Bipolar Depression in Children and Teenagers
Bipolar disorder (Bipolar Disorder) is thought to be just as common among children and adolescents as it is among adults. Studies also show that 20% of teens with major depression will develop Bipolar Disorder within several years of the onset of major depression. Of the estimated four million children and teens with depression, about one-third may be experiencing more than depression. In fact, research suggests they could be experiencing symptoms of bipolar depression.
The primary problem with diagnosing bipolar disorder in older children and teenagers is the similarity between Bipolar Disorder symptoms and the often erratic behavior of teenagers. Parents may assume their teen’s extreme behavior is just “growing pains” and a normal aspect of transitioning into adolescence. Unfortunately, a bipolar teen who does not receive the treatment they need may suffer intense bipolar depression that leads to suicide ideation.
How does a parent know when their teen could be bipolar? Although research has yet to uncover the exact causes of Bipolar Disorder, they now know that genetic mechanisms may play a key role in whether someone develops Bipolar Disorder at any age. If a child has a parent, grandparent or sibling with bipolar disorder, their risk for having Bipolar Disorder increases significantly. However, multiple genes are involved in expressing Bipolar Disorder and having a family member with Bipolar Disorder does not automatically mean a child will eventually have symptoms.
Other risk factors include experiencing stressful or traumatic life events (parents getting divorced, death of a close family member, loss of the family home to fire or other catastrophic event) and having slightly abnormal brain architecture conducive to neurotransmitter imbalance. However, the hypothesis that the brain structure of teenagers and adults with Bipolar Disorder is still being studied and no conclusive results have been determined yet.
What is the Difference Between Bipolar Depression and Major Depression?
Bipolar disorder is actually comprised of four subtypes of Bipolar Disorder:
- Bipolar I
- Bipolar II
- Cyclothymic disorder
- Bipolar disorder not specified
Extreme mood swings characterize all subtypes of Bipolar Disorder. The primary difference between bipolar I and bipolar 2 is the intensity of manic symptoms. For example, a bipolar teenager with bipolar I disorder experiences extreme manic episodes.
Alternately, teens with bipolar II disorder will experience extremely hypomanic (depressed) episodes punctuated by manic episodes less severe than those suffered by teens with bipolar I disorder. Children and adults with bipolar I may or may not go through episodes of severe depression.
Bipolar depression in children may be diagnosed as bipolar II disorder instead of just general Bipolar Disorder. Characteristics of Bipolar Disorder II are:
- Major depression lasting for at least two weeks that also involves one manic episode (manic episodes associated with Bipolar Disorder II are less severe than Bipolar Disorder I manic episodes)
- Sleeping/staying in bed more than 10 hours a day
- Not eating/eating only “junk” food
- Complaining of physical problems not attributable to infection or disease (headaches, joint pain, stomachaches, nausea, temperature sensitivity)
- Refusing to go to school/refusing to do homework
- Increasing irritability and hostility
- Isolating themselves for days
- Talking about suicide/attempting suicide
When parenting a bipolar teenager with bipolar depression II, you may not notice the mild manic episodes emerging between major depressive episodes. When a bipolar II teen is more “up” than usual, they may be a bit more talkative and sociable. They may not spend hours lying in bed and even eat dinner with the family.
If you suspect your child may be bipolar, it is essential you have your child evaluated by a psychologist or psychiatrist specializing in adolescent mental illness. An accurate diagnosis means your child can receive the appropriate treatment needed to help them manage and cope with bipolar depression.
Is Bipolar Depression in Teen Girls Different Than Bipolar Depression in Teen Boys?
Adolescent girls are at a much higher risk for having bipolar depression than adolescent boys. Gender-specific effects on brain areas involved in depression have been found in neuroimaging research studies, with teen girls experiencing greater imbalances of neurotransmitters than teen boys. Reasons for higher incidences of depression in teen girls than teen boys involve hormones, body image stress and genetics.
During an episode of bipolar depression, teenage girls are more likely to:
- Isolate themselves from friends and family
- Sleep excessively
- Complain about physical issues
- Avoid eating meals
- Cry easily
- Attempt suicide by overdosing on OTC medication or their parent’s prescriptions
Bipolar depression symptoms in teen boys tend to be more gender-specific. They involve:
- Engaging in risky behaviors (driving too fast, drinking alcohol, abusing drugs, hanging out with “questionable” people, refusing to obey curfew)
- Acting more hostile towards family members
- Uncharacteristic aggressive behavior (throwing items when angry, slamming doors, threatening siblings or parents with physical harm)
- Eating too much or too little
- Being secretive about what they are doing outside the home
- Verbalizing suicide threats
Sometimes, bipolar depression in teen boys may be misdiagnosed as oppositional defiant disorder since symptoms appear more hostile than depressed. Parents should keep a detailed record of their child’s mood swings if they suspect bipolar II disorder to determine if signs of mild to moderate mania emerges between depressed episodes.
Bipolar Depression Treatment for Older Children and Teenagers
Adolescents with major depressive disorder are typically given a selective serotonin reuptake inhibitor (SSRI) to stabilize serotonin levels in the brain. However, giving SSRIs to teens with bipolar depression may cause manic episodes to worsen. Several FDA-approved medications that do not carry that risk are now available to treat bipolar depression in children between the ages of 10 and 17. Medications such as Lurasidone, Olanzapine, lithium and Lamotrigine have been shown to reduce symptoms of bipolar depression while causing only mild, temporary side effects like nausea, headache and fatigue.
Lurasidone is one of the more effective pharmacological treatments for bipolar depression in teens. In addition to raising serotonin levels, it moderates dopamine release in the brain. A neurotransmitter implicated in schizophrenia and other serious mental illnesses, dopamine is responsible for motivation and reward-seeking behavior. Since severely depressed individuals show significantly reduced motivation, Lurasidone works to ensure a balance exists between dopamine and serotonin.
Cognitive behavioral therapy and stress management counseling should also be part of a treatment program for teens with bipolar depression. While CBT helps teens understand how their thoughts shape their emotions and behaviors, counseling educates teens in how to cope with daily anxiety using a variety of stress management techniques.
Advice for Parenting a Teenager with Bipolar Depression–What the Experts Say
Ensuring your teen is taking their medication properly and attending all scheduled therapy sessions are the top two things a parent can do to help their child cope with bipolar depression. Psychologists also want parents to pay close attention to how they communicate with their teenager, especially when they are feeling especially frustrated and discouraged. Phrases parents should never say to a bipolar teen include:
- Why can’t you be like your brother or sister?
- Would you stop being lazy and get out of bed?
- You have nothing to be unhappy about. You’ve got food to eat and a roof over your head.
- If you don’t straighten up, we’re going to send you to boot camp!
Of course, no parent would deliberately say these things to their bipolar child but in the heat of combative moments, it’s difficult to stop overwhelming emotions from taking over your rational side. If you sense your impatience rising, stop and take a deep breath. Leave the room if necessary and restart the conversation after you and your teen have calmed down.
Teens with bipolar depression cannot control what they think, how they feel and why they can’t just “shake” their depression. Mental illnesses are medical diseases just like diabetes and high blood pressure are medical diseases. Bipolar disorder is a medical disease because symptoms emerge from a physical illness affecting the brain.
Chemical imbalances, structural abnormalities and dysfunction of cell signaling are physical in nature. When medications and CBT are used to treat this physical illness, symptoms can be managed and dealt with successfully. Much like people with diabetes have to take insulin to control blood sugar, your bipolar teen will need to take medications probably for the rest of their life to prevent bipolar depression and mania.
Other ways to help your teen cope with bipolar depression include keeping stress in the household at a minimum, establishing a daily routine for your child and respecting your child’s “space”. Just because your teen chooses to remain in their room for several hours doesn’t necessarily mean they are having a depressive episode. Keep track of your teen’s moods and review them after several weeks. Don’t hesitate to call their doctor if you suspect their medication may need adjusted or counseling sessions may not be addressing your child’s needs.