Teens and Bipolar Disorder

Reviewed by Roy Benaroch, MD 

If you met Jordan (not his real name), you might be surprised to learn that the teen has bipolar disorder. President of his senior class and lead actor in the school play, Jordan is outgoing, popular, and a high achiever. But that wasn't always the case.

When Jordan turned 16, his mood suddenly changed. He felt irritable, angry, and extremely fatigued. When he wasn't at school, he locked himself in his bedroom, sleeping all afternoon or playing "dark" video games. His parents noticed the dramatic change and realized that it was more than an adolescent mood swing. Jordan needed medical intervention.

He and his parents talked to a psychiatrist, a doctor who specializes in treating bipolar and other mood disorders. They discussed Jordan's recent mood swings, along with his increased need for sleep, his temper fits, and his desire to be alone all the time. Jordan talked openly about his feelings of hopelessness, sadness, and worthlessness. His mother also mentioned a time a few months before, when Jordan was unusually energetic, talkative, and excitable -- the opposite of the sadness he now felt.

The psychiatrist diagnosed Jordan with bipolar disorder and prescribed a medication to regulate the extreme highs and lows of the illness. She also started Jordan in regular cognitive psychotherapy sessions to help educate him and his parents about the mood disorder and its treatment.

What Is Bipolar Disorder?

Bipolar disorder is characterized by dramatic or unusual mood swings betweenmajor depression and extreme elation, or mania. The mood swings can be mild or extreme. They can come on slowly or quickly, within hours to days. Bipolar disorder usually starts between 15 and 30 years of age. It's more prevalent in those teens who have a family history of the mood disorder.

There are two subtypes of bipolar disorder: bipolar I and bipolar II.

• With bipolar I, the teenager alternates between extreme states of depression and intense mania. With the mania, the teen might be abnormally happy, energetic, and very talkative, with no need for sleep for days. He or she might also have hallucinations, psychosis, grandiose delusions, and/or paranoid rage, all of which might require hospitalization and medications. Once bipolar I begins, it typically persists throughout the person's life.
• With bipolar II, the teen has depression but a lesser form of elation called "hypomania." While someone with either mania or hypomania may have grandiose mood and reduced need for sleep, hypomania is a period of incredible energy, charm, and productivity. It's often associated with high achievers.

While many teens can be irritable with or without bipolar disorder, the irritability that comes with mania or hypomania may be more hostile. Some believe there is a link between ADHD and bipolar disorder. Some 57% of teens who have adolescent-onset bipolar disorder also have ADHD.

What Causes Bipolar Disorder?

Scientists don't know the exact cause of bipolar disorder. Still, many experts believe that of all psychiatric disorders, bipolar is the most closely linked to genetics. For example, if your parent has bipolar disorder, you are about nine times more likely to get the condition than other teens.

Biochemical and environmental factors play a role in bipolar disorder, too. In fact, researchers think that imbalances in neurotransmitters (brain chemicals that regulate moods) increase the chance of bipolar disorder.

What Are the Symptoms of Bipolar Disorder?

Symptoms of bipolar disorder include mania (highs), hypomania (mild highs), and depression (lows). Feeling manic or hypomanic is not the same as having super-energy and being very outgoing or highly productive one weekend. Likewise, depression is not a temporary bad mood that happens when you don't have a date for the school dance.

The mood episodes with bipolar disorder are intense, and noticeable by friends and family. A teen with mania might be hyper-excited, silly, and have laughing fits in class that are inappropriate. In some teens, mania's grandiosity may cause problems with defiance, as the teen refuses to comply with any authority at home or at school.

Symptoms of mania include:

• Racing speech and thoughts.
• Increased energy.
• Decreased need for sleep.
• Elevated mood and exaggerated optimism.
• Increased physical and mental activity.
• Excessive irritability, aggressive behavior, and impatience.
• Hypersexuality, increased sexual thoughts, feeling or behaviors; use of sexual language.
• Reckless behavior, like excessive spending, making rash decisions, and erratic driving.
• Difficulty concentrating.
• Inflated sense of self-importance.

Symptoms of hypomania include:

• Exuberant and elated mood.
• Increased confidence.
• Extremely focused on projects at work or at home.
• Increased creativity and productivity.
• Decreased need for sleep.
• Increased energy and libido.
• Risk-taking behaviors.
• Reckless behaviors.

Symptoms of depression include:

• Loss of interest in usual activities.
• Prolonged sad or irritable mood.
• Loss of energy or fatigue.
• Feelings of guilt or worthlessness.
• Sleeping too much, inability to sleep, or difficulty falling asleep.
• Drop in grades and inability to concentrate.
• Inability to experience pleasure.
• Loss of appetite or overeating.
• Anger, worry, and anxiety.
• Thoughts of death or suicide.

In adults, bipolar mood swings can last for weeks to months. Teens may experience much shorter mood swings, going from mania or hypomania to depression in a few short hours or days.

Between episodes, a person with bipolar disorder usually returns to normal (or near-normal) functioning. For some people, though, there is little or no "break period" between their cycles.

Some people with bipolar disorder turn to alcohol and drugs because they feel temporarily better when they're high. But substance abuse can make the symptoms of bipolar disorder worse. It also makes the condition harder for doctors to diagnose and treat.

How Is Bipolar Disorder Treated?

If your doctor determines you have bipolar disorder, he or she may prescribe one or more medications, depending on the type and severity of the symptoms.

Some drugs often used to stabilize mania or hypomania include lithium carbonate, anticonvulsants, antipsychotics, and benzodiazepines. Lithium and lamotrigine (Lamictal) are standard treatments for the depressed phase of bipolar disorder. Doctors are cautious in using antidepressants alone, as they might trigger a manic mood swing.

Psychotherapy can help the patient and family learn more about the illness and how to cope with the mood changes. Because of the relapses and remissions of bipolar disorder, the illness has a high rate of recurrence if untreated.

When Should I Call the Doctor About Bipolar Disorder?

If you have symptoms of bipolar disorder, talk to your doctor. It may be nothing at all. Or, your doctor might refer you to a bipolar specialist, a psychiatrist, or psychopharmacologist, for a second opinion and accurate diagnosis. (A psychopharmacologist is a psychiatrist who is an expert in using medications to treat psychiatric chemical imbalances.)

The specialist will talk to you about your symptoms. After a physical exam and patient history, the specialist will rule out other possible causes of depression and mania, such as medications, alcohol, illicit drug use, illnesses such as hypothyroidism and hyperthyroidism, or injuries to the central nervous system.

Paradigm Malibu is devoted to the provision of state of the art Teen Drug Treatment, Adolescent Behavioral Health, Mental Health and Emotional Health Treatment. To learn more about our services, please visit our web site at: www.paradigmmalibu.com