Bipolar Disorder

Chances are, you’ve read or heard the term “bipolar” used to describe someone whose moods change rapidly—often rather dramatically, and in a short period of time.  It’s important to note that, while all children and adolescents who have bipolar disorder will have dramatic mood changes, the vast majority of kids experiencing mood changes (even pretty dramatic ones!) do not have bipolar disorder. This distinction can cause confusion for many parents and some clinicians, and we hope the information on these pages will help.

So what does it really mean when someone has bipolar disorder? And what should you do if that person is your child?
Bipolar disorder, which is also known as manic-depressive illness:

  • is a chronic (long-lasting), intermittent (comes and goes) mental health condition that affects people of all ages
  • is a serious disorder that always causes serious emotional and behavioral problems (minor problems alone aren’t consistent with bipolar illness)
  • is always episodic, meaning that a child experiences cycles of major changes in her level of functioning
  • always includes mania, which involves a marked increase in energy, activity, rates of speech or ideas, and a decreased need for sleep that lasts days or even weeks (one hour of “racing around” does not mean mania)
  • almost always includes unpleasant moods (feelings of depression or unusual irritability)

In addition, bipolar disorder:

  • is not particularly common: In all of its different degrees of severity, it only affects 1 to 3 percent of children
  • is estimated to affect as many as 7 percent of all children seen at psychiatric treatment facilities (with even higher rates among children hospitalized for inpatient psychiatric care)
  • while rare in school-age children, has been diagnosed in children as young as 5
  • is caused by a combination of biological or genetic factors and life experiences
  • is not clearly linked to any specific experiences or stresses
  • runs in families,  but the vast majority of parents with bipolar disorder will not have children with the condition

A child or adolescent who has bipolar disorder experiences both manic phases (periods of abnormally high energy, activity and decreased need for sleep) and depressive phases (periods of intense sadness, tiredness, hopelessness or extreme irritability). These periods are known as mood episodes. Sometimes, the manic and depressive symptoms happen at the same time; this is called a mixed mood episode.

While all children (and especially adolescents) experience peaks and valleys in their moods and energy levels, the mood episodes of someone with bipolar disorder are very different:

  • Their depressive symptoms last most of the day, every day, for at least two weeks
  • Their manic symptoms last most of the day, every day, for four to seven days
  • Mood episodes cause serious disruptions to eating, sleeping, schoolwork, home life and social life that represent a real change from the child’s general level of functioning.
  • The problems caused by mood episodes are never limited to only happening at home—they extend to several other areas of the child’s life.
  • The episodes are cyclical, meaning that even though they might go away, they almost always return.

Although there is no cure for bipolar disorder, there are effective, evidence-based treatments that can help.

How Boston Children’s Hospital approaches bipolar disorder

Children’s Hospital Boston has long been at the forefront of providing expert, compassionate care to children and adolescents with emotional and behavioral health issues. As one of the largest pediatric psychiatric services in New England, Children’s has a team of expert psychiatrists, psychologists and social workers ready to help you, your child and your family get the individualized treatment you need to cope with bipolar disorder.

Our Department of Psychiatry team members are leaders in researching, diagnosing and treating bipolar disorder, as well as many other conditions like:

Our approach to all mental health care is evidence-based—which means that our evaluations and treatments have been tested and proven effective through scientific studies, both here at our hospital and by other leading institutions worldwide.

We always begin our care with a careful diagnostic evaluation. Once a clear diagnosis has been made, all of our interventions start with a combination of psychoeducation—the facts you need to understand and actively participate in your child’s care—and “talk therapy” as our primary methods of treatment. Talk therapy focuses on teaching children (and their families) helpful thinking, management and coping skills to overcome symptoms and adopt new, healthier thought patterns and behaviors.

When your child’s specific diagnosis and symptoms warrant it, we might also recommend a psychiatric medication evaluation through our Psychopharmacology Clinic.

Evidence has shown us that a combination of talk therapy and medication therapy is key for children with bipolar disorder. Our recommendations will generally include both of these treatment methods, but will be designed with your child and family’s individual needs and circumstances in mind.

Bipolar disorder: Reviewed by David R. DeMaso, MD, and Stuart J. Goldman, MD
© Children’s Hospital Boston; posted in 2011