens.
An effective treatment plan usually includes a combination of the following therapies:
Psychotherapy (talk therapy).
Medications.
Helpful lifestyle habits, such as exercise, meditation and consistent routines.
Other therapies.
Bipolar disorder is a lifelong condition, so treatment is a lifelong commitment. It can sometimes take several months to years before you, your child and their provider find a comprehensive treatment plan that works best for your child. Although this can be discouraging, it’s important for your child to continue treatment.
Psychotherapy for children with bipolar disorder
Psychotherapy, also called “talk therapy,” can be an effective part of the treatment plan for children with bipolar disorder.
Psychotherapy is a term for a variety of treatment techniques that aim to help your child identify and change troubling emotions, thoughts and behaviors. Working with a mental health professional, such as a psychologist or psychiatrist, can provide support, education and guidance to your child and your family.
Some types of therapy for bipolar disorder include:
Psychoeducation: Psychoeducation is the way that mental health professionals teach people and their families about their mental health conditions.
Family-focused therapy (FFT): This therapy is for people with bipolar disorder and their caregivers and family. During this treatment, together, your child and your family learn about bipolar disorder, communication improvement training and problem-solving skills training. It greatly helps family members to recognize symptoms of the condition and develop a plan for managing manic and depressive episodes.
Chronotherapy: This therapy helps your child establish a steady and predictable sleep routine. Your child learns to go to bed at the same time and wake up at the same time every day.
Interpersonal and social rhythm therapy (IPSRT): This therapy is designed to help your child improve their moods by understanding and working with their biological and social rhythms. IPSRT emphasizes techniques to improve medication adherence, manage stressful life events and reduce disruptions in social rhythms (day-to-day variability of habitual behaviors).
Medications for children with bipolar disorder
Mood stabilizers and antipsychotic (neuroleptic) drugs, which healthcare providers have used for decades to treat bipolar disorder in adults, are also effective in children with bipolar disorder.
Your child’s provider will work with you and them to select the best medicine. If your child also has attention-deficit/hyperactivity disorder (ADHD), their provider may prescribe medicines for it. But, in some cases, the medicines for ADHD can trigger manic symptoms or mood swings in children with bipolar disorder. Depression medications can also bring on bipolar symptoms in children.
Mood-stabilizing medications can help manage manic or hypomanic episodes. Types of mood stabilizers and their brand names include:
Providers often prescribe second-generation or “atypical” antipsychotics (neuroleptics) in combination with a mood stabilizer for people with bipolar disorder. These medications help with both manic and depressive episodes.
Only four of these drugs are FDA-approved to help treat bipolar depression, including:
What are the possible side effects of medications used to treat bipolar disorder in children?
Side effects of bipolar disorder medications are common and vary by medication.
It’s important to talk with your child’s healthcare provider about what you and your child can expect when taking certain medications. It’s also important to carefully assess your child for side effects and encourage them to tell you if they’re experiencing any. Report any negative side effects to their provider as soon as possible.
Your child should never stop taking their medication unless their provider tells them to do so. Abruptly stopping medication can cause severe side effects and trigger severe episodes.
The most common side effects of bipolar disorder medications include:
Akathisia — feelings of restlessness and agitation with a compelling need to move, rock or pace.
Lithium is one of the most common drugs used to treat bipolar disorder. Anything that lowers the level of sodium (salt) in your child’s body, such as switching to a low-sodium diet, heavy sweating, fever, vomiting or diarrhea may cause a toxic buildup of lithium in their body.
The following are signs of lithium toxicity (lithium overdose). Call your child’s provider immediately or go to the nearest emergency room if your child experiences:
To be diagnosed with bipolar disorder, your child must have experienced at least one episode of mania or hypomania (with or without a depressive episode).
To diagnose bipolar disorder, your child’s healthcare provider may use many tools, including:
A thorough medical history, which will include asking about your child’s symptoms, lifetime history, experiences and family history.
Medical tests, such as blood tests, to rule out other conditions that could be causing your child’s symptoms.
A mental health evaluation. Your child’s provider may perform the evaluation, or they may refer your child to a mental health specialist, such as a psychologist or psychiatrist, to get one.
Providers can often diagnose bipolar disorder in children more accurately when they ask the children, their teachers and their caregivers to fill out questionnaires that ask about mood, energy levels and other factors.
Signs and symptoms of bipolar disorder may overlap with symptoms of other disorders that are common in children and teens, including:
Because of this, diagnosing bipolar disorder in children can be complicated and requires a careful and thorough evaluation by a trained, experienced mental health professional.
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