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Bipolar Disorder in Teens

Bipolar disorder is a lifelong illness that often begins in adolescence and is marked by unusual and unpredictable swings from one extreme mood to another. When bipolar symptoms happen alongside drug or alcohol abuse, it's likely your teen has a co-occurring disorder. Call us now to discuss how rehab can help your teen.

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What Is Bipolar Disorder?

A teen diagnosed with bipolar disorder (or is simply “bipolar”) suffers from uncontrollable shifts in mood, energy and activity levels. It’s defined by periods of highs and lows, the symptoms of which can be severe. This disorder is often confused with other adolescent mental problems — especially depression in teens — but is diagnosed as a standalone illness. Around 4% of Americans meet the criteria for bipolarity in their lifetime, with 5.7 million adults affected in a given year. Teens are also affected — 2.5% of youth meet the criteria in their lifetime. It’s the 6th leading cause of disability in the world.

The swings of bipolar disorder are often described as “manic” or “mania” (the highs) and “depressive” or “depression” (the lows). While “manic-depressive disorder” is another commonly used name for the disease, doctors now mostly veer away from this term. Periods of intense symptoms in either direction are referred to as “episodes.” Individuals can suffer from either manic or depressive episodes at some point in their life without being diagnosed as bipolar. But once both types of episodes become common, a doctor may label this a bipolar disorder.

An individual with bipolar disorder can go extended periods of time without an episode. But left untreated, it’s only a matter of time until their next fit. Bipolar disorder is a lifelong illness, and 83% of cases are deemed “severe.”

What Are the Causes of Bipolar Disorder?

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Environment factors and traumatic life events can contribute to triggering this disease. But one’s brain structure and brain function play a significant role, as bipolar disorder in teens manifests in similar ways as kids with “multi-dimensional impairment.” Parts of the brain, specifically the prefrontal cortex — involved with solving problems and making decisions — tend to be smaller and less functional in bipolar individuals. Though the onset may come about later in the life, bipolar disorder typically develops as the brain develops: throughout childhood and adolescence.

Is Bipolar Disorder Hereditary?

Studies have shown a major significance in the genetics of bipolar individuals, to a greater degree than many other brain diseases. When one parent is bipolar, a child’s risk of developing the disorder is 15–30%. If both parents have it, the risk increases to 50–75%. Among bipolar individuals, 50% have a parent with a history of clinical depression.

Kids with a bipolar sibling are 8–10 times more likely to develop bipolar disorder. More than two-thirds of people struggling with bipolar disorder have a close relative with bipolar disorder or major depression.

While bipolarity can exist from a very early age, the major symptoms typically don’t appear until the late teen years or the early 20s.

Prevalence Among Teens

Children and teens are especially susceptible to this disease. The average age of onset is 25, but cases pop up in children of all ages. When it occurs at an early age, it’s referred to as early-onset bipolar disorder. Approximately 20% of kids with major depression develop bipolar disorder within 5 years of the onset of depression symptoms. According to a study by the American Academy of Child and Adolescent Psychiatry, up to one-third of the 3.5 million young people in the U.S. with depression may actually be experiencing early-onset bipolar disorder.

If your teen has bipolar disorder, they may experience more mixed episodes, have symptoms more often and switch moods more frequently than bipolar adults, Their mood episodes will last a week or two, and occasionally even longer. Episodes can be very intense and be a troubling experience for them and the rest of your family. Considering this, and the fact that the prevalence of bipolar disorder in teens is approaching that of adults, it’s important to stay informed and look out for signs in your children. According to the National Center for Health Statistics, between 1995 and 2003, the number of adolescent diagnoses for bipolar disorder increased by 4000%.

Types of Bipolar Disorder

There are various types of bipolar disorder defined by varying characteristics. If someone you know is diagnosed as bipolar, their doctor will determine which form of the illness they have, and this will affect their recommended treatment and what symptoms can expected.

The different types of bipolar disorder are:

  • Bipolar I – characterized by periods of severe mood episodes from mania to depression
  • Bipolar II – severe periods of depression that alternate with milder episodes of mania (or “hypomania”)
  • Cyclothymic Disorder – characterized by periods of hypomania and brief, less extensive periods of depression
  • Mixed Bipolar – describes those who suffer from simultaneous symptoms of the opposing episodes (e.g. high energy while sad and hopeless)
  • Rapid-Cycling Bipolar – having 4 or more mood episodes within a 12-month period, sometimes experiencing swings within a week

In general, bipolar disorder affects males and females at an equal rate, albeit with a few differences. Females are 3 times as likely to experience rapid-cycling bipolar episodes. They may have more depressive episodes and mixed episodes, and are more likely to be diagnosed as bipolar II than males. Women are also more vulnerable to the symptoms of bipolar disorder during and after pregnancy — pregnant women and new moms have twice the risk of a recurrent episode and 7 times the risk of hospitalization.

Regarding males, symptoms of bipolar disorder tend to begin earlier and be more severe. They’re more likely to experience manic episodes from the start, and more prone to act out during their mania (becoming violent or turning to drugs or alcohol). Bipolar males are less likely to voluntarily seek out medical care, and perhaps because of this, cases of adolescent suicide and teen self-harm are more common among males.

History of Bipolar Disorder

Accounts of depression and depressive disorders date back to ancient civilizations. Diagnosing mania came about at a slower rate, as people with manic episodes (e.g. overactivity, great excitement, occasional delusions or unrealistic, wild beliefs) were often considered insane. As early as the 2nd century A.D., people had the idea that depression (or “melancholia”) and mania could be related in some way. In the 17th century, a British physician named Richard Napier wrote about mental conditions he’d observed that match the symptoms of bipolar disorder. Several authors across the 18th and 19th century continued to expand on the idea, applying different labels to the disorder along the way.

A man named Emil Kraeplin, in his 1896 German-language textbook, offered a definitive description of bipolar disorder, and he is considered the father of the modern conceptualization of bipolar disorder. “Manic-depressive insanity,” he writes, “includes on the one hand the whole domain of so-called periodic and circular insanity, on the other hand simple mania, [and] the greater part of the morbid states termed melancholia.”

The illness was studied continuously in the 20th century, with several findings on the relationship between heredity and individuals with bipolar disorder. Despite centuries of research and millions of cases, it’s still a difficult illness to understand among doctors and scientists.

Misconceptions About Bipolar Disorder

Bipolar disorder misconceptions

Even after centuries of research, bipolar disorder remains an unusual phenomenon in the medical community. Especially on initial presentation, the disorder is often misdiagnosed, or determined to be a different medical problem. Approximately 69% of patients with bipolar disorder are misdiagnosed initially, with more than one-third remaining misdiagnosed for 10 years or more.

Among the general population, several misconceptions exist about this disabling psychiatric illness, and many may not even know what it is. Between a potentially inaccurate diagnosis at the doctor’s office and public misconceptions about it, bipolar disorder is often confused for the following problems.

Bipolar Disorder vs. Depression

The closest relative of bipolar disorder is depression. The depressive episodes typical of bipolar disorder share many qualities with major depression and persistent depressive disorder, the most common forms of clinical depression. So if a doctor or family member observes a teen during a “low” episode, it’s not hard to see the resemblance to clinical depression.

Symptoms of mania may blend more easily into a person’s everyday life — particularly a teenager, full of energy and raging hormones — making the depressive side of bipolar disorder seem like the real problem. Studies in 1999 and 2000 revealed that nearly 40% of bipolar patients are initially diagnosed with depression. Females are more likely to be misdiagnosed with depression than males.

Bipolar Disorder vs. ADHD

Restlessness and distraction are symptoms associated with ADHD in teens (also known as attention deficit hyperactivity disorder). ADHD is a behavioral disorder that affects more than 6 million adolescents in the U.S. Due to its similarities to manic episodes, teens actually battling bipolar disorder are regularly misdiagnosed with ADHD.

Bipolar Disorder vs. Schizophrenia

Another debilitating mental health disorder is schizophrenia in teens, in which patients break from reality and exhibit unpredictable behavior. More than 50 million people around the world suffer from this disease, which makes them erratic and difficult to manage.

One symptom of schizophrenia is delusions of grandeur — unreasonable beliefs that one is greater than they are or are in fact someone they are not, like a celebrity. During mania, a number of bipolar individuals experience the same sensation. They may also have hallucinations (i.e. seeing things or hearing voices), another side effect of schizophrenia. Depressive episodes can share certain aspects of schizophrenia as well, such as becoming withdrawn and losing interest in activities. Males are more likely to be misdiagnosed with schizophrenia than females.

While both teen bipolar disorder and schizophrenia are serious and potentially dangerous brain illnesses, they should not be be mixed up.

Bipolar Disorder vs. Borderline Personality Disorder

Borderline personality disorder (BPD) is another mental illness often misdiagnosed for bipolar disorder. It is marked by unstable moods, behavior and relationships. The affective instability, impulsivity and episodic nature of bipolar disorders can appear in a similar fashion in people with borderline personality disorder. Depending on what symptoms are present during a doctor’s assessment, bipolar disorder may be misdiagnosed as BPD. At least 1.6% of the U.S. population has BPD.

Signs of Bipolar Disorder in Teens

Your best bet in identifying bipolar disorder in your teenager is seeing the symptoms of a specific episode. During these periods of time, they should exhibit noticeably different behaviors and attitudes, even if they don’t believe anything to be wrong.

Signs of a manic episode can include:

  • Unusual amounts of happiness or silliness
  • Unrealistic highs in self-esteem
  • Very short temper
  • Talking fast and jumping from topic to topic
  • Restlessness
  • Trouble staying focused
  • Increased talking or thinking about sex
  • Risky behavior

On the other hand, signs of depressive episodes can include:

  • Feeling very sad
  • Low energy
  • Complaining about pain, such as stomachaches or headaches
  • Complaints of boredom
  • Sleeping too much or too little
  • Change in eating habits
  • Feeling guilty or worthless
  • Losing interest in school or activities
  • Talking about death or suicide

In between episodes, a bipolar teen can seem relatively normal, although they may be irritable and worn out following a particular episode. If you notice these dramatic swings in mood without a good explanation, it may be a sign of early-onset bipolar disorder or a similar mental disorder. At the first hint of something wrong, research their symptoms and try to determine if a doctor’s visit may be necessary.

What Are the Effects of Bipolar Disorder?

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In cases of bipolar disorder, the life expectancy prognosis is 9.2 years less than the average person. The effects of the disorder on the mind, body and spirit can be detrimental. Left untreated, teens living with the disease are prone to pick up harmful habits and lose the good ones. They are also at risk for a number of other health problems, both big and small, that can stay with them for a lifetime.

Effects on the Brain

Bipolar disorder in children stems from issues already present in the adolescent brain — abnormalities, problems in development and atypical shape and/or activity. As the illness progresses, it may inflict additional, progressive damage to certain regions of the brain.

Studies reveal a lower-than-average concentration of N-acetylaspartate (NAA) — an important amino acid — in the brains of patients with bipolar disorder. Decreasing levels of NAA is a problem associated with other serious diseases, such as Alzheimer’s disease, Parkinson’s disease and multiple sclerosis.

The brain’s learning and memory systems can also sustain damage from the disorder, and these effects worsen the longer a patient goes untreated. People with chronic, multiple-episode bipolar disorder can exhibit severe cognitive impairment compared to healthier individuals. They can also suffer from chemical imbalances, such as glucose and phospholipid metabolism.

One medical review of bipolar lists several brain abnormalities that can result from the disease. These include enlargements, atrophies and hypertension across the brain’s major regions. While these symptoms don’t result from every case of bipolar disorder, they are a possibility — particularly if the disorder goes unaddressed.

Effects on the Body

The body is also affected by the illness — inconsistent sleep schedules, self-harm and eating disorders in teens are most common. Bipolar individuals also report migraine headaches. The violent ups and downs of severe bipolar disorder can leave a patient’s body in rough shape, and set them up for major issues down the road.

Hormones, the chemical messengers of the brain, play a role in the development of the illness. Hormonal problems, specifically issues with thyroid hormone (produced by the thyroid, an organ in the neck) and reproductive hormones, are a major topic of research regarding bipolarity and other mood disorders. Hormonal dysfunction is considered by some experts to be a cause of bipolar disorders.

As bipolar disorder takes its toll on the adolescent body, it can cause progressive problems with hormone development and functionality. In the long-term, people with bipolar disorder are more likely to experience serious health issues, which may or may not involve hormone problems. These issues include:

  • Thyroid disease
  • Heart disease
  • Diabetes
  • Obesity

Teen Suicide

During the turbulent adolescent years, your teen may have their first encounter with thoughts of self-harm. At least 1 in 12 teens will attempt suicide at some point. An obstacle like early-onset bipolar disorder can push them over the edge, particular if their symptoms go unnoticed and they’re too afraid to reach out for help. The lifetime risk of suicide is 20 times greater in teens diagnosed with bipolar disorder. Identifying your teen’s problem at the earliest possible stages allows you to address their needs before their pains become too much to handle.

Other Effects

If your teen develops bipolar disorder, their seesawing episodes can complicate even the most simple tasks. It will disturb their sleep patterns, interrupt their progress in school, crush their self-esteem with friends and family, and make them a danger to themselves. The longer these symptoms persist and the worse they get, your teen will have trouble reaching their potential, maintaining relationships or feeling good about the future. In the worst cases, it can also land them in trouble with the law if they act during during a particular episode. In one study, bipolar individuals were more than twice as likely to commit violent crime, especially those with a co-occurring substance use disorder.

Co-Occurring Disorders

In cases of teen bipolar disorder, it’s not uncommon for the illness to exist simultaneously with a second, equally serious disorder — an issue known as co-occurring disorders (also referred to as dual disorders). Substance use disorders — the medical term given to those with diagnosable drug or alcohol problems — are the most common co-occurring disorders related to bipolar patients. Males are more likely than females to develop dual disorders. Those with the highest risk of co-occurring disorders are patients from lower-income families and military veterans, but this complex problem can affect anyone. In 2014, nearly 8 million Americans had a co-occurring mental illness and substance use disorder.

Teens with co-occurring disorders have an increased chance of relapse following treatment for their bipolar symptoms. These cases present a hefty challenge for doctors, as the complications of dual disorders make them difficult to properly diagnose and treat.

Common co-occurring disorders with bipolar disorder include:

  • Panic disorder
  • Anxiety disorder
  • Obsessive-compulsive disorder
  • Social phobia
  • Eating disorders (e.g. anorexia and bulimia)

In addition to the laundry list of risks associated with bipolar disorder, a co-occurring disorder creates an entirely new set of possible side effects. These patients typically experience more severe and chronic medical, social and emotional problems, and the symptoms of one disorder historically aggravate the symptoms of the other. The woes of someone struggling with dual disorders can only increase the longer they live with these illnesses. Problems can include:

  • Persistent social isolation
  • Trouble budgeting or saving money
  • Inconsistent employment and living situations
  • Legal problems
  • Violent behavior
  • Non-compliance with treatment

Bipolar Disorder and Substance Abuse

Adolescent bipolar disorder is often often linked with teen addiction — a physical and psychological reliance on the substance that hinders their normal functions — and more general teen substance abuse. In one study of teens with bipolar, 46% reported alcohol abuse or dependence, and 41% reported drug abuse or dependence. In another study of bipolar I patients, 58% abused or were dependent on one substance, 28% abused or were dependent on two substances, and 11% abused or were dependent on 3 or more substances.

While teen alcohol abuse is the most prevalent among young people with bipolar disorder, more severe bipolar patients may turn to harder drugs to self-medicate against their better judgment.

Bipolar Disorder Treatment Options for Teens

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Diagnosing adolescent bipolar disorder is the crucial first step, and it’s a far more difficult issue to diagnose than most. No blood test or brain scan can determine the presence of bipolarity. Doctors rely on detailed accounts of a patient’s mood, sleeping patterns, energy levels and behavior. One of the major reasons that doctors misdiagnose bipolar disorder is that families often don’t track this history properly.

During a diagnosis, your teen’s doctor will also test them for other illnesses that may be related to bipolar disorder. On top of this, they will look into the patient’s family history. Any instances of bipolar disorder or major depression in your teen’s bloodline can increase their odds of being bipolar.

Medication is often the first course of action in treating bipolar disorder, typically with drugs called “mood stabilizers.” Lithium, the oldest and most trusted mood stabilizer, might be recommended. It’s highly effective for treating mania and also effective in reducing depressive symptoms. Once your teen begins taking lithium, the medication takes 1-2 weeks to reach its full effect. Although it’s commonly prescribed for bipolar I and bipolar II patients, it’s less effective for mixed episodes or rapid-cycling bipolar disorder.

Other commonly prescribed mood stabilizers include:

  • Carbamazepine (Tegretol)
  • Lamotrigine (Lamictal)
  • Topiramate (Topamax)
  • Valproic acid, which is also known as valproate or divalproex (Depakote)

If mood stabilizers don’t have a positive effect, your doctor may also prescribe antipsychotics. They may also recommend these medications immediately following a manic episode or serious depressive episode. Common antipsychotics prescribed to bipolar patients include:

  • Olanzapine (Zyprexa)
  • Quetiapine (Seroquel)
  • Risperidone (Risperdal)
  • Aripiprazole (Abilify)
  • Ziprasidone (Geodon)
  • Clozapine (Clozaril)

If your teen begins a regimen with any of these drugs, including lithium, you’ll need to monitor their progress and any changes to their health closely over the following months. At the first sign of undesirable side effects, make a return trip to your doctor and they may alter the dosage or switch medications.

Does My Teen Need Rehab?

Whether your teen is using drugs or alcohol, there is a risk of addiction. If you notice signs that your teen is abusing any substance, make an appointment to speak with a treatment professional such as your family doctor, your child’s school guidance counselor, or just call us at TeenRehabCenter.org for free, confidential guidance.

If your child is struggling with both addiction and bipolar disorder, rehab treatment may be the necessary next step. Especially with bipolar disorder, you need to consider highly structured treatment options, which can address both mental illness and addiction behaviors. Solutions may include counseling and therapy, along with a host of other teen drug rehab options that aim to build a strong support network for your teen. Depending upon the level of addiction that your teen is facing, inpatient or outpatient rehab may be needed to achieve long-term recovery.

But in order for your teen to get the help they need, you have to be involved in their lives and point them in the right direction. With help from medical professionals and caring rehab counselors, a co-occurring bipolar disorder can be a manageable illness — despite the fact that it will linger for a lifetime. With the right approach, your teen can get it under control and keep the disorder symptoms to a minimum.

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