Bipolar disorder is a serious mental health problem that affects between 1% and 5% of children and adolescents. Bipolar disorder is classified as a mood disorder by the mental health profession, and can include two types of mood disturbances: depression and mania (joyful, elevated or severely irritable moods). Bipolar disorders can affect all aspects of a child or adolescent's life, causing them difficulties at home, in school, and in getting along with friends and classmates.
How do I know when to seek help?
If you see the signs or symptoms of bipolar disorder in your child or adolescent, it is important to seek a professional evaluation. If these symptoms are causing problems for your child, leaving them untreated can result in needless suffering. It is important to be able to recognize both types of mood disturbances--depression and mania--that can occur in bipolar disorders.
Depression, often characterized by a very sad or irritable mood, is accompanied by some or all of the following symptoms:
- Loss of interest or pleasure in things normally enjoyed
- Increase or decrease in appetite or weight
- Difficulty sleeping, or sleeping much more than usual
- Feeling fatigued or worn out easily
- Body movements slowed down, or feeling agitated (can't sit still)
- Feeling worthless or inappropriately guilty
- Trouble thinking or concentrating; difficulty making decisions
- Thoughts about death, suicide, or wishing one were never born
Mania includes an abnormally joyful or elevated mood--super happy, silly, laughing at things no one else finds funny--or an intensely irritable mood.
Mania can include some or all of these symptoms:
- Inflated self-esteem or belief that one is better than others or has special powers
- Needing much less sleep than usual to feel rested
- Talking more or faster than usual
- Jumping from idea to idea, or having faster thoughts than usual
- Distractibility (attention drawn away from things more easily than usual)
- More involved than usual in social, work, school, or sexual activities
- More involved in pleasurable activities that have a high risk for negative consequences (dangerous or risky behavior)
Symptoms of depression and mania can alternate back and forth, or even occur at the same time. Mood disturbances can also go away for a length of time, and then return later. It is common to see short periods of these mood problems. They can last a few days or less, or "cycle" up to several times per day.
If only depression (and not mania) has been present in your child or adolescent, he or she may not have a bipolar disorder. However, depression by itself is also a serious mental health problem that can cause severe pain and suffering. Therefore, any of the above mood problems should be evaluated by a mental health professional.
Clearly, bipolar disorders cause suffering for an affected child or adolescent, getting in the way of their relationships with family and friends, and often causing difficulties in school. Children with these disorders commonly suffer from other mental health problems as well, such as Attention Deficit-Hyperactivity Disorder (ADHD). Parents suffer too, often feeling guilty that their child has the illness, while also frustrated by their inability to "make it better." Siblings can feel jealous or forgotten when the affected child seems to get all the attention. Bipolar disorders are very strongly (though not completely) linked to genetics, so other family members may experience similar mood problems.
What kinds of treatments are commonly used?
Almost all children with bipolar disorders need to take medication to help stabilize their moods. Medications do not cure the disorders--they help reduce the symptoms. Often, more than one medication has to be tried before symptoms are stabilized. Many times, a combination of two or more medications works better, if one medication alone does not produce a satisfactory response.
Many of the medications used to treat bipolar disorders can have unwanted side effects. Common examples include weight gain or sleepiness. Parents may have to help their child take the necessary steps (diet or exercise changes, sticking to a sleep schedule, etc.) to cope with these side effects. Parents should not hesitate to ask the physician questions about medications or side effects.
Medications are usually necessary, but are not the only treatment available. Psychotherapy is often a very helpful addition to medication treatment. A therapist or counselor can help a child or adolescent learn about bipolar disorders, help them understand how to cope with the symptoms, the importance of taking medication, and how to work actively with other members of the treatment team. Psychotherapy can also help decrease chances of relapse. Family therapy is helpful too, to help all family members cope with the suffering and turmoil caused by this serious mental health problem. Many children and adolescents with bipolar disorders will need to receive special services in school. Also, parental support groups are available in many communities and on the Internet.
Bipolar disorder is a major mental illness that involves extreme swings in mood, ranging from the low of depression to the high of mania. When depressed, a person may feel sad, have problems with sleeping, eating, and loosing weight, have many negative thoughts about oneself (including thoughts about death and hurting oneself), and experience difficulties with attention and concentration. During periods of mania, the individual may experience euphoric or irritable mood, inflated self-esteem and over-confidence, increased talkativeness, distractibility, and boundless energy, including a decreased need for sleep. People with bipolar disorder also have hallucinations (such as hearing voices when no one is talking to them) and delusions (such as the paranoid delusion that someone is out to get the person when no one is) when their mood is either depressed or manic, but these symptoms usually go away when the person's mood becomes normal again.
Bipolar disorder can have a dramatic effect on a person's functioning. It can affect relationships with family members and others, self-care skills, as well as the ability to work, attend school, parent, or be a homemaker. When the symptoms of bipolar disorder are severe, and the person presents a threat to self or others, temporary psychiatric hospitalization may be necessary.
What Causes Bipolar Disorder?
Bipolar disorder occurs in between 1 in 100 and 1 in 200 people. The disorder occurs equally among men and women, different racial and ethnic groups, and different social classes. Bipolar disorder is believed to be caused by biochemical imbalances in the brain and is not the result of parenting or family relationships. Although bipolar disorder is a serious illness, if it is diagnosed and treated appropriately, the symptoms can be effectively controlled, relapses can be prevented, and the person can live a happy and rewarding life.
What Types of Treatments are Commonly Used?
The most important ingredient for effective treatment of bipolar disorder is medication. Several different medications have been found to be effective for treating bipolar disorder, including:
- lithium carbonate (Lithobid)
- valproic acid (Depakote)
- carbamazepine (Tegratol)
- antipsychotic medications such as olanzapine (Zypreza).
All of these medications have been found to reduce the severity of symptoms and to prevent relapses and re-hospitalizations. Sometimes other medications may be used as well, such as antidepressant medication during periods of depression.
In addition to medications, therapy can also be helpful and beneficial. Cognitive-behavioral therapy has been shown to be effective and is aimed at helping consumers develop relapse prevention plans, cope with persistent symptoms, and develop strategies for making progress toward personal goals. Other kinds of therapy can also be helpful, such as supportive therapy or therapy aimed at helping people develop meaningful structure in their lives.
Because the symptoms of bipolar disorder can be quite severe and can have a major effect on people whom the person is close to, family therapy can be very helpful in the management of the condition. The primary goal of family therapy for bipolar disorder is to teach the family, including the client, information and skills necessary to effectively manage this condition. Family therapy is provided in a collaborative, positive, educational fashion in order to inform all family members about bipolar disorder and to get everyone working together. Families can play a critical role in helping to monitor the symptoms of bipolar disorder, collaborating with the treatment team to prevent relapses, and working together to achieve personal and shared goals. To accomplish this, family therapy usually involves educating the family about bipolar disorder, improving communication skills, and teaching problem solving techniques so that families are able to solve problems on their own.
Alcohol Problems and Drug Use
All individuals and families experiencing bipolar disorder should be aware of the common problem of drug and alcohol abuse in persons with this disorder. Because of their extreme mood swings and their biological sensitivity to mind-altering substances, people with bipolar disorder are more prone to developing problems with alcohol and drug use compared to people who do not have bipolar disorder. In fact, more than half of all individuals with bipolar disorder experience problems related to alcohol and drug use, compared to less then one-fifth of people who do not have bipolar disorder.
Drug or alcohol abuse can make it much more difficult to successfully treat bipolar disorder. If an individual with bipolar disorder has substance use problems, it is of critical importance to treat these problems as soon as possible. The most effective treatment for substance abuse in people with bipolar disorder is when the same practitioner (or team of practitioners) treats both disorders at the same time in an integrated fashion. By integrating treatment, both disorders receive attention, and the interactions between the two disorders can be most effectively addressed.
Successful Management of Bipolar Disorder
Bipolar disorder can be frightening to both people with the illness and their family members. In addition, because bipolar disorder often develops early in life and has disruptive effects on functioning, the illness can interrupt normal development and interfere with people's desires to achieve their aspirations. However, there are very good reasons to be hopeful that through collaborative work among individuals, their families, and practitioners, bipolar disorder can be successfully managed and people can achieve their personal life goals. Many people with bipolar disorder are extremely bright, talented, and creative. For example, the writer Virginia Woolf, the artist Vincent van Gogh, and the actress Patty Duke all had bipolar disorder. With proper treatment and family help, individuals with bipolar disorder can pursue and fulfill their life goals and dreams.
The mental health profession categorizes depression as a mood disorder, but also recognizes that its symptoms can vary widely from one person to another. It is also accurate to think of depression as a complex problem that can affect many different aspects of the sufferer’s life. It can affect the body, and generate such physical symptoms as insomnia, fatigue, appetite disturbances, diminished sex drive, and anxiety. It can affect the mind, interfering with the ability to think clearly, notice and remember details, and make good decisions. It can affect emotions, causing feelings of sadness, despair, guilt, worthlessness, and apathy. It can affect behavior, leading to alcohol or drug abuse, suicide attempts, and other socially or self-destructive behaviors. It can affect interpersonal (social and family) relationships, leading to aggression, withdrawal, or marital and family distress.
The main forms of depression are: major depressive disorder, also called "unipolar" for its affecting only one end of the mood continuum -- depression; and bipolar disorder, formerly called manic-depressive illness, ("bipolar" for its affecting both ends of the mood continuum -- depression and euphoria, or mania.) Depression can also present itself as dysthymia, a less intense and more chronic form of depression. Major depression is far more common than bipolar disorder, and has a much wider range of contributing factors.
What are depression’s effects on personal and family life?
The symptoms of depression described above make it clear: To be depressed is to suffer. The hopelessness and helplessness that people experience when they are depressed is more than just a frame of mind at such times -- it is an entire way of being. People stop trying, they stop caring, they withdraw from life, and of course, this makes them feel even worse. Their lives deteriorate, and it affects others as well. Family members are not immune to the depressive’s negativity -- the never-ending complaints, the steady stream of criticisms, the lack of emotional closeness, and the loss of the ability to have fun together. Spouses can feel hurt and alienated, and children may feel guilty, resentful, and as if they are to blame. In turn, family relationships can also exacerbate depressive symptoms.
How do you know when to seek help?
As a general answer, you should seek help when depression is starting to affect your life (your family, your job, your outlook) in negative ways, and you are not very clear about what you need to do to prevent things from getting worse. You should seek help -- for yourself, loved ones, or both -- long before things get really bad.
To be more specific, take into account the following factors when deciding to seek professional treatment:
- Feeling emotionally disconnected from or invalidated by their parents
- Wanting to "fit in" within a particular peer group that encourages and rewards self-harming behavior
- Feeling emotionally dead inside or feeling invisible in their parents' eyes. Self-harm makes them feel alive inside and helps confirm their existence in reality.
- For girls, self-harm may be used as a coping strategy with overly demanding parents, especially in situations where the father is the dominant voice when it comes to discipline and decision-making
Since adolescents often engage in self-harming behaviors in privacy or with their friends, parents may not be aware that this problem exists. In addition, parents also need to be aware that there is a big difference between self-decorating and self-harming behavior. It is a popular fad among youth today to body pierce and tattoo as a form of self-decorating. Teens who self-harm are seeking relief from emotional distress, they are not self-decorating.
Here are some signs that might indicate that a teen has a problem with self-harming behavior:
- Suicidal thoughts or feelings: Suicide is a terrible and irreversible solution to specific problems. The depressed person and his or her family need to think preventively, and get help immediately if someone is suicidal.
- Acute depression turning chronic: Before settling into "life as a depressed person," the depressed person, and family if possible, should do all they can to resolve it early on. Every day spent suffering is too costly.
- Lifestyle disruption: The depressed person, and his or her family, can prevent bad circumstances from getting worse by acting quickly. The depressed person does not have to ignore his or her health, lose a job, or hurt or alienate family and friends.
- Reality testing: If a family and their depressed member do not have someone good to talk to, someone with whom they can share their private thoughts, then how will they know whether what they are thinking makes sense? A good therapist is a valuable partner for "reality testing."
What kinds of treatments are commonly used?
Psychotherapy and antidepressant medications are the two most commonly used treatments for managing depression. Many people use a combination of the two. People’s responses vary, of course, but these approaches hold good promise for providing relief. Most people have already heard of the popular antidepressant medication, Prozac. It is only one of the many "newer generation" medications that do, in fact, help the majority of people who take them. Medication is a valuable tool for reducing symptoms and "raising the floor" on depression. Speaking to a psychiatrist about the use of medications in your particular case is the best way to explore whether medications are viable for you. A psychotherapist can also help you with this decision.
Psychotherapy is an non-drug alternative that is generally as effective as medication, and in some ways is even superior (though not quite as fast-acting). For example, people who receive therapy tend to have a lower relapse (recurrence) rate, and tend to feel better as an active participant in the recovery process. Psychotherapy can help individuals and families who are dealing with depression. The most effective psychotherapies are called cognitive therapy (which teaches how to identify and correct distorted thinking), behavior therapy (which teaches how to behave more effectively), and interpersonal therapy (which teaches relationship skills). All of these are short-term therapies, and all focus on changing things in the present.
The fact that long-term research shows the effectiveness of medication and psychotherapy for treating depression can be wonderfully reassuring for depression sufferers and their families. Depression is highly responsive to good treatment, and good treatment is available from a variety of sources.