Maybe you've heard about or know someone with Bipolar Disorder, have a vague or general understanding, or maybe you have Bipolar Disorder yourself. Whatever the case may be, it's important to know what Bipolar Disorder is (including its signs & symptoms), treatment options, and recognizing Bipolar Disorder in children and teens. Knowing this information about mental health and mental illness will not only benefit you but the people around you.
Treatment for every mental illness always depends on the person, and not every treatment plan will work for everyone (but that doesn't mean there's no treatment out there for you). Always check with your psychiatrist, general doctor, or therapist before switching treatments or trying out a new one! Also, I'm not a doctor, and you should always check with yours first before changing up your regimen!
What is Bipolar Disorder?
If you aren't sure exactly what Bipolar Disorder is or you want to learn more, keep reading! However, if you already know about Bipolar Disorder you can skip ahead to Misconceptions or Treatment Options! The categories of Bipolar Disorder are listed below, followed by the signs and symptoms of Bipolar Disorder.
Bipolar I Disorder
Bipolar I is the more "extreme" category of Bipolar disorder, just meaning the symptoms are more severe and tend to last longer than the other categories of Bipolar Disorder. Someone with Bipolar I Disorder experiences at least a week or longer of manic symptoms/episodes, which sometimes can get so bad someone may need hospitalization during one of these manic episodes. The other defining characteristic of Bipolar I Disorder is the depressive symptoms/episodes that typically last 2 weeks or longer.
Bipolar II Disorder
Bipolar II Disorder is the less "extreme" version of the 2 main categories defining Bipolar Disorder. The episodes experienced don't tend to last as long as Bipolar I, but the pattern of depressive and hypomanic episodes are still present with less frequency and intensity.
Mixed Bipolar Episodes
Mixed Bipolar Episodes is a category of Bipolar Disorder where one experiences both depressive symptoms and mania or hypomania. These episodes can also appear in rapid sequence or happening right after the other with very little time passing.
Rapid Cycling
Rapid cycling occurs when someone experiences four or more depressive or manic episodes in a year. Rapid cycling can occur at any time during Bipolar Disorder, or symptoms can occur as a rapid sequence, like in Mixed Bipolar Episodes mentioned above.
Cyclothymia
This one may sound like a mouthful, however, Cyclothymia (si-clo-thee-mia), or Cyclothymic Disorder isn't very hard to understand. Someone with Cyclothymia will experience multiple symptoms of hypomanic symptoms as well as multiple symptoms of depressive symptoms within a 2 year period. For children and teens, this period only needs to be 1 year for a diagnosis. The hypomanic and depressive symptoms usually aren't frequent or intense enough to be diagnostically considered hypomanic or depressive episodes.
Unspecified Bipolar Disorders, or Bipolar Spectrum
This category includes the symptoms of Bipolar Disorder that do not fall into any of the previous categories mentioned. It can encompass not only depressive, manic, and hypomanic symptoms but also other mental health conditions involving mood swings or depression.
Symptoms of Bipolar Disorder
Depressive Episodes
Someone experiencing a depressive episode may experience some/any/all of the following symptoms:
Persistently feeling down, slow, empty, or numb
Loss of interest in activities you once enjoyed
Problems with sleep (oversleeping, insomnia, restless sleep, etc.)
Feeling hopeless or helpless
A decrease in self-esteem, self-confidence, self-love, etc.
Retreating from friends and social activities
Crying spells
Low energy, or loss of energy
Changes in appetite (over-eating, under-eating, etc.)
Loss of motivation/drive to complete activities you want and/or need to do
Low productivity
Feeling careless towards responsibilities
Feeling emotionally numb, mentally foggy, or having problems concentrating
Learned helplessness
Self-harm, suicidal thoughts, or suicide attempts
Manic Episodes
Someone experiencing a manic episode may experience some/any/all of the following symptoms:
Increased energy levels (for no apparent reason)
Racing thoughts
Impulsive or risky behavior (in or out of character)
Feeling invincible or "on top of the world"
Acting jumpy, high, or wired
Feelings of euphoria, intense pleasure, or productivity
Irritable, "on edge", or easily agitated
Having trouble sleeping
Fast-talking, switching from subject to subject
Heightened senses such as sensitivity to sound or touch
What is Hypomania?
Hypomania, in short, is the less severe form of mania. Someone with Bipolar II Disorder experiencing a hypomanic episode may just feel more energized, in a good mood, or more productive during that episode. Hypomania is considered less severe than mania because hypomania doesn't get out of control. Hypomania is still troublesome, however, because it either evolves into mania, or unpredictably swings from high energy and feeling on top of the world into a depressive episode.
Bipolar Disorder's symptoms, episodes, and mood swings/changes are unpredictable.
Signs of Bipolar Disorder
Acting out at school/work, using dangerous drugs, spending large amounts of money spontaneously, or having unsafe/risky sex (no protection, with an untrustworthy stranger in an unsafe environment, apathetic/careless about consequences of unsafe sex, etc.) are all examples of warning signs in someone possibly experiencing a manic or hypomanic episode. Bipolar Disorder warning signs mainly revolve around manic symptoms, because just observing depressive symptoms could appear to be warning signs of Major Depressive Disorder, or related disorders without further inspection for manic symptoms.
Friends and family often spot signs of Bipolar Disorder from manic/hypomanic symptoms in loved ones before the people with the disorder themselves actually do. During manic episodes, a person often doesn't feel anything is wrong, and enjoys the energy, productivity, and sometimes sociability they feel (especially in contrast to depressive episodes). This results in more people seeking treatment for Bipolar Disorder during depressive episodes because the symptoms are more unpleasant and often debilitating.
This can be a problem during diagnosis if your doctor is only aware of the depressive symptoms, and not the manic, causing a common misdiagnosis of Major Depressive Disorder in some cases. Misdiagnosis can also occur when there is a lack of awareness about Bipolar Disorder and mania/hypomania, so hopefully this article can spread some knowledge & shed some light!
Bipolar Signs & Symptoms: Normal or Abnormal?
How do you know when to seek treatment for a mental illness? Which behaviors are normal, and which are abnormal and need to be checked out by a mental health professional? It's vital to remember that while increased energy can be a symptom of mania, by itself increased energy isn't cause for alarm. Self-diagnosing can be dangerous, especially without professional advice and proper treatment.
Be sure to always step back and look at the big picture; psychiatrists use the DSM-5 to diagnose mental health/behavioral disorders because it gives clear guidelines for diagnosing mental illnesses. It lists symptoms of mental illnesses, the required amount of symptoms someone must experience to be diagnosed, and symptom/disorder time frames that indicate an abnormality.
The first question you should ask when debating behavioral abnormality is, is it maladaptive? That is, does the behavior seem self-destructive or self-defeating? After you ask this, always check the Three D's!
Disturbing; socially unacceptable behavior
Distressing; behavior, emotions, or thoughts cause personal distress
Distorted Thoughts; cognitive ability is impaired (ex. problems concentrating, connecting thoughts, reasoning, recognizing social norms, lack of empathy, etc.)
Time is an important factor when considering whether or not a behavior is normal or abnormal. Someone may be experiencing a manic or hypomanic episode if symptoms last longer than 7 days, while depressive episodes last 2 weeks or longer. Depending on the type of Bipolar Disorder and the developmental age of the person, diagnosis for Bipolar Disorder (& its category) can be affected by the episodes' time periods. The length of time one has been experiencing Bipolar symptoms (compared to the period of time the episodes themselves last) can also affect diagnosis; psychiatrists will inquire about symptoms you've experienced within the previous 6 months.
How To Treat Bipolar Disorder
Treatment Options
The most effective treatment plan for Bipolar Disorder (and many other mental illnesses)*, is a personalized combination of psychotherapy, medication prescribed from your doctor, and as a bonus, if you like all-natural treatment options (I mean, who doesn't), the incorporation of Mother Nature's medicine. Bipolar Disorder in children and teens, as well as their treatment options, will be discussed next.
*Treatment affects each person individually, and it's important to work with your psychiatrist and/or therapist to find the best treatment plan for you!
Psychotherapy
The importance of psychotherapy or "talk therapy" has been stressed on Rose-Minded before in other articles. What does psychotherapy do?
Helps someone identify automatic or programmed thoughts and thought patterns that can be harmful to oneself
These self-defeating thought patterns are examined to learn about their origins, how they affect emotions and behavior, and ways to try and transform these thoughts into healthier, more self-compassionate thought patterns
Helps someone identify and personalize healthy coping strategies for challenges and stress
Teaches relaxation techniques, mindfulness, locus of control, self-reflection, self-compassion
Safety planning for suicidal patients, patients who self-harm, or patients who have problems with impulse-control
Offers a place for emotional expression, works through emotion and mood tracking, and helps plan appropriate emotion regulation strategies
Helps with life planning, interpersonal communication and relationships, and social situations
Medication
Medication can be very effective in treating Bipolar Disorder, especially in combination with psychotherapy. Remain cautious in your decision to include medication in your treatment plan, many times other treatments can be attempted first to see if medication really needs to be introduced. This can be the case with some mental health disorders, however, Bipolar Disorder usually involves long-term treatment that typically requires medications such as mood stabilizers, anti-depressants, or in some cases, anti-psychotics. Always be wary of the side effects that come with medications, especially psychotropic medication (psychiatric medication), and never take a medication that wasn't prescribed by your doctor!
Mood Stabilizers
What are Mood Stabilizers?
Mood stabilizers are a type of psychotropic medication for the treatment of mood-related disorders. Anticonvulsants are also sometimes used to treat Bipolar Disorder, although they were originally created for the treatment of seizures, they were also found to help with mood swings and maintaining mood disorders. Some antipsychotics are used as mood stabilizers in more severe disorders because someone who experiences severe manic episodes with Bipolar Disorder can also experience hallucinations or delusions as symptoms of their manic episodes. Mood stabilizers are often used in combination with antidepressants and can be very effective in the treatment and maintenance of Bipolar Disorder.
Side Effects:
Here are possible side effects of mood stabilizers:
Itching & rashes
Dry mouth, excessive thirst, frequent urination
Tremors
Nausea
Changes in vision, "clumsiness"
Seizures
Swelling in extremities or face
Hallucinations or blackouts
Here are some possible side effects for anticonvulsants:
Irritability, agitation, or mood swings
Dizziness or drowsiness
Changes in vision
Weight and appetite changes, or constipation
Remember, not all medications will have these side effects and medication affects everyone differently. Always talk with your psychiatrist about possible side effects and alternative medication. Many people taking mood stabilizers or anticonvulsants are routinely checking up with their doctor to check the Lithium levels in their blood and their kidney and thyroid health.
Examples:
Lithium
Valproic Acid
Carbamazepine
Lamotrigine
Oxcarbazepine
Valproate
Asenapine (antipsychotic usually used as a mood stabilizer)
Antidepressants
What are Antidepressants?
Antidepressants are a type of psychotropic medication designed to regulate the neurotransmitters in your brain to try and remain at healthy levels. Antidepressants come in multiple forms, including SSRIs (Selective Serotonin Re-uptake Inhibitors), SNRIs (Serotonin and Norepinephrine Re-uptake Inhibitors), NASSAs (Norepinephrine and Specific Serotoninergic Antidepressants), NDRIs (Norepinephrine Dopamine Re-uptake Inhibitors), Tricyclics, and MAOIs (Monoamine Oxidase Inhibitors). Antidepressants are used in combination with many other types of psychotropics to treat multiple disorders, like Major Depressive Disorder.
Side Effects:
Here are possible side effects of antidepressants:
Nausea
Trouble sleeping or sleepiness
Sexual problems
Diarrhea
Weight gain
Occasionally with antidepressants, in the first week/month of taking a new antidepressant one may experience worsened symptoms or side effects before symptoms get better. If you or someone you know is having suicidal thoughts, call your doctor, local suicide hotline, or 911 right away.
Examples:
Fluoxetine
Citalopram
Sertraline
Paroxetine
Escitalopram
Bupropion
All-Natural Options
All-natural options are optimal as aides in your treatment plan for Bipolar Disorder. All-natural aides may not always produce strong results alone compared to psychotherapy or psychotropics, but with other treatments, it can be extremely beneficial to the management of Bipolar Disorder. The other benefit to natural treatments is the low amount (or complete lack of) side effects that medications can produce.
and now...
Bipolar Disorder in Children & Teens
Signs of Mania in Children & Teens:
Acts unusually happy or silly compared to other people their age or in inappropriate situations
Has a short temper or gets irritable quickly
Talks fast and switches subjects quickly
Increase in impulsivity and risk-taking
Problems sleeping, restlessness, or feeling awake after little rest
Trouble staying focused or attempting to multitask often
Signs of Depression in Children & Teens:
Low energy
Feels sad often
Complaining of stomachaches or headaches often
Oversleeping or undersleeping
Feelings of guilt or worthlessness
Low self-esteem
Changes in appetite or weight
Suicidal thoughts or self-harm
Other problems can also occur at the same time in a child, teen, or even adult with Bipolar Disorder:
Substance abuse
ADHD
Anxiety Disorders
Treatment for Children & Teens with Bipolar Disorder
Treatment for children and teens is actually quite similar to adults in that psychotherapy and medication is often required to treat and manage Bipolar Disorder. An important quote to remember when it comes to medication for children and teens is "start low, go slow."
Untreated symptoms in children and teens can evolve into worse symptoms in adulthood, so it's important to seek treatment as soon as you see warning signs. When approaching medication, talk with your doctor about your concerns and possible side effects, and be sure to write down all the signs and symptoms you've noticed in your child or teen.
Start with the lowest dose possible, and with the least amount of medications possible. Don't forget to talk to the child/teen about their symptoms as well, as they might have insights that could help you or the doctor. And remember... start low, go slow!
Always remember a combination of treatments is the best approach to treating and managing Bipolar Disorder in children, teens, and adults. Psychotherapy and medication, along with natural treatments, can definitely help with problematic symptoms!
Journaling can also help with managing symptoms, self-esteem, calming the mind, and improving mood. Currently, on Rose-Minded, there are 3 mental health journal guides- one for depression, anxiety, and now bipolar disorder.
References
https://www.nimh.nih.gov/health/publications/bipolar-disorder-in-children-and-teens/index.shtml
https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml#part_145406
https://www.webmd.com/bipolar-disorder/guide/bipolar-disorder-symptoms-types
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