Bipolar disorder, or manic depression, is not just an adult disease. Research and clinical experience shows that it is just as common in children and teenagers.
It's harder to diagnose however, because its symptoms can resemble or accompany those of other common mental disorders which start in childhood.
Symptoms may also be confused with normal child or teenage behavior and emotions. However unlike normal mood changes, bipolar disorder interferes with the way a child or teenager functions at school, home or with friends.
More research is needed to better understand how to diagnose and treat bipolar disorder in youth.
Generally in adults it consists of recurring extreme mood changes, energy or behavior, from a depressed state to a manic state, or a mix of both.
The manic state often shows extreme mood changes, from being extremely irritable to overly silly and elated. It also shows over-inflated self-esteem, more energy and a severely decreased need to sleep. A person may talk too much, too fast, change topics too quickly or not let themselves be interrupted. They also may be easily distracted, shifting attention constantly from one thing to another, or show physical agitation, excessive risky behavior, increased sexual thoughts, feelings or behaviors, or use of explicit sexual language.
The depressed state may show a persisting sad or irritable mood, a loss of interest in activities, a substantial change in appetite or body weight, difficulty sleeping or oversleeping. They may also suffer from a loss of energy, physical agitation, feelings of worthlessness, inappropriate guilt, problems concentrating or recurrent thoughts of death or suicide.
In children and teenagers, these symptoms may be different however.
When manic, they are more likely to be irritable and prone to destructive outbursts than to be elated or euphoric.
When depressed, they may have physical complaints like headaches, stomach aches or tiredness. They may skip school, get bad grades, talk about running away from home, complain, be irritable, spend time alone, cry for no reason, communicate poorly or be very sensitive to rejection or failure.
They may also abuse alcohol or drugs and have relationship problems.
Bipolar disorder that begins in childhood or early adolescence may be different or more severe than others. It often shows continuous, rapid-cycling, irritable mixed symptoms, which may occur with ADHD (attention deficit hyperactivity disorder) or CD (conduct disorder), or may have features of these disorders as initial symptoms.
In contrast, later adolescent or adult-onset bipolar disorder usually begins suddenly, often with a classic manic episode, with more stable periods between episodes and often not with ADHD or CD.
A child or teenager who appears to be depressed and shows severe ADHD symptoms, with excessive temper outbursts and mood changes, should be seen by a psychiatrist or psychologist experienced in bipolar disorder, especially if there is a family history of bipolar disorder. ADHD medications may worsen manic symptoms.