Bipolar Disorder in Children, Teen, Adults:

Symptoms, Signs & Types

● What Is It?
○ Bipolar disorder facts
○ What is bipolar disorder?
○ What is the history of bipolar disorder?
○ Where can people find more information about bipolar disorder, bipolar disorder
support groups, and doctors who treat it?
● 2 Types
○ What are the types of bipolar disorder?
● Signs and Symptoms
○ What are bipolar disorder symptoms and signs in adults, teenagers, and
children?
○ What illnesses coexist with bipolar disorder?
● Causes
● Tests
○ What tests do health care professionals use to diagnose bipolar disorder?
● Treatment
○ What are bipolar disorder medications and other treatments? Are there any
home remedies or alternative treatments for bipolar disorder?
● During Pregnancy
○ How is bipolar disorder treated during pregnancy and the postpartum period?
● Complications
● How to Prevent
○ Is it possible to prevent bipolar disorder?
Bipolar disorder facts

Bipolar disorder is a condition that involves mood swings with at least one episode of mania.

● Bipolar disorder also called bipolar I disorder and previously called manic depression, is
a condition that involves mood swings with at least one episode of mania and may also
include repeated episodes of depression.
● Bipolar disorder afflicts up to 4 million people in the United States and is the fifth leading
cause of disability worldwide.
● The suicide rate for people with bipolar disorder is 60 times higher than in the general
public.
● Bipolar disorder was conceptualized by Emil Kraeplin more than 100 years ago, but its
symptoms were first described as long ago as 200 A.D.
● Bipolar disorder has several types, including bipolar I and bipolar II disorder based on
the severity of symptoms, and may be described as mixed or rapid cycling based on the
duration and frequency of episodes.
● As with most other mental illnesses, bipolar disorder is not directly passed from one
generation to another genetically but is thought to be due to a complex group of genetic,
psychological, and environmental risk factors.
● An adolescent with bipolar disorder is more likely to have depression and mixed
episodes, with rapid mood changes.
● Symptoms of bipolar disorder in women tend to include more depression and anxiety as
well as a rapid-cycling pattern compared to symptoms in men.
● Since no one test definitively determines that someone has bipolar disorder, health care
professionals diagnose this syndrome by gathering comprehensive medical, family, and
 mental health information in addition to performing physical and mental health
assessments.
● Treatment of bipolar disorder with medications tends to relieve already existing
symptoms of mania or depression and prevent symptoms from returning.
● Talk therapy (psychotherapy) is an important part of helping people with bipolar disorder
achieve the highest level of functioning possible.
● When treating bipolar disorder sufferers who are pregnant or nursing, health care
professionals take great care to balance the need to maintain the person's stable mood
and behavior while minimizing the risks that medications used to treat this disorder may
present.

Bipolar Disorder

Symptoms and Signs

The symptoms of bipolar disorder depend upon whether the sufferer is experiencing a
depressive or manic episode. A person must have experienced at least one manic episode to
be diagnosed with bipolar disorder. Symptoms and signs of manic episodes include

● elevated or expansive mood,

● rushed or pressured speech,
● racing thoughts,
● decreased need for sleep,
● poor judgment,
● increased goal-directed activity,
● impulsivity,
● grandiose thoughts (thinking one has superpowers or special abilities), and
● tangential speech (switching topics frequently).
What is bipolar disorder?

Bipolar disorder is a mental illness, specifically one of the affective (mood) disorders. It is
characterized by severe mood swings, at least one episode of mania and may include repeated
episodes of depression.

This illness afflicts more than 1% of adults in the United States, up to as many as 4 million
people. Some additional facts and statistics about bipolar disorder include the following:

● Bipolar disorder is the fifth leading cause of disability worldwide.

● Bipolar disorder is the ninth leading cause of years lost to death or disability worldwide.
● The number of individuals with bipolar disorder who commit suicide is 60 times higher
than that of the general population.
● There seems to be no increase in involvement with violent crime for people with bipolar
disorder compared to the general population except for those bipolar disorder sufferers
that also suffer from an alcohol or other substance use disorder.
● People who have bipolar disorder are at a higher risk of also suffering from substance
abuse such as alcoholism as well as other mental health problems.
● A number of medical problems tend to co-occur with bipolar disorder, including some
pain and neurological and genetic disorders.
● Males may develop bipolar disorder earlier in life compared to females.
● Blacks are sometimes diagnosed more often with bipolar disorder compared to whites.

What is the history of bipolar disorder?

Bipolar disorder was formally conceptualized by Emil Kraeplin more than 100 years ago, at
which time he described it as manic-depressive insanity. However, mood problems that include
depression alternating with symptoms that are now understood to be manic have been
referenced in history as long ago as 200 A.D.

At that time, this condition, like unipolar depression, was thought to be the result of bad blood,
called black bile. In the 19th century, this illness was referred to by terms like biphasic illness,
circular insanity, and dual-form insanity. Despite such negative terminology for this disease,
bipolar disorder is also known to be associated with significant achievement in some individuals.

Many historical figures and currently successful people suffer from this disorder, whose
creativity and accomplishments can therefore be an inspiration for current sufferers of the
disorder.
QUESTION
Another term that has been previously used for bipolar disorder is ___________________. See
Answer

What are the types of bipolar disorder?

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Bipolar disorder has several types, including:

● bipolar I disorder
● bipolar II disorder

Depending on how rapidly the mood swings occur, the episodes of bipolar disorder can also be
described as having mixed (mood disordered episodes that last less than the usual amount of
time required for the diagnosis) features or rapid cycling (four or more mood disordered
episodes per year) features.

About two-fifths of people with bipolar disorder have at least one period of rapid cycling
throughout their lifetime.

For every type and duration of the illness, the sufferer experiences significant problems with his
or her functioning at school, at work, socially, or otherwise in their community, may need
hospitalization, or may have psychotic symptoms (for example, delusions or hallucinations).

● The diagnosis of bipolar I disorder requires that the individual has at least one manic
episode but does not require a history of major depression.
● Bipolar II disorder is diagnosed if the person has experienced at least one episode of
major depression and at least one episode of hypomania (a milder form of mania).
Cyclothymic disorder is characterized by at least two years in adults, or one year in children and
adolescents, of episodes of having symptoms of depression and episodes of hypomanic
symptoms that do not qualify for having either a full major depressive, manic, or hypomanic
episode.

Mixed features are defined as meeting full diagnostic criteria for a manic episode while also
suffering from at least three symptoms of a depressive episode, or meeting full diagnostic
criteria for a major depressive episode while also suffering from at least three symptoms of a
manic or hypomanic episode.

People who suffer from significant, debilitating seasonal mood changes year after year may be
classified as having a seasonal pattern to their bipolar disorder.

What are bipolar disorder symptoms and signs in adults, teenagers, and
children?

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As indicated in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V),
to qualify for the diagnosis of bipolar disorder, a person must experience at least one manic
episode. Characteristics of mania must last at least a week (unless it is part of mixed features)
and include

● elevated, expansive, or irritable mood;

● racing thoughts;
● pressured speech (rapid, excessive, and frenzied speaking);
● decreased need for sleep;
● grandiose ideas (for example, false beliefs of superiority or failures);
● tangential speech (repeatedly changing conversational topics to topics that are hardly
related);
● restlessness/increased goal-directed activity;
● impulsivity, poor judgment, or engaging in risky activity (like spending sprees,
promiscuity, or excess desire for sex).

Symptoms of the manic episode of early-onset bipolar disorder in childhood or adolescence

tend to include

● outbursts of anger,
● rage, and
● aggression, as well as irritability, as opposed to the expansive, excessively elevated
mood seen in adults.
An adolescent with bipolar disorder is more likely to exhibit depression and mixed episodes with
rapid mood changes. Despite differences in the symptoms of bipolar disorder in teens and
children compared to adults, many who are diagnosed with certain kinds of pediatric bipolar
disorder continue to have those symptoms as adults.

Symptoms of bipolar disorder in women tend to include more depression and anxiety and a
rapid-cycling pattern compared to symptoms in men, and men with bipolar disorder are more at
risk for having an alcohol or other substance use disorder compared to women with the mood
disorder. Women bipolar disorder sufferers are also more prone to experience thyroid disease or
obesity compared to men.

Although a major depressive episode is not required for the diagnosis of bipolar disorder, such
episodes often alternate with manic episodes. Persistent sadness tends to occur more often
than mania in many people with bipolar disorder.

Characteristics of depressive episodes (bipolar depression) include a number of the following

symptoms:

● persistently depressed or irritable mood

● feelings of apprehension
● frequent crying, inability to feel pleasure
● loss of interest in previously pleasurable activities
● apathy, low motivation
● increased or decreased appetite, weight loss, or weight gain
● difficulty falling asleep
● excess sleepiness, agitation, or lack of activity
● fatigue/low energy
● feelings of worthlessness
● lack of concentration
● slowness in activity and thought
● inappropriate feelings of guilt
● hopelessness
● thoughts of death, self-harm or suicidal thoughts, plans, or actions.
SLIDESHOW
What Is Bipolar Disorder? Symptoms, Manic Episodes, Testing See Slideshow

What are bipolar disorder causes and risk factors?

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One frequently asked a question about bipolar disorder is if it is hereditary. As with most other
mental disorders, bipolar disorder is not directly passed from one generation to another
genetically. Rather, it is the result of a complex group of genetic, psychological, and
environmental vulnerabilities.

Genetically, bipolar disorder and schizophrenia have much in common, in that the two disorders
share a number of the same risk genes. However, both illnesses also have some unique genetic
risk factors.

Other mental health disorders, like anxiety and behavior disorders, can increase the likelihood
of developing bipolar disorder.

Stress is a significant contributor to the development of most mental health conditions, including
bipolar disorder. For example, gay, lesbian, and bisexual people are thought to experience
increased emotional struggles associated with the multiple social stressors that are linked to
coping with societal reactions to their sexuality.
People who have similar stress levels are equally prone to developing bipolar disorder
regardless of nationality, race, or socioeconomic status.

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What tests do health care professionals use to diagnose bipolar disorder?

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As is true with virtually any mental health diagnosis, no one test definitively assesses that
someone has bipolar disorder. Therefore, health care clinicians, like psychiatrists and clinical
psychologists, diagnose this disease by gathering comprehensive medical, family, and mental
health information.

● The health care professional will also either perform a physical examination or request
that the individual's primary care doctor perform one.
● The medical examination will usually include lab tests to evaluate the person's general
health and to explore whether or not the individual has mental health symptoms like
○ euphoria,
○ depression,
○ agitated depression, and
○ rarely paranoia or other symptoms of psychosis that are associated with a
medical condition.
●

In asking questions about mental health symptoms, mental health professionals are often
exploring if the individual suffers from depression and/or manic disorders, but also anxiety,
substance abuse, hallucinations or delusions, as well as some personality and behavioral
disorders.

Health care professionals may provide the people they evaluate with a quiz or self-test as a
screening tool for bipolar disorder and other mood disorders.

Since some of the symptoms of bipolar disorder can also occur in other mental illnesses, the
mental health screening is to determine if the individual suffers from bipolar disorder, a
depressive disorder, or the less severe symptoms of depression and hypomania associated with
cyclothymia.
The evaluation will also screen for an anxiety disorder like panic disorder, generalized anxiety
disorder, or posttraumatic stress disorder (PTSD), as well as whether the person with bipolar
disorder suffers from other mental illnesses like schizophrenia, schizoaffective disorder, and
other psychotic disorders, a substance abuse disorder like narcotic (for example, hydrocodone)
withdrawal or stimulant (for example, cocaine) intoxication, or a personality or behavior disorder
like attention-deficit hyperactivity disorder (ADHD).

Any disorder that is associated with sudden changes in behavior, mood, or thinking, like a
psychotic disorder, borderline personality disorder, or multiple personality disorder (MPD), may
be particularly challenging to distinguish from bipolar disorder. To assess the person's current
emotional state, health care professionals perform a mental status examination, as well.

From

What illnesses coexist with bipolar disorder?

In addition to providing treatment that is appropriate to the diagnosis, determining the presence
of mental illnesses that may co-occur (be co-morbid) with bipolar disorder is important in
improving outcomes.

● For example, people with bipolar disorder are at increased risk of committing suicide,
particularly after engaging in previous episodes of cutting or other self-harm.
● Therefore, mental health care professionals will carefully assess for any warning signs
that the person with bipolar disorder is thinking of harming himself or herself or others.

Individuals who suffer from this condition, in addition to either alcohol or substance-abuse
problems or borderline personality disorder, are also at risk of committing suicide.

● People with bipolar disorder are at higher risk of having an anxiety disorder like panic
disorder, phobias, generalized anxiety disorder, or obsessive-compulsive disorder
(OCD).

Several medical problems tend to co-occur with bipolar disorder, including pain disorders like
migraine headaches, neurological problems like multiple sclerosis, and genetic disorders like
velocardiofacial syndrome.

What are bipolar disorder medications and other treatments? Are there any
home remedies or alternative treatments for bipolar disorder?

● Read Doctor's View

● Readers Comments 28
● Share Your Story
Many people, whether they suffer from bipolar disorder or any medical or other mental illness,
understandably wonder how they might help themselves to have the best outcome of treatment.
While there is no cure for bipolar disorder, medications and psychotherapies remain the
mainstays of treatment of this illness.

Also, lifestyle improvements can be important complementary measures to care for this
population. For example, aerobic exercise has been found to help alleviate some of the thinking
problems, like memory and the ability to pay attention, that are associated with bipolar disorder
and other mental health problems.

While some home remedies or alternative/over-the-counter treatments like St. John's wort have
been found to help mild depression, they may induce a manic episode. There remains
insufficient evidence that such treatments successfully treat manic symptoms. Although
alternative medicine treatments for a bipolar disorder like St. John's wort or ginkgo Biloba are
not recognized as standard care for bipolar disorder, as many as one-third of some patient
groups being treated for this disorder report using them.

Medications that treat bipolar disorder

In terms of the overall approach to treatment, people with bipolar disorder can expect their
mental health professionals to consider several medical interventions in the form of medications,
psychotherapies, and lifestyle advice.

Treatment of bipolar disorder with medications (psychopharmacology) tends to address two

aspects:

● relieving already existing symptoms of the manic or depressive phases of the illness,
and
● preventing symptoms from returning.

Antipsychotic medications that are thought to be particularly effective in treating manic and
mixed symptoms include:

● olanzapine (Zyprexa),
● risperidone (Risperdal),
● quetiapine (Seroquel),
● ziprasidone (Geodon),
● aripiprazole (Abilify, Abilify Maintena, Aristrada),
● paliperidone (Invega),
● asenapine (Saphris),
● iloperidone (Fanapt),
● lurasidone (Latuda), and
● brexpiprazole (Rexulti).

Antipsychotic drugs belong to a group of medications called neuroleptics and are known for
having the ability to work quickly (in one to two weeks) compared to many other psychiatric
medications. For this group of medications, side effects that occur most often include
sleepiness, dizziness, and increased appetite. Weight gain, which may be associated with
elevated blood sugar, elevated lipid levels, and sometimes increased levels of a hormone called
prolactin, may also occur.

Although older drugs in this class, like haloperidol (Haldol), Thorazine (Chlorpromazine), and
thioridazine (Mellaril), are more likely to cause muscle stiffness, shakiness, and very rarely
uncoordinated muscle twitches (tardive dyskinesia) that can be permanent, health care
professionals appropriately monitor the people they treat for these potential side effects on a
long-term basis, as well.

Mood-stabilizer medications like lithium (Lithobid), as well as antiseizure (anticonvulsant)

medications like Divalproex (Depakote), carbamazepine (Tegretol, Tegretol XR, Equetro,
Carbatrol), and lamotrigine (Lamictal) can be useful in treating active (acute) symptoms of manic
or mixed episodes, as well as preventing the return of such symptoms. These medications may
take a bit longer to work compared to the neuroleptic medications, some (for example, lithium,
Divalproex, and carbamazepine) require monitoring of medication blood levels, and some can
be associated with birth defects when taken by pregnant women.

Antidepressant medications are the primary medical treatment for the depressive symptoms of
bipolar disorder. Examples of antidepressants that are commonly prescribed for that purpose
include:

● serotonergic (selective serotonin reuptake inhibitor or SSRI) medications like

○ fluoxetine (Prozac),
○ sertraline (Zoloft),
○ paroxetine (Paxil),
○ citalopram (Celexa),
○ escitalopram (Lexapro),
○ vortioxetine (Trintellix), and
○ vilazodone (Viibryd)
●
● there are also combination serotonergic/adrenergic medications (SNRIs) like
○ venlafaxine (Effexor),
○ duloxetine (Cymbalta),
○ desvenlafaxine (Pristiq), and
○ levomilnacipran (Fetzima), as well as
○ bupropion (Wellbutrin), which is a dopaminergic antidepressant.
●

While antidepressant medication remains a mainstay of treatment for the sadness of bipolar
disorder, the prescribing physician will remain watchful since there is some risk that
antidepressants can induce a manic or near-manic (hypomanic) episode or to the rapid
mood-cycling pattern of symptoms.
When using medicines to prevent symptoms of manic or mixed episodes, mood-stabilizer
medications like lithium or lamotrigine (Lamictal) are often used. Health care professionals who
prescribe lithium monitor blood levels of the medication to be sure it is within a therapeutic, safe
range of levels.

The functioning of other body systems is frequently followed to quickly address any abnormal
changes that may be associated with the medication. When a neuroleptic like olanzapine is
used in combination with lithium, symptoms of relapse may be prevented for a longer period
compared to when lithium is used alone.

While lamotrigine tends to cause few side effects, practitioners tend to question the people they
treat closely about symptoms of persistent fever, rash, or sore throat that may be warning signs
of a rare but potentially fatal side effect. Depakote is also associated with that rare but
potentially dangerous side effect.

Medications like topiramate (Topamax) are being researched as a potential treatment for people
with bipolar disorder who engage in pedophilia, sexual addiction, or are otherwise considered
sexually deviant. While oxcarbazepine (Trileptal) is sometimes used by many in an attempt to
manage the mood swings of both adult and pediatric bipolar disorder, its effectiveness remains
a matter of debate.

Despite its stigmatized history, electroconvulsive therapy (ECT) can be a viable treatment for
people whose bipolar disorder is severe and has inadequately responded to psychotherapies
and several drug trials. Transmagnetic stimulation (TMS) has been approved by the U.S. Food
and Drug Administration (FDA) for the treatment of mildly resistant depression and is thought to
be a helpful addition to medication in the treatment of bipolar disorder in individuals who have
not responded to at least one trial of medication. However, it is not yet considered to be an
adequate treatment of this illness by itself.

Psychotherapies

Talk therapy (psychotherapy) is an important part of helping individuals who are living with
bipolar disorder achieve the highest level of functioning possible by improving ways of coping
with the illness from day to day, as well as on a long-term basis. These interventions are
therefore seen by some as being forms of occupational therapy for people with bipolar disorder.

Psychotherapy may also engage people with bipolar disorder who prefer to receive treatment
without medication. While medications can be quite helpful in alleviating and preventing overt
symptoms, they do not address the many complex social and psychological issues that can play
a major role in how the person with this disease functions at work, home, and in his or her
relationships.

Since about 60% of people with bipolar disorder take less than 30% of their medications as
prescribed, any supports that can promote compliance with treatment and otherwise promote
the health of individuals in this population are valuable.
Psychotherapies that are effective in treating bipolar disorder include:

● family-focused therapy,
● psycho-education,
● cognitive behavioral therapy,
● interpersonal therapy, and
● social rhythm therapy.

Family-focused therapy involves the education of family members about the disorder and how to
provide appropriate support (psycho-education) to their loved ones. This intervention also
includes communication-enhancement training and problem-solving skills training for family
members.

Psycho-education involves teaching the person with bipolar disorder and their family members
about the symptoms of full-blown depressive and manic symptoms, as well as warning signs (for
example, feeling sad, change in sleep pattern or appetite, general discontent, change in activity
level, or increased irritability) that the person is beginning to experience either a mood episode
or the triggers for mood episodes (like lack of sleep, use of alcohol or other drugs, exposure to
severe stress).

In cognitive-behavioral therapy, the clinician works to help the person with bipolar disorder
identify, challenge, and decrease negative thinking and otherwise dysfunctional belief systems
that may impair their functioning relationships and self-esteem.

The goal of interpersonal therapy tends to be identifying and managing problems the sufferers
of bipolar disorder may have in their relationships with others.

Social rhythm therapy encourages stability of sleep-wake cycles, to prevent or alleviate the
sleep disturbances often associated with this disorder.

How is bipolar disorder treated during pregnancy and the postpartum

period?

When treating pregnant or postpartum individuals with bipolar disorder, health care
professionals take great care to balance the need to maintain the person's stable mood and
behavior while minimizing the risks that medications used to treat this disorder may present to
the patient, developing fetus, or nursing infant.

While many medications that treat bipolar disorder may carry risks to the fetus in pregnancy and
during breastfeeding, careful monitoring of the amount of medication that is administered as well
as the health of the fetus or infant and of the mother can go a long way toward protecting the
fetus or infant from any such risks, while maximizing the chance that the fetus or infant will grow
in the healthier environment inside or outside the womb afforded by an emotionally healthy
mother.
What are complications and the prognosis/effects over time of bipolar
disorder?

While the prognosis for bipolar disorder indicates that individuals with this disorder can expect to
experience episodes of some sort of mood problem (like depression, mania, or hypomania) up
to 60% of the time, those episodes can be well managed by the combination of psychotherapy
and medication treatment.

Clinical trials indicate that people who have a mixed pattern of symptoms can be more difficult to
stabilize with treatment and have a more problematic course than those who do not have mixed
episodes. Individuals who were misdiagnosed with other mental illnesses, thereby delaying
treatment for bipolar disorder, are at risk for a longer, more difficult duration of illness.

There are several potential complications of bipolar disorder, particularly if left untreated. This
illness may be compounded by other mental health problems including substance abuse and
addiction, whether it be to legal substances like alcohol or tobacco, prescription medications like
amphetamine and dextroamphetamine (Adderall), or hydrocodone/acetaminophen (Vicodin), or
illicit drugs like heroin or cocaine.

Bipolar disorder sufferers tend to experience thinking (cognitive) problems and those who are
repeatedly hospitalized psychiatrically have more trouble functioning throughout life. The risk of
committing suicide is 60 times higher for people with bipolar disorder compared to the general
population. That may be partly due to the chronic emotional pain that some people with this
disorder experience, in that they endure years of depressive and manic symptoms, the
consequences of their actions during those disease states, as well as potentially longing for the
increased energy and sense of well-being of mania that may be quelled by psychiatric
medications.

As with people with other mood disorders, those with bipolar disorder are at higher risk for
developing a medical illness and for having a higher number of medical illnesses than people
who do not have a mental illness. Bipolar disorder is the fifth leading cause of disability and the
ninth leading cause of years lost to death or disability worldwide.

Is it possible to prevent bipolar disorder?

While far more seems to be known about the prevention of symptoms of bipolar disorder
following its diagnosis, there is emerging research about ways to attempt to decrease the
development of the full-blown disease altogether. For example, when family-focused therapy is
provided to children who have more subtle symptoms preceding bipolar disorder and who have
bipolar relatives, they may be less likely to develop the full-blown disorder as adults.
Where can people find more information about bipolar disorder, bipolar
disorder self-help support groups, and doctors who treat it?

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● Share Your Story

Depression and Related Affective Disorders Association

2330 West Joppa Road, Suite 100

Lutherville, MD 21093

Phone: 410-583-2919

Fax: 410-614-3241

drada@jhmi.edu

National Federation of Families for Children's Mental Health

9605 Medical Center Drive

Rockville, MD 20850

Phone: 240-403-1901

Fax: 240-403-1909

National Alliance on Mental Illness (NAMI)

3803 N. Fairfax Dr., Suite 100

Arlington, VA 22203

Main: 703-524-7600

Fax: 703-524-9094

Member services: 888-999-NAMI (6264)

National Depression and Bipolar Support Alliance (DBSA)

730 N. Franklin Street, Suite 501

Chicago, Illinois 60654-7225

Toll-free: 800-826-3632
Fax: 312-642-7243

http://www.DBSAlliance.org

National Foundation for Depressive Illness, Inc.

PO Box 2257

New York, NY 10116

800-239-1265

National Institute of Mental Health

9000 Rockville Pike

Bethesda, Maryland 20892

301-496-4000

NIHinfo@od.nih.gov

Mental Health America

2000 N. Beauregard Street, 6th Floor

Alexandria, VA 22311

Phone: 703-684-7722

Toll free: 800-969-6642

Fax: 703-684-5968

Medically Reviewed on 12/21/2021

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