Continuing our series on Pediatric Bipolar Disorder, this month we will talk about Bipolar Disorder in adolescents. Remember that the terms Pediatric Bipolar Disorder and Early-Onset Bipolar Disorder are interchangeable and refer to the same disorder.

When Bipolar Disorder presents itself in adolescents, it may resemble any of the following traditional adult presentations of the disorder:

Bipolar I: In this form of Bipolar Disorder, the adolescent will experience alternating episodes of intense (sometimes psychotic) depression and mania.

Symptoms of depression include:

  • pervasive sadness and crying spells
  • agitation and irritability
  • sleeping too much or inability to sleep
  • withdrawal from activities formerly enjoyed
  • inability to concentrate (with subsequent drop in grades)
  • low energy
  • thoughts of death and suicide
  • significant change in appetite

Symptoms of mania include:

  • elevated, expansive or irritable mood
  • racing speech and pressure to keep talking
  • decreased need for sleep
  • grandiose delusions
  • excessive involvement in pleasurable but risky activities
  • poor judgment
  • increased physical and mental activity
  • hallucinations (in severe cases)

Periods of relative (or even complete) wellness will occur between these episodes.

Bipolar II: In this form of Bipolar Disorder, adolescents experience episodes of hypomania between recurrent periods of depression. Hypomania is when a markedly elevated or irritable mood is accompanied by increased physical and mental energy. Hypomania can sometimes be a time of great creativity for an adolescent.

Cyclothymia: Adolescents who have this form of Bipolar Disorder experience periods of less severe, but definite, mood swings.

Bipolar Disorder NOS (Not Otherwise Specified): Doctors make this diagnosis in the adolescent when it is not clear which type of Bipolar Disorder is emerging.

For some adolescents, a loss (or other traumatic event) can trigger their first episode of depression or mania. Later episodes can occur independently of any obvious stresses, or can worsen with stress. For an adolescent, puberty is a time of risk. In adolescent girls, the onset of menstruation can trigger Bipolar Disorder, and symptoms often vary in intensity (severity) with their monthly cycle.

Once Bipolar Disorder starts in an adolescent, episodes will then tend to recur and worsen without treatment. Studies show that after symptoms first appear, there is typically a 10-year lag until treatment begins.

The Child and Adolescent Bipolar Foundation (CABF) encourages parents to take their adolescent for an evaluation of Bipolar Disorder if four or more of the above symptoms listed in this article persist for more than two weeks in their adolescent.

During this critical time of development in an adolescent, early intervention and treatment can make all the difference in the world.