Bipolar disorder is a mood disorder characterized by the vacillation between two extreme mood states. People with bipolar disorder experience periods of markedly elevated mood as well as periods of depressed mood. The elevated mood is known as mania and the low mood is known as depression. Mood swings are often drastic and unpredictable, and the person who is displaying them may not be aware that their behavior has changed.
The Manic Phase
During the manic phase, the teen experiences an extreme elevation in mood. They are either joyful and ecstatic, extremely irritable or some combination of the two. Behavior changes drastically and often includes poor decisions such as spending large amounts of money, engaging in risky behaviors such as unsafe sex, speeding, drug abuse etc. The teen’s speech may seem pressured or very fast and they may talk incessantly, switching from topic to topic without consistency or focus. The manic phase is also characterized by a diminished need for sleep and a manic teen will likely sleep very little or not at all. They may believe things that are untrue like they have magical abilities, they are friends with celebrities or they that are some sort of representative of God. The manic phase is characteristic of Bipolar I. A manic phase left untreated can last weeks or months.
The Hypomanic Phase
The hypomanic phase is a less severe type of mania. The teen may experience an abnormally elevated mood accompanied with increased levels of activity and decreased need for sleep. The hypomanic phase does not include psychotic symptoms and usually hypomanic people are able to function somewhat normally, unlike mania which is truly disabling and destructive.
The Depressed Phase
The depressed phase of Bipolar Disorder is similar to Major Depression. The sufferer may sleep a great deal or not sleep well at all. They are plagued by thoughts of hopelessness and inadequacy and often struggle a great deal to carry out even the most mundane daily activities such as getting out of bed, showering and going to school. The depressive state is a serious as the manic state due to the fact that, left untreated, it can lead to self harm, substance abuse and even suicidal thoughts and actions.
Oftentimes an adolescent with bipolar disorder is unaware that their thoughts and behavior have changed. Instead, it is friends and family who notice that the teen is acting strange or different and start to wonder if something is wrong. It may seem that the teen’s behavior is defiant and “out of control”, but in reality bipolar disorder is a medical condition that requires professional treatmet. Bipolar disorder is a serious condition and left untreated it can cause the patient to make extremely rash and devastating decisions such as racking up debt, running away from home, engaging in risky sex , abusing drugs and even suicide.
Types of Bipolar Disorder
There are three types of bipolar disorder: Bipolar I, Bipolar II and Cyclothymia. Bipolar I is diagnosed if the patient has experienced at least one true manic state (see above). Bipolar II is when the patient cycles between depression and hypomania, and cyclothymia is a milder version of bipolar wherein the sufferer vacillates between mild depression and slightly elevated moods.
Causes of Bipolar Disorder
There is no single known cause of bipolar disorder, but it does tend to run in families. Bipolar disorder affects males and females equally. Signs and symptoms typically begin to appear between the ages of fifteen and twenty five years. The following life events can trigger a manic episode:
- Medications such as antidepressants or steroids
- Lack of sleep
- Drug use
- Stressful life events such as a death in the family.
Symptoms of Bipolar Disorder in Teens
Symptoms of Bipolar Disorder in teens include symptoms of mania and symptoms of depression.
- Sadness or depressed mood
- Feeling worthless, hopeless, helpless or guilty
- Eating problems (overeating with weight gain or under eating with weight loss)
- Sleeping problems (increased or decreased)
- Withdrawing from family, friends and relationships
- Anhedonia (lack of enjoyment in previously enjoyed activities)
- Fatigue or low energy
- Loss of self-esteem
- Difficulty concentrating, remembering or making decisions
- Thoughts of death and suicide
- Hyper sexuality
- Pressured speech
- Racing thoughts
- Poor judgment
- Decreased need for sleep
- Increased energy
- Substance abuse
- Suicidal tendencies
- Excessive spending
- Inflated self esteem
- Running away
- Reckless behaviors like leaving home in the middle of the night
- Delusional, bizarre thoughts
- Excessive talking
- Poor temper control
- Difficulty waiting or delaying gratification
- Eating impairments (binging or lack of appetite)
- Raging angry episodes
- Destruction of property
- Violence/aggression toward others.
Treatment of Bipolar Disorder
It is imperative to provide a Bipolar teen with appropriate treatment. Left untreated Bipolar Disorder can have serious, life altering consequences. The following is a list of important goals when treating adolescents with bipolar:
- Educate the minor and their family about the disorder.
- Explore recent substance and/or alcohol abuse
- Avoid moving from one phase to another phase
- Prevent self injury
- Cope with and ultimately avoid suicidal thoughts and behaviors
- Consider hospitalization if the adolescent needs stabilization
- Teach coping skills that will aid them in the future
Bipolar Disorder is a lifelong illness that requires constant maintenance. Teens are educated on recognizing the warning signs of an oncoming mood change and how to cope with and prevent those events from happening.
Families are educated on Bipolar Disorder and taught coping skills. They are also taught to recognize signs and symptoms of the manic and depressive episodes. Our licensed therapists teach families how to support the positive changes that their teen makes in our program.
Families learn how to minimize re-surfacing symptoms of bipolar and why it is important to encourage their loved one to stay in treatment.
The Role of Medication in Treating Bipolar Disorder
Bipolar disorder is most often treated with a combination of talk therapy and mood stabilizing medication. Mood stabilizers are a class of drugs that suppress the disruptive swings between mania and depression. Although the teen may not like the idea of taking medication long term, they must understand that in many cases it is necessary for maintaining mood stability.
However, medication alone does not solve the problems associated with Bipolar Disorder. The teen should attend talk therapy in order to learn about their triggers, effective coping techniques and healthy lifestyle choices that will diminish the likelihood of another manic or depressive episode.
Although a bipolar teen’s mood and behavior may seem unpredictable, they can be predicted and managed. With good clinical and familial support, knowledge of triggers, sufficient coping skills and a solid medication regime, Bipolar teens can learn to manage their disorder effectively.
It is important to continue your hard work even after the primary phase of treatment is over. The following are recommendations for successful aftercare:
- Regular consultations with a child and adolescent psychiatrist will help manage medication and reduce the risk of manic episodes.
- Continue ongoing talk therapy to address bipolar symptoms.
- Keep up a regular exercise routine. Exercise helps manage depressive symptoms.
- Family and friends must continue to support the positive changes the adolescent learned in treatment.
- Suicidal thoughts and gestures must be taken seriously because suicide is a viable risk in both manic and depressed episodes.