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Bipolar disorder can appear at any age, but it is very rare in children and teens. Bipolar disorder can cause mood swings with extreme ups (mania) and downs (depression). When people with this problem are up, they have brief, intense outbursts or feel irritable or extremely happy several times almost every day. They have a lot of energy and a high activity level, and often make impulsive decisions without thinking of the consequences (mania). When they are down, they feel unhappy, unmotivated, depressed and sad.
Experts don't fully understand what causes bipolar disorder. But they believe many factors may be involved.
It seems to run in families. Your child has a greater risk of having it if a close family member such as a parent, grandparent, brother, or sister has it.
Bipolar disorder can be related to genetics or an imbalance in your child’s hormones. Negative experiences, unsafe or unstable environments, and stressful life events (trauma) can also increase the chances of developing bipolar disorder.
In children and teens, moods quickly change from one extreme to another without a clear reason. It's typical for children and teens to feel down, irritable, angry, or hyperactive at times. But for a child to have bipolar disorder, these mood changes must be noticeably different from the child's usual moods and must happen with other symptoms or noticeable changes in behaviour. These symptoms must also be present most of the day, nearly every day, for at least one week. These distinct periods of time with changes in mood and behaviour are called mood episodes. People with bipolar disorder have manic and depressive mood episodes.
Times of mania (ups) or depression (downs) may be less obvious in children and teens than in adults.
This disorder can be hard to diagnose in children and teens. Diagnosing bipolar disorder can be a long process that involves careful monitoring and ruling out other explanations. But it’s important to identify the right diagnosis as this helps your child or teen’s healthcare team communicate and plan the right treatment together. The symptoms can look a lot like the symptoms of other problems, such as:
Bipolar disorder can often occur along with these problems.
If your doctor thinks your child or teen may have bipolar disorder, they may ask questions about your child's feelings and behaviour. Your doctor may also give you and your child written tests to find out how severe the mania or depression is.
Healthcare providers may do other tests (such as a blood test) to rule out other health problems. They can do psychological or physical tests, and may ask if your family has any history of mental illness or problems with substance use or misuse. Any of these concerns can be linked to bipolar disorder.
Children with this disorder are more likely to have other concerns. These include substance use and misuse, trouble in school, running away from home, fighting, and even suicide. Treating the disorder as early as possible may keep your child from having these concerns.
Watch for the warning signs of suicide, which change with age. Warning signs of suicide in children and teens may include thinking about self-harm, death, or suicide. Watch also for things that can trigger a suicide attempt such as a recent breakup of a relationship or the loss of a parent or close family member through death or divorce.
If you are worried that your child might hurt themself, take steps to make sure they are safe, like asking for help or calling a suicide crisis centre. Keep the number for a suicide crisis centre on or near your phone. Visit Canadian Association for Suicide Prevention to find support in your area. In Alberta, support is available by phone:
The mood changes that come with bipolar disorder can be a challenge. But with the right treatment, they can be managed well. Treatment may vary depending on how bad the condition is and your child’s age, medical history, and tolerance to medicine. It usually includes both medicine (such as mood stabilizers) and counselling.
An important part of treatment is making sure your child takes their medicine. Children and teens with this disorder sometimes stop taking their medicines when they feel better. But without medicine, their symptoms usually come back.
Medicines for bipolar disorder in adults have been well studied. But more research is being done on how the medicines work and if they are safe for children and teens. If your child or teen’s treatment includes prescribed medicines, it is important that they are watched closely by a healthcare provider.
Keeping a consistent sleep-wake schedule is an important first step in managing bipolar disorder. Set a regular sleep-wake schedule for your child, to make sure they go to bed and wake up the same time every day, even on weekends.
Maintaining a healthy lifestyle is also important. Eat healthy foods, have regular routines, and set good habits like regular exercise and managing stress. Join a support group to meet other people who may being experiencing similar concerns. These activities can keep your child motivated, and can help to manage their condition better.
Accepting that your child has bipolar disorder can be hard. The disorder can be serious. It's a lifelong illness that needs to be managed throughout your child's life. Your child will need long-term treatment and will need to be watched carefully. By working with your child's service providers and mental health specialists (like teachers, counsellors, or occupational therapists), you can find a treatment and resources that will help your child.
Caregivers also experience a lot of stress and emotional challenges. Concerns about their loved one's health can make caregivers forget to take care of themselves. As a caregiver, be mindful of your needs and seek help as needed.
The cause of bipolar disorder is not well understood.
It seems to run in families. Your child is at greater risk of having bipolar disorder if a close family member such as a parent, grandparent, brother, or sister has it.
Stressful or traumatic events may trigger episodes of mania or depression in a child who has bipolar disorder. While it is normal for such events to cause mood changes, these reactions are much more extreme for children with bipolar disorder.
Sometimes symptoms of mania occur as a result of another medical condition, such as an overactive thyroid gland (hyperthyroidism) or multiple sclerosis. Talk to your doctor to rule out other medical conditions. Although rare, symptoms can also develop as a side effect of some medicines, such as corticosteroids or antidepressants. Talk to your doctor or pharmacist right away if you notice major mood changes after starting a medicine. Using drugs or alcohol, or not getting enough sleep can also trigger a manic episode.
Bipolar disorder causes cycles of mania (or hypomania, a less severe form of mania) and depression. The different types of bipolar disorder are based on whether a person has more severe symptoms of mania or depression.
In children and younger teens, bipolar disorder tends to be rapid-cycling or mixed cycling:
Following are some common symptoms of bipolar disorder in children and teens.footnote 1
During severe episodes of mania, your child may suffer from symptoms of psychosis, such as having hallucinations or delusions of grandeur (for example, telling people that a rock band is coming to their birthday party).
Bipolar disorder frequently occurs along with other conditions, such as conduct disorder. And each condition needs treatment.
Untreated bipolar disorder can lead to suicide. Warning signs of suicide in children and teens may include preoccupation with death or suicide or a recent breakup of a relationship.
People sometimes confuse bipolar disorder in children with other conditions with similar symptoms, such as attention deficit hyperactivity disorder (ADHD). Although there is some evidence of a link between ADHD and bipolar disorder, the conditions have distinct features that you can usually identify.
In young children, the symptoms of mania are more than just being a bother to adults and other children now and then. For example, many children can be silly and giggly to a point that it bothers their parents sometimes. This is not considered to be a sign of mania. But if a child is silly and giggly for several hours, several times almost every day, and this is interrupting the family's usual routine, then it may be a symptom of mania.
Often the first signs of bipolar disorder are severe moodiness, unhappiness, or other symptoms of depression. It is common for children with bipolar disorder to be diagnosed first with only depression and then later to be diagnosed with bipolar disorder.
A first manic or hypomanic episode can be triggered by a stressful situation or by certain medicines. Or it may occur without an obvious cause.
Children with bipolar disorder may:
In addition to having manic symptoms, children may have severe, seizure-like temper tantrums when they are told "no." A child with bipolar disorder may kick, bite, hit, and make hateful comments, including threats and curses. During tantrums, which may last for hours, a child may destroy property or become increasingly violent.
Young children with bipolar disorder may have more extreme happy or silly moods than most children have.
Manic behaviour by a teen with bipolar disorder may result in such problems as:
During depressive episodes, a teen may do poorly in school and may stop taking part in activities they enjoyed in the past, such as a sports team.
Watch for warning signs of suicide, which can include preoccupation with death or suicide or a recent breakup of a relationship.
Substance use disorder is common. Your teen's doctor may recommend an evaluation for both substance use disorder and bipolar disorder if your teen appears to suffer from either condition.
Sometimes treatment for other conditions can make your child's bipolar disorder worse. For example:
Medicines that intensify bipolar symptoms may need to be stopped or changed to a different dose or medicine. Sometimes an additional medicine (such as a mood stabilizer) can solve the problem. But each individual responds to medicines differently. And it may take several tries before your doctor can identify an effective medicine, dose, or combination of medicines for your child's conditions.
Your child's risk for bipolar disorder or other mood disorders is higher if the child:
Call 911 or other emergency services immediately if:
If your child talks about suicide, self-harm, or feeling hopeless, get help right away. Call your provincial suicide hotline or Crisis Services Canada: 1-833-456-4566, or go to www.crisisservicescanada.ca for more information.
Call a doctor now if:
Seek care soon if:
It's best to build a long-term relationship with your child's care providers. Then when a depressive or manic episode occurs, the care providers can recognize the changes in the child's behaviour and provide quick treatment advice.
If you are a family member of a child with bipolar disorder, it's very important to get the support and help you need. Living with or caring for someone who has bipolar disorder can really disrupt your own life. Manic episodes can be extra tough. It may help to seek your own counsellor or therapist to support you.
Also, some national support organizations may have a local chapter in your area or provide information online. Examples of such groups include the Canadian Mental Health Association and the Mood Disorders Society of Canada.
There is no lab test that can diagnose bipolar disorder. Doctors work with other healthcare professionals and service providers to make the diagnosis through a combination of:
Before prescribing medicine to treat bipolar disorder, your doctor will ask questions about possible suicidal behaviour.
Mood changes and other symptoms of bipolar disorder are challenging, but they can be managed effectively. Treatment usually includes medicines (such as mood stabilizers) and counselling. Often a combination of both is needed.
An important part of treatment is making sure your child takes their bipolar disorder medicine. Often people who feel better after taking their medicine for a while think they are cured and no longer need treatment. But when a person stops taking medicine, symptoms usually return. So it is important that your child follow their treatment plan.
Counselling works best when symptoms of bipolar disorder are controlled with medicines. For more information on the types of counselling used to treat bipolar disorder, see Other Treatment.
Home treatment includes helping your child get regular exercise, eat a balanced diet, and have a regular sleep schedule. For more information, see Home Treatment.
If your child's behaviour is suicidal, aggressive, reckless, or dangerous, or if they are out of touch with reality (psychotic) or unable to function, the child may need to go into the hospital for a while. Also, many medicines can make the symptoms of bipolar disorder worse. If your child is taking one of these, they may need to taper off and stop the medicine. This should only be done under the supervision of a doctor.
Bipolar disorder has a big impact on both the child and their family. Successful treatment requires that the child and family members know what happens in bipolar disorder and that the family members help make sure that the child follows the treatment.
It can take time for you and your child to accept that the child has a serious, long-term condition that requires ongoing treatment and constant monitoring. But keep in mind that by working with your child's healthcare team and service providers, you and your child can find treatment that works.
Bipolar disorder can't be prevented. But there are ways to help manage or prevent mood changes.
The first and most important preventive measure is to make sure that your child takes their medicines as directed. Bipolar disorder is a long-term condition and often requires lifelong treatment with medicines.
Reducing stress, getting regular sleep and exercise, and staying on a daily routine may help prevent mood swings and can help with the symptoms of depression and mania.
Learning as much as you can about bipolar disorder may help you recognize mood changes in your child as they begin to occur. Catching and treating these mood changes early may help reduce the length of the manic or depressive episode and improve the quality of your child's life.
There are steps you can take at home to reduce your child's symptoms.
Steps your child can take to help control moods include:
For some children with bipolar disorder, depression can cause debilitating symptoms. For information about managing childhood depression, see the topic Depression in Children and Teens.
Medicines for bipolar disorder in adults have been well studied. But more research is being done on how well the medicines work and if they are safe for children and teens.
When you and your child's doctor are deciding which types of medicines to use, think about:
Be sure to use all medicines exactly as your child's doctor has prescribed them. If your child has intolerable side effects from any medicine, call your doctor immediately.
Medicines most often used to treat bipolar disorder in children and teens include:
While antidepressants can be helpful for some children with bipolar disorder, they can also trigger mania. Doctors usually prescribe antidepressants along with mood stabilizers or antipsychotics to help prevent a manic episode. And the doctor needs to carefully monitor the child for mood changes. Antipsychotics can be used alone, or they may be combined with mood stabilizers for more effective control of manic episodes.
Medicines for bipolar disorder have side effects that need to be managed. Some things you cannot change, such as increased urination (common with lithium). But you can deal with some side effects like weight gain (common with several medicines used to treat bipolar disorder) by increasing exercise and reducing calorie intake.
You can work with your child and their healthcare team to find ways of coping with side effects. If side effects from a medicine are intolerable, the doctor may have to change the dose or the medicine.
Advisories. Health Canada and the U.S. Food and Drug Administration (FDA) have issued advisories on antidepressant medicines and the risk of suicide. Talk to your doctor about possible side effects and the warning signs of suicide.
Most children who have bipolar disorder need medicine. But other forms of treatment used along with medicine play an important role in balancing mood and improving quality of life. Counselling, education about the disorder, and stress reduction can help.
Counselling along with medicine has been used effectively to manage bipolar disorder. Types of therapy that counsellors use to treat bipolar disorder include:
In some cases, electroconvulsive therapy (ECT) may be an option. In this procedure, brief electrical stimulation to the brain is given through electrodes placed on the head. The stimulation produces a short seizure that is thought to balance brain chemicals.
Complementary medicine is a term used for a wide variety of health care practices that may be used along with standard medical treatment. A few studies suggest that adding omega-3 fatty acids to medicine (such as lithium) can help reduce the depressive symptoms of bipolar disorder in some people. Omega-3 fatty acids don't seem to have an effect on the manic symptoms of bipolar disorder. And omega-3 fatty acids alone are not a good treatment for bipolar disorder. They are not a replacement for medicine or other therapy used to treat bipolar disorder.footnote 3, footnote 4
CitationsAmerican Psychiatric Association (2013). Bipolar and related disorders. In Diagnostic and Statistical Manual of Mental Disorders, 5th ed., pp. 123–154. Washington, DC: American Psychiatric Association.Health Canada (2012). Category-specific guidance for temporary marketing authorization: Caffeinated energy drinks. Available online: http://www.hc-sc.gc.ca/fn-an/legislation/guide-ld/guidance-caf-drink-boiss-tma-amt-eng.php.Sarris J, et al. (2012). Omega-3 for bipolar disorder: Meta-analyses of use in mania and bipolar depression. Journal of Clinical Psychiatry, 73(1): 81–86.Montgomery P, Richardson AJ (2009). Omega-3 fatty acids for bipolar disorder. Cochrane Database of Systematic Reviews (1).
Adaptation Date: 3/21/2022
Adapted By: Alberta Health Services
Adaptation Reviewed By: Alberta Health Services
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