What is bipolar disorder?
Teenagers with bipolar disorder have an ongoing combination of extremely high (manic) and low (depressed) moods. Highs may alternate with lows, or the person may feel both extremes at close to the same time. The pattern of the mood alternations varies widely among sufferers. In some people, years of normal functioning can separate manic and depressive episodes. In others, the episodes cycle frequently, three or four times a year, with temporary reliefs between. For some people, depression and mania cycle continuously and sometimes rapidly.
There are also people who experience mixed episodes, in which mania and depression occur together or alternate rapidly within a brief period of time. And for a rare few, an episode of bipolar disorder may occur only once in a lifetime. (If it occurs twice, it is usually followed by other episodes.) Generally, the depressive phase lasts longer than the manic phase, and it also tends to be more frequent; the cycle can be erratic.
What causes bipolar disorder?
Bipolar disorder is thought to result from chemical imbalances in the brain, caused by a defective gene or genes. Among the brain chemicals possibly involved are serotonin and norepinephrine, but the chemical interaction in bipolar disorder is complex and not yet completely understood. The likelihood that genes play a role is supported by the fact that usually there is some family history of mood swings, depressive illness, or suicide.
What are the symptoms of bipolar disorder?
Manic-depressive illness may begin either with manic or depressive symptoms.
The manic symptoms include:
- Severe changes in mood compared to others of the same age and background - either unusually happy or silly, or very irritable
- Unrealistic highs in self-esteem - for example, a teenager who feels specially connected to God
- Great energy increase and the ability to go with little or no sleep for days without feeling tired
- Increased talking - the adolescent talks too much, too fast, changes topics too quickly, and cannot be interrupted
- Distractibility - the teen's attention moves constantly from one thing to the next
- High risk-taking behavior, such as jumping off a roof with the belief that this will not cause injury
The depressive symptoms include:
- Persistent sadness, frequent crying, depression
- Loss of enjoyment in favorite activities
- Frequent complaints of physical illnesses such as headaches or stomach aches
- Low energy level, poor concentration, complaints of boredom
- Major change in eating or sleeping patterns, such as oversleeping or overeating
Some of these signs are similar to those that occur in teenagers with other problems such as drug abuse, delinquency, attention-deficit hyperactivity disorder, or even schizophrenia. The diagnosis can only be made with careful observation over an extended period of time. A thorough evaluation by a child and adolescent psychiatrist can be helpful in identifying the problems, manic-depressive or other, and starting specific treatment.
The illness is sometimes linked to seasonal affective disorder, with depression occurring in late fall or winter, giving way to remission in the spring, and progressing to mania or hypomania in the summer.
What are the forms of bipolar disorder?
The disorder occurs in two main forms, known as bipolar I and bipolar II; they may have separate genetic origins. In bipolar I, both phases of the illness are apt to be very pronounced. In bipolar II, mania is often mild (it is termed hypomania), and the depression can be either mild or severe. Bipolar II is more difficult to diagnose and is often mistaken for generalized depression. It has fewer and shorter periods of remission than bipolar I, tends to run in families, and is somewhat less responsive to treatment. It may be the more common form of bipolar disorder.
How common is bipolar disorder?
Bipolar disorder is known to afflict about 1% of the U.S. population, although its frequency may be much higher because almost 75% of cases go untreated. Men and women are equally susceptible. Much evidence suggests that the illness has a genetic basis, but its origins are still uncertain. The symptoms result from chemical imbalances in the brain, and they lie beyond voluntary control. The disorder is not only life-disrupting but can also be dangerous: About 20% of people with bipolar disorder commit suicide, usually when they are passing from one phase to another and feel disoriented. Some 11% of sufferers take this drastic action in the first decade after diagnosis.
About one case of bipolar disorder in five begins in late childhood or adolescence; adolescents are more likely than adults to have physical and psychotic symptoms, such as hallucinations and delusions, and they are more apt to be misdiagnosed. Usually, however, the illness strikes young adults between the ages of 25 and 35. The first episode in males is likely to be manic; the first episode in females, depressive -- and frequently, a woman will experience several episodes of depression before a manic episode occurs. As patients grow older, recurrences of either bipolar I or bipolar II tend to come more frequently and last longer.
Is bipolar disorder treatable?
Teenagers with bipolar disorder can be effectively treated. Effective treatment for bipolar disorder usually includes education of the patient and the family about the illness, medication such as lithium, and psychotherapy. Lithium often reduces the number and severity of manic episodes, and also helps to prevent depression. Psychotherapy helps the teenager understand himself or herself, adapt to stresses, rebuild self-esteem and improve relationships. Fortunately, great strides have recently been made in treating this illness; in most cases, the symptoms can be controlled effectively by medication and other therapies.
American Academy of Child & Adolescent Psychiatry (AACAP)