A person with bipolar disorder has extreme changes or swings in moods, from mania to depression. Because of the two “poles” of mood, this illness is called "bipolar" disorder.

Bipolar disorder is sometimes called manic-depression because people experience both mania and depression. The word "manic" means a person feels overly excited and confident. The person 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.

The symptoms of mania and depression can also happen at the same time. These periods are called mixed episodes. In between episodes of mood swings, they may experience normal moods.

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, not do well in school, or get into accidents. They are also at risk for coming in contact with the justice system or committing suicide.

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

When does it start?

People often develop bipolar disorder during puberty. In a survey of adults with bipolar disorder:

• 59% said they had symptoms during or before adolescence
• 50% reported having it before the age of 17
• 20% reported it happening between the ages of 10 and 14
• 10% had it for the first time between ages 5 and 9*

It is becoming more common for children and youth to be diagnosed with bipolar disorder. Between 1-2% of all people are affected by bipolar disorder. A trained professional (such as a psychiatrist, psychologist, or pediatric neurologist) can use information from the child or youth’s home, school, and clinical visit to make a diagnosis of bipolar disorder.

 ^{*James Chandler, MD, FRCPC Bipolar Affective Disorder (Manic Depressive disorder) in Children and Adolescents}

When children and youth first get a bipolar disorder, they may have depression or mania or a combination of 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 mania symptoms 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 experience a change in their mood and energy. The following changes are visible:

• being very irritable or aggressive
• difficult to comfort or console
• being very happy, silly or giddy
• sleeping less, being restless and/or very active
• talking more than normal
• being easily distracted
• 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 they may think they have superpowers
• may hear voices
• explosive outbursts that may involve physical aggression or long, raging tantrums

Children and youth with a bipolar disorder have mood swings that often 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 a child or youth’s severe tantrums and 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 have most bipolar symptoms at home. Their moods are harder to control when they feel tired or they are stressed by family relationships. They may feel pressured by the things they have to do like homework and getting ready for school on time. Children and youth are also more likely to show troubling emotions such as anger, anxiety, and frustration in the safety and privacy of their own home and family.

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 giddy 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, and use abstract reasoning
• extremely irritable
• rages, tantrums, crying spells, or explosive outbursts that can last for hours, 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 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:

• changes in alertness and in their ability to think and concentrate
• difficulty with planning, organizing, concentrating, and reasoning
• extra sensitive to what they think is criticism
• hostile or defiant and easily provoked
• crying for no real reason, being upset out of proportion to actual events, can’t be reasoned with or consoled when upset
• extremely high levels of anxiety that interferes with their ability to make sense of a situation
• easily frustrated or discouraged, tasks seem much more difficult than for a typical child

The differences in behaviour at home and at school can be dramatic. It is hard to predict how a child will react to the stresses of schoolwork, classroom noise, and travelling 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)
• behavioural disorders
• learning disability

If a child or youth still has trouble learning after their bipolar disorder is treated, they may need to be tested for a learning disability. 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 (such as a psychiatrist or psychologist) 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 who knows the symptoms and treatment of early-onset bipolar disorder.

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

• mood, particularly highlighting any patterns of mood changes
• behaviour in different settings, such as at home, school, in extracurricular 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 and with the professional who eventually treats the child. Children and youth with bipolar disorder may seem to be functioning well during their first appointment. A good evaluation can take several appointments and include a detailed family history.

Medications

There are medications that are effective at managing bipolar disorder. These medications can help address severe agitation in mania and help reduce the length of a manic episode. Children and youth taking these medications sometimes have 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

In addition to medications, different types of therapies can help children, youth and their families manage symptoms of bipolar disorder. Family skill building and psychoeducation, as well as dialectical behaviour therapy (DBT), have been tested and have evidence that they can be effective for bipolar disorder. Other therapies have been considered and their effectiveness is being tested. Learn more about types of therapy.

Can Bipolar Disorder be prevented?

Right now, we do not know the exact causes of bipolar disorder. However, it is important to know the symptoms of bipolar disorder so there is a better chance of finding out early, and starting effective treatment and ways to deal with the disorder. This may prevent long periods of illness and hospital stays, and even suicide.

• Talk to your doctor, and ask if they can provide a referral to a specialist (like a psychiatrist) who can evaluate your child
• Get a mental health assessment and support through 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 to discover additional resources, learn more about support and treatment options, or just to find a listening ear.