Condition Basics

Bipolar disorder in children: Overview

Bipolar disorder can appear at any age, but it is very rare in children and teens. Bipolar disorder is sometimes called manic depression. It is an illness that causes extreme mood changes. Moods go from times of very high energy to times of depression. These moods may cause problems with your child's schooling, family life, friendships, and ability to function.

There is no cure for bipolar disorder. But it can be helped with medicines. Counselling may also help. It is important for your child to take any medicines exactly as prescribed, even when they feel well. Your child may need lifelong treatment.

What causes it?

The cause of bipolar disorder isn't completely understood. There are likely many factors involved. It seems to run in families. Your child has a greater risk of having bipolar disorder if a close family member has it. Bipolar disorder can be related to genetics or an imbalance in your child’s hormones. Negative experiences, unsafe or unstable environments, and stressful life events (trauma) can also increase the chances of developing bipolar disorder.

What are the symptoms?

Bipolar disorder causes cycles of mania and depression. Mania is a period of an extremely happy, irritable, or angry mood. Your child may need little sleep and talk very fast. During a depressive episode, your child may have a sad, low, or cranky mood. Your child may have low energy.

How is it diagnosed?

Doctors make the diagnosis by asking about health problems your child and family members have had. The doctor will ask about your child's feelings and behaviour. Your child will also get a physical exam. And the doctor may ask questions to rule out conditions with similar symptoms, like disruptive mood dysregulation disorder (DMDD).

How is bipolar disorder treated?

Bipolar disorder can be managed. Treatment may vary depending on how bad the condition is and your child's age, medical history, and tolerance to medicine. It usually includes medicines (such as mood stabilizers) and counselling. Often a combination of both is needed. To help at home, see that your child gets exercise and has a regular sleep schedule. If your child shows dangerous behaviour, he or she may need to go to the hospital.

What Increases Your Risk

Your child's risk for bipolar disorder or other mood disorders is higher if the child:

• Has a close relative such as a parent, sibling, or grandparent with bipolar disorder or another mood disorder.
• Has a family history of substance use disorder.

Symptoms

Bipolar disorder causes cycles of mania and depression.

Manic symptoms

A manic episode lasts at least a week. It's a period of being extremely happy, irritable, or motivated. The child or teen may:

• Have little need for sleep.
• Have high energy levels.
• Have extreme self-confidence.
• Talk very fast.
• Have many thoughts at once.
• Seem very distracted and unable to focus.
• Touch their genitals, use sexual language, and approach others in a sexual way.
• Act inappropriately or intrude in social settings.
• Show risky, wild, thrill-seeking behaviour.

Depressive symptoms

A depressive episode is a period of a sad, low, or cranky mood. The child or teen may:

• Not find pleasure in things that they normally enjoy.
• Have low energy or feel "slowed down."
• Have sleep and appetite changes.
• Have low self-esteem.
• Feel guilty or worthless.
• Withdraw from friends or family.
• Have trouble focusing.
• Have thoughts about death or suicide.

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What Happens

Bipolar disorder can include both manic and depressive episodes. Often the first signs of bipolar disorder are being severely moody, unhappy, or depressed.

Children and teens having a manic episode may:

• Have trouble sleeping.
• Have more extreme happy or silly moods than most others their age have.
• Be irritable or have a short temper.
• Take risks and not think about the consequences.
• Have trouble staying focused.

Children and teens having a depressive episode may:

• Not find pleasure in things that they normally enjoy.
• Sleep more.
• Feel guilty or worthless.
• Withdraw from friends or family.

Watch for warning signs of suicide. This can include preoccupation with death or suicide or a recent breakup of a relationship. If you notice any signs that your child may hurt themself, get help right away.

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When to Call a Doctor

Call 911 or other emergency services immediately if:

• Your child is thinking seriously of suicide or has recently tried suicide. Serious signs include these thoughts:
  • Deciding how to kill themself, such as with a weapon or medicines.
  • Setting a time and having a plan.
  • Thinking there is no other way to solve the problem or end the pain.
• Your child feels that they can't stop from hurting themself or someone else.

Where to get help 24 hours a day, 7 days a week

If your child talks about suicide, self-harm, a mental health crisis, a substance use crisis, or any other kind of emotional distress, get help right away.

• Call or text Canada's suicide and crisis hotline at 988.
• Health Link: 811
• Mental Health Helpline: 1-877-303-2642
• 211 Alberta: 211 (text and online chat are also available)
• Call Talk Suicide Canada: 1-833-456-4566 or text 45645 (4 p.m. to midnight ET).
• Kids or teens can call Kids Help Phone: 1-800-668-6868 or text CONNECT to 686868.
• Go to the Talk Suicide Canada website at https://talksuicide.ca or the Kids Help Phone website at https://kidshelpphone.ca for more information.

Consider saving these numbers in your phone.

Call a doctor now if:

• Your child hears voices.
• Your child has been thinking about death or suicide a lot but doesn't have a suicide plan.
• Your child is worried a lot that the feelings of depression or thoughts of suicide aren't going away.

Seek care soon if:

• Your child has symptoms of depression or mania, such as:
  • Feeling sad or hopeless.
  • Not enjoying anything.
  • Having trouble with sleep.
  • Feeling guilty.
  • Feeling anxious or worried.
  • Feeling extremely happy or very grouchy.
  • Talking too fast or more than usual.
  • Being more active than usual.
  • Having trouble concentrating because of having too many thoughts at the same time (racing thoughts).
  • Acting inappropriately or intruding in social settings.
  • Touching their genitals, using sexual language, and approaching others in a sexual way.
  • Showing risky, wild, thrill-seeking behaviour.
• Your child has been treated for depression for more than 3 weeks but is not getting better.

Family support

It's best to build a long-term relationship with your child's care providers. Then when a depressive or manic episode occurs, the care providers can recognize the changes in the child's behaviour and provide quick treatment advice.

If you are a family member of a child with bipolar disorder, it's very important to get the support and help you need. Living with or caring for someone who has bipolar disorder can really disrupt your own life. Manic episodes can be extra tough. It may help to seek your own counsellor or therapist to support you.

Also, some national support organizations may have a local chapter in your area or provide information online. Examples of such groups include the Canadian Mental Health Association and the Mood Disorders Society of Canada.

Examinations and Tests

Doctors make the diagnosis through a combination of:

• A medical history. The doctor will ask questions to help find other past and present health conditions that could cause the symptoms.
• A family history. This can identify bipolar disorder, other mood disorders, or a substance use disorder in close relatives. (All of these conditions are linked to bipolar disorder.)
• A physical exam. It can rule out other conditions with similar symptoms.
• A mental health assessment. It can help identify your child's current mental state and the severity of depression or mania.
• Asking questions about your child's feelings and behaviour. And the doctor may ask questions to rule out conditions with similar symptoms, such as disruptive mood dysregulation disorder (DMDD).
• Other written or verbal mental health tests.

The doctor may do other tests (such as a blood test) to rule out other health problems.

Treatment Overview

The mood changes that come with bipolar disorder can be a challenge. But with the right treatment, they can be managed. Treatment usually includes medicines (such as mood stabilizers) and counselling. Often a combination of both is needed.

Treatment options include:

Medicines.

Make sure your child takes their medicine. Children and teens with this disorder sometimes stop taking their medicines when they feel better. But without medicine, the symptoms usually come back.

Counselling.

Counselling works best when symptoms of bipolar disorder are controlled with medicines.

Home treatment.

This includes helping your child get regular exercise, eat healthy foods, and have a regular sleep schedule.

Hospital treatment.

If your child's behaviour is suicidal, aggressive, reckless, or dangerous, or if they have symptoms of psychosis such as hallucinations, your child may need to go into the hospital for a while.

Self-Care

Learning as much as you can about bipolar disorder may help you recognize mood changes in your child as they start to occur. Catching and treating these mood changes early may help reduce the length of the manic or depressive episode and improve the quality of your child's life.

Here are some steps you can take at home to reduce your child's symptoms and manage your child's moods.

• Be sure your child gets enough sleep.

  Keep your child's room quiet. And have your child go to bed at the same time every night.

• Help manage the amount of stress in your child's life.

  You may need to find ways to help your child reduce school requirements during times of severe mania or depression.

• Recognize early signs of manic and depressive mood episodes.
• Be sure your child gets enough exercise.

  During a depressive episode, your child may feel like doing only gentle exercises, such as taking a walk or swimming.

• Be sure your child eats healthy foods.

  Try to avoid beverages that contain caffeine, including coffee, tea, colas, and energy drinks. The Canadian Paediatric Society recommends that children and teens not drink energy drinks. ^{footnote 1}

• Help your child avoid things that may lead to a mood episode.

  Don't let your child use alcohol or drugs. Substance use disorder makes bipolar disorder worse.

• Ask for help from friends and family when you need it.

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Medicines

Medicines most often used to treat bipolar disorder in children and teens include mood stabilizers, antipsychotics, and antidepressants.

Before prescribing medicine to treat bipolar disorder, your child's doctor will ask questions about possible suicidal behaviour.

When you and the doctor are deciding which types of medicines to use, think about:

• The side effects of each medicine.
• How often your child will need to take the medicines.
• Whether your child is being treated for other illnesses or mental health conditions. How will those medicines interact with medicines for bipolar disorder?
• Whether your child has used any of the medicines before. Did they work?

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Counselling-Based Treatment

Counselling along with medicine can work well to manage bipolar disorder. Types of counselling include:

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