Bipolar Disorder in Children and Teens

Although mood changes and other symptoms associated with bipolar disorder are challenging, they can be managed effectively. Treatment usually includes medicines (such as mood stabilizers) and professional counseling, and often a combination of both is needed.

Bipolar illness is a serious disorder that has a big impact on both the child and his or her family. Successful treatment requires that the child and family members know what happens in bipolar disorder and that the family members help make sure that the child follows the treatment.

It can take time for you and your child to accept that the child has a serious, long-term condition that requires ongoing treatment and constant monitoring. But keep in mind that by working with your child's doctor, you and your child can find effective treatment for the condition.

You and your child's doctor can discuss which treatment is right for your child. Older children and teens may want to participate in their own treatment decisions.

Initial treatment

The first step in determining appropriate treatment for your child with bipolar disorder is evaluating the severity of his or her symptoms. If your child's behavior is suicidal, aggressive, reckless, or dangerous, or if he or she is out of touch with reality (psychotic) or unable to function, the child may need a period of hospitalization. Also, many medicines can make the symptoms of bipolar disorder worse, and if your child is taking one of these, he or she may need to taper off and stop the medicine. This should only be done under the supervision of a doctor.

Initial treatment usually includes medicines and counseling.

Medicines. Medicines most often used include:

• Mood stabilizers, such as lithium (for example, Eskalith or Lithobid), divalproex (Depakote), carbamazepine (for example, Tegretol), lamotrigine (Lamictal), or valproate (Depacon).
• Antipsychotics, such as aripiprazole (Abilify) or risperidone (Risperdal), which your doctor may combine with a mood stabilizer for more effective control of manic episodes.
• Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (for example, Prozac), or other types of antidepressants to control episodes of depression. While antidepressants can be helpful for some children, they might also trigger mania. A doctor will usually prescribe antidepressants with other medicines that help regulate mood, and he or she must carefully monitor the child.

Before prescribing medicine to treat bipolar disorder, your doctor will check your child for possible suicidal behavior by asking a few questions. See a list of questions your doctor may ask your child.

Professional counseling. Counseling works best when symptoms of bipolar disorder are controlled with medicines. Several types of therapy may be helpful, depending on the age of the child. These include:

• Cognitive-behavioral therapy, which focuses on modifying certain thinking and behavior patterns.
• Interpersonal therapy, which focuses on social and personal relationships and related problems.
• Problem-solving therapy, a brief type of cognitive therapy that helps you find immediate solutions to problems.
• Family therapy, which can help educate and support the entire family.
• Play therapy for very young children.
• Psychological education and support groups.
• Dialectical-behavioral therapy, which focuses on building skills to manage mood swings.

Ongoing treatment

Ongoing treatment of bipolar disorder includes long-term treatment with medicines and may include professional counseling.

Some children and teens do not respond to the first medicine they try, and they may need to try several different medicines to find relief from the symptoms. A combination of medicine and professional counseling may be the most effective treatment.

An important part of ongoing treatment is making sure your child takes the medicine as prescribed. Often people who feel better after taking bipolar medicine for a period of time may feel that they are cured and no longer need treatment. But when a person stops taking medicine, symptoms usually return, so it is important that your child follows the treatment plan.

Medicines for bipolar disorder have side effects that need to be managed. Some things you cannot change, such as increased urination (common with lithium). But you can deal with some side effects like weight gain (common with several medicines used to treat bipolar disorder) by increasing exercise and reducing calorie intake. You can work with your child and his or her doctor to find ways of coping with side effects. If side effects from a medicine are intolerable, the doctor may have to change the dose or the medicine.

Some medicines, such as lithium carbonate (Eskalith or Lithobid, for example) and divalproex (Depakote), require ongoing blood monitoring every few months. Your doctor may have to adjust the amount of medicine your child is taking so your child has the right amount of medicine for treatment.

During initial treatment, your doctor may prescribe a medicine such as an antipsychotic for a short time to help your child deal with immediate symptoms. After your child's long-term medicines kick in and symptoms improve, he or she will need to taper off and stop the short-term medicine.

Other ongoing treatment includes:

• Academic adjustments. If your child is in school, he or she may need a reduced homework load or school schedule during severe depressive or manic episodes. You can work with the school to find ways to help your child maintain performance requirements until the symptoms are under control.
• Relaxation and exercise. Steps your child can take at home to improve symptoms include:
  • Getting regular physical exercise, such as swimming or walking, to help reduce stress.
  • Avoiding the use of drugs, alcohol, tobacco, caffeinated beverages, and energy drinks.
  • Eating a balanced diet.
  • Getting enough sleep and keeping a regular sleep-wake cycle. (Children and teens need more sleep than adults.)

Sometimes treatment for other conditions can make your child's bipolar disorder worse. For example, treating depression with antidepressants can trigger a manic episode or make one worse. Treating attention deficit hyperactivity disorder (ADHD) with stimulants may also trigger severe mania, depression, and even psychosis (loss of touch with reality). Treatment with corticosteroids for conditions such as asthma may also trigger a manic episode. Medicines that intensify bipolar symptoms may need to be stopped or changed to a different dose or medicine. Sometimes an additional medicine (such as a mood stabilizer) can solve the problem. But each child responds to medicines differently. And it may take several tries before your doctor can identify an effective medicine or combination of medicines for your child's conditions.

Learning as much as you can about child and teen bipolar disorder may help you recognize mood changes in your child as they begin to occur. Catching and treating these mood changes early may help reduce the length of the manic or depressive episode and improve the quality of your child's life.

Treatment if the condition gets worse

If your child's condition gets worse while he or she is being treated for bipolar disorder (including medicines, counseling, and lifestyle changes), the doctor may give additional treatment. You and your doctor should:

• Make sure your child is taking medicines as prescribed and following other treatment recommendations.
• Determine whether ongoing symptoms are caused by another disorder (such as attention deficit hyperactivity disorder or post-traumatic stress disorder), and treat the other condition if necessary.
• Identify and reduce stresses that may be making symptoms worse.
• Adjust the dose of medicines if the current dose is not effective.
• Add or change medicines if the current ones are not working.

A brief hospital stay may be necessary, especially if your child is showing any warning signs of suicide. The warning signs of suicide change with age. Warning signs of suicide in children and teens may include preoccupation with death or suicide or a recent breakup of a relationship.

For older children with severe bipolar symptoms who have not responded to medicines, electroconvulsive therapy (ECT) may be an option. In this procedure, brief electrical stimulation to the brain is given through electrodes placed on the head. The stimulation produces a short seizure that is thought to balance brain chemicals.