A person with bipolar disorder has extreme changes or swings in moods, from mania to depression. This illness is called "bipolar" disorder because of the two "poles" of mood. It is sometimes called manic depression because people have periods of mania and periods of depression.  

The word "manic" means a person feels overly excited and confident. They may then quickly change to feeling confused, irritable, angry, and even full of rage.

A person with depression feels very sad or may lose interest in things they used to enjoy. Sometimes people with bipolar disorder are diagnosed as having major depression by mistake.

People can also have symptoms of mania and depression at the same time. These periods are called mixed episodes. They may have normal moods between mood swings.

We do not know the exact cause of bipolar disorder. It seems to involve several factors that are both genetic and environmental. Children and youth with this disorder tend to get worse over time if they do not get the proper treatment. They may have difficulties with substance use, get into accidents or not do well in school. They are also at risk for coming in contact with the justice system or to die by suicide.

There are different types of bipolar disorder.

• Bipolar I disorder is when someone:
  • has manic episodes that last at least 7 days (most of the day, nearly every day)  
  • has manic symptoms that are so severe that hospital care is needed
  • usually has episodes of depression as well, and usually for at least 2 weeks  
  • may also have episodes of mood changes with mixed features
  • may experience four or more episodes of mania or depression within a year called "rapid cycling".
• Bipolar II disorder is when someone has depressive and hypomanic episodes and the manic episodes are less severe than in bipolar I disorder.
• Cyclothymic disorder is when someone has recurring symptoms that are not intense enough or do not last long enough to be called hypomanic or depressive episodes. This disorder is also known as cyclothymia.

There is also a newer diagnosis for children who often have abnormal mood changes - Disruptive Mood Dysregulation Disorder. Children and youth with this disorder usually have regular and lasting mood and temper outbursts at least three times a week for at least a 12-month period.  

There is no cure for bipolar disorder at this time. However, the symptoms can be managed with proper treatment, understanding, and life changes. 

When does it start?

Bipolar disorder can happen at any age but it is not common in young children and early adolescence. Most people with bipolar disorder have their first episode of mania or hypomania late in adolescence or early adulthood. Before their first episode, young people often experience other issues such as anxiety and depression.  

Between 1-2% of all people are affected by bipolar disorder. The diagnosis can be made by a trained professional (such as a psychiatrist, psychologist, or pediatric neurologist). They use information from a child or youth’s home, school, and a clinical visit to diagnose bipolar disorder. 

When children and youth first get bipolar disorder, they may have depression or mania or both. They do not have to have depression to be diagnosed with a bipolar disorder. It may be hard to identify their first episode. Children and youth who have symptoms of depression first may actually turn out to have a bipolar disorder. They should be carefully monitored to see if symptoms of mania develop.

When children and youth are depressed, they may:

• look sad or tearful
• be constantly irritable
• be tired or listless
• not be interested in their favourite activities

Children and youth with mania have a significant change in their mood and energy. The following changes are visible:

• being very irritable or aggressive
• difficult to comfort or console
• being abnormally happy, silly or giddy
• needing to sleep less, being restless and/or overly active
• talking a lot more than normal
• being easily distracted that is not usual for them
• risky behaviours or sexual behaviours beyond what is normal for their age
• strange thoughts (for example, they may believe they are more powerful than other people or think they have superpowers)
• hearing voices that are not real
• exploding with anger and may yell or scream for a long time
• may get aggressive and hit, kick, bite or break toys or other objects

Children and youth with bipolar disorder have mood swings that may seem to happen without warning. They often do not respond to normal parenting efforts. Parents can become discouraged and exhausted. They may try almost anything to avoid or stop the severe tantrums. It’s common to feel helpless and guilty when nothing seems to work. Children and youth may be frightened and confused by moods they can’t control. They often feel bad for the hurt they cause others.

At Home

Children and youth can have more obvious symptoms at home. Their moods are harder to control when they feel tired or stressed by family relationships. They may feel pressured by the things they have to do like homework and getting ready for school on time. They are also more likely to show troubling emotions such as anger, anxiety, and frustration in the safety of their own home.

At home, children and youth may show some of these symptoms:

• moods that swing rapidly
• depressed or sad moods
• loss of interest in things they used to enjoy
• talk of suicide, self-harm behaviours, or hurting themselves or others
• overexcited or silly mood
• feelings of being "the best", think they can succeed in superhuman efforts or risky behaviours
• extra sensitive to what they think is criticism
• easily frustrated
• less able to plan, organize, concentrate, reason or solve problems
• extremely irritable
• rages, tantrums, crying spells, or explosive outbursts that can last for hours and happen many times each day or week for little reason (such as being told "no"). These can last longer, be stronger, be triggered more easily and take more time to get over than other children
• unusually aggressive to the closest person, parents and siblings are often the main targets
• restless or fidgety, often with no order or plan
• changes in sleep patterns, too much or too little sleep or difficulty falling asleep
• unusual sexualized behaviours or comments
• beliefs that things that are not real ("People are talking in my closet") or fears ("Everyone at school hates me, so I'm not going")

At School

At school, children and youth may show some of these symptoms:

• less alert, less able to think and concentrate
• trouble planning, organizing, concentrating, and reasoning
• extra sensitive to what they think is criticism
• unfriendly, doesn’t cooperate, gets angry easily  
• crying for no real reason, being overly upset in situations, can’t be reasoned with or consoled when upset
• extremely high level of anxiety that makes it difficult to make sense of a situation
• easily frustrated or discouraged, tasks seem much harder than for most children

It is difficult to predict how a child will react to the stresses of schoolwork, classroom noise, and going between classes and activities. Over time, symptoms may get worse if the child is not treated or new problems develop.

Children and youth with bipolar disorder may have other conditions that make learning more challenging, such as:

• attention deficit/hyperactivity disorder (ADHD)
• anxiety disorders
• behavioural disorders
• learning disability
• problematic substance use

A child or youth may need to be assessed for a learning disability or ADHD if they still have trouble learning after their bipolar disorder is treated. A child that doesn't want to go to school may also have a learning disability.

If you are concerned about a child or youth’s behaviour, it’s important to have a trained mental health professional evaluate the child. This needs to happen immediately if the child seems to be thinking about suicide or if their behaviour has become out of control. The best person to see is a professional such as a psychiatrist or psychologist who knows the symptoms and treatment of early-onset bipolar disorder.

Before the evaluation, it will help to make daily notes of the child or youth’s:

• mood, especially any patterns of mood changes
• behaviour in different places, such as at home, school, activities, and with peers
• sleep patterns
• triggers for mood changes, or unusual events or stressors
• things the child says that are of concern

Share these notes with the doctor or professional making the evaluation. Then share them with the professional who treats the child. A child or youth with bipolar disorder may seem to be functioning well during their first appointment. That is one reason a good evaluation can take several appointments and include a detailed family history.

Medications

There are medications that are effective at managing bipolar disorder. They can help with severe agitation in mania. Some may reduce the length of a manic episode. There are medications that can treat bipolar depression as well. Children and youth taking these medications sometimes experience side effects. They may:

• feel really tired
• feel very thirsty
• have an upset stomach
• gain weight
• have trouble thinking and performing at school

It is important for the school to have information about the child or youth's medications. Learn more about medications used to treat bipolar disorder.  

Therapy

There are therapies that have been tested and shown to help children, youth and their families manage symptoms of bipolar disorder. 

These therapies include:

• Family skill building
• Psychoeducation
• Cognitive behavioural therapy
• Dialectical behaviour therapy (DBT)

Other therapies are also being tested to see if they are effective in treating bipolar disorder. Learn more about types of therapy.

Can bipolar disorder be prevented?

Right now, we do not know the exact causes of bipolar disorder. But we do know the symptoms, and there is a better chance of finding it early and starting treatment that is effective. This may prevent long periods of illness and hospital stays, and even suicide. 

• Talk to your doctor, and ask for a referral to a specialist (like a psychiatrist) who can evaluate your child
• Get support and a mental health assessment at your local Child and Youth Mental Health team (through a walk-in intake clinic in your community).  
• Contact a private psychologist who is able to evaluate your child:
  • visit the BC Psychological Association website or call 1-800-730-0522

Looking for more information on this topic? Connect with a family peer support worker at the Kelty Centre and discover additional resources, learn more about support and treatment options, or just to find a listening ear.