Bipolar disorder is a serious mental disorder with bouts of extreme changes in mood, thinking, behavior and energy. Bipolar disorder (also known as manic-depression illness) is often considered a mental illness affecting only adults. However, research has found that bipolar disorder can affect children and adolescents as well; and the onset can be as early as age six.

 

Who gets bipolar disorder?

According to American Academy of Child and Adolescent Psychiatry, 3.4 million children and adolescents with depression in US may have early onset bipolar disorder. Another study found that bipolar disorder affects children and adolescents more than adults. Children and adolescents converted from a lesser form of bipolar disorder to a more severe form at a much higher rate than adults.

Causes

Bipolar disorders are caused by abnormal brain functions or structures. Bipolar disorder is often inherited genetically. Children who have bipolar disorder often have a parent with the illness. Children with anxiety disorder are more like to get bipolar disorder also.

Symptoms

Bipolar disorder is characterized by 1) episodes of mania and depression or both at the same time and 2) episodes of wellness in between. However, not all children with bipolar disorder exhibit all the symptoms. Some of the chief symptoms prevalent during episodes are:

Manic symptoms

• Elevated mood - Children are found unusually happy and may laugh hysterically without any reason, act unusually silly, quickly become short tempered or aggressive.
• Grandiose behavior - Children hold unrealisticly high self-esteem and exhibit behaviors of grandeur; speech and behavior show signs of superiority and they are often non-compliant to rules.
• Flight of ideas and increased talking – Children with bipolar disorder talk a lot and very fast. They jump from topic to topic, and this is difficult to redirect. They have racing of thoughts or feelings in their mind, which pressure them to talk continuously.
• Increased energy - Children display a heightened level of energy and want to be involved in multiple tasks one after the other; and they are also easily distracted.
• Decreased sleep - In spite of increased energy to do multiple activities, children sleep much less or have trouble sleeping.
• Risky behavior - Children display risky behaviors such as daredevil acts (jumping from heights), drug or alcohol abuse, etc.
• Hypersexuality - Children talk and think about sex more often. They may act flirtatious beyond their age. Show interest in touching private parts and explicitly use sexual language. 

Depressive symptoms

• Unusual sadness – Feels very sad and cries often
• Withdrawal - from activities, friends and family members
• Low energy level - does not do anything or does not participate in fun activities
• Negative feelings - sense of unworthiness or guilt
• Excessive or insufficient sleep or eating pattern
• Extreme sensitivity - to failure, rejection or accusations
• Physical complaints – complaints about stomachache, headache, etc
• Thoughts of death - Thinks about suicide and death often

Treatment

There is no cure for bipolar disorder. However, there are medications to control symptoms. The treatment for children and adolescents with bipolar disorder is same as for adults. Treatment of bipolar disorder includes administration of medications such as antipsychotics, lithium, antidepressants and anticonvulsants. Medications are given for symptoms that are prevalent. Since bipolar symptoms for each child vary, medications appropriate for those symptoms are to be given. Different bipolar medications will be tried either alone or in combination to see which works best for the child. However, medications should be started with low doses and adjusted appropriately. For best results two or more medications may be given such as mood stabilizers and antidepressants.

Medications should be continued and not stopped. A particular medication can be stopped only if the doctor prescribes a change.  Treatment should not be on and off based on the episodes of wellness and episodes of symptoms.  If a medication is stopped suddenly, it can make bipolar worse.

If the symptoms are severe, then the child may require hospitalization and treatment will continue with the administration of medications until symptoms subside. Severe symptoms include psychosis, suicidal thoughts, aggression, dangerous or destructive behavior and sleep disturbances. Unfortunately, bipolar may have episodes of relapse (in spite of taking medications), which may require hospitalization or longer stay at residential centers.

If symptoms are moderate, bipolar can be managed at home with medications. Follow up with the doctor should not be missed, as regular monitoring is a must for better control of bipolar symptoms. Side effects of medications (such as weight gain, hypothyroidism, diabetes, tardive dyskinesia, etc.) should be monitored. Side effects of some medications may have lasting effects on the child’s health, which may require a change of medicine. The fine-tuning of medication dosage itself is a long process.

Therapies

Psychotherapy along with medication often helps children with bipolar manage the symptoms more effectively. Talk therapy is proven to be effective for bipolar children. Dialectical behavioral therapy may help child learn to control extreme mood swings. Psychotherapy will help the child learn relaxation techniques and build self-esteem.

Before administration of any therapy, the child’s mood should reach a stable plateau. Therefore, mood stabilizers are given to enable the child’s cognitive ability to absorb concepts of various therapies.

Management

Management of bipolar disorder is a stressful task for the child as well as the family. With the change of symptoms in the child, the treatment may also change. Some symptoms, which have disappeared, may appear after months or years requiring adjustments not only in medications but with the disease management. The family of the child with bipolar disorder will require family counseling from the child’s psychiatrist.  From accepting the child’s illness, to coping up with the child’s symptoms, managing and helping the child to comply with treatment requires time and mental strength. Parents should take their time to mentally accept and deal with the disorder. They should take the help of the psychiatrist or the counselor to help them cope and deal with BPD. Psychoeducation is also given to parents to help them understand bipolar disorder, its associated illness, disease management therapies and treatment. Parents should join support groups to network with other parents of children with bipolar disorder. This will help them to gain strength, learn coping strategies and other ideas for parenting children with bipolar disorder.

Written by: Irene J

Edited by: Michael K. Davis, MD

References

1. Child and Adolescent Bipolar Foundation, 2007, About Pediatric Bipolar Disorder, http://www.bpkids.org/learn/library/about-pediatric-bipolar-disorder
2. Mental Health America, 2010, Fact sheet: Bipolar Disorder in Children,, http://www.nmha.org/index.cfm?objectid=ca866daf-1372-4d20-c8023899e7497020
3. National Institute of Mental Health, Bipolar Disorder in Children and Teens,, http://www.nimh.nih.gov/health/publications/bipolar-disorder-in-children-and-teens-easy-to-read/index.shtml