Mental Health and Growing Up
Factsheet
Bipolar disorder (Manic Depression): information for parents,
carers and anyone who works with young people
About this leaflet
This is one in a series of leaflets for
parents, teachers and young people entitled Mental Health and
Growing Up. These leaflets aim to provide practical,
up-to-date information about mental health problems (emotional,
behavioural and psychiatric disorders) that can affect children and
young people. This leaflet gives some basic information about the
symptoms and effects of bipolar disorder, and gives some practical
advice on how to get help for this problem.
What is bipolar disorder?
Bipolar disorder (BD) is a condition in which
a young person has extreme changes of mood - periods of being
unusually happy (known as ‘mania’ or ‘hypomania’), and periods of
being unusually sad (‘depression’). It is sometimes called’ manic
depressive disorder’,’ bipolar affective disorder’ or ‘bipolar mood
disorder’.
The mood-swings are way beyond what would be
considered normal for a particular individual, and are out of
keeping with their personality.
How common is bipolar affective disorder?
BD is extremely rare before puberty but
becomes slightly more common during teenage years. BD occurs in one
in 100 or fewer children and teenagers. In adults it affects one in
100 people.
The condition can be hard to recognise in
teenagers because more extreme behaviour can be part of this stage
of life.
What causes it?
Although the causes are not fully understood,
BD tends to run in families. In people who have BD, episodes may be
triggered by physical illness, stressful events or lack of
sleep.
What are the symptoms?
In BD, a person can have:
- manic or hypomanic periods (or ‘episodes’)
- depressive periods
- mixed periods.
Below is a list of the symptoms in each
episode. A young person needs to have at least one manic or
hypomanic episode to be diagnosed with BD.
There needs to be several of these symptoms
happening at the same time for at least several days. If there is
just one symptom, then it is unlikely to be bipolar disorder.
The mood changes can sometimes occur very
rapidly within hours or days. The mood changes can sometimes occur
very rapidly within hours or days (sometimes called ‘rapid
cycling’). For some, the mood symptoms are less severe (sometimes
called’ cyclothymia’).
In between the highs and lows, there are
‘normal’ periods that can last for weeks or months. However, for
some, especially when they have had disorder from some time, these
periods of ‘normalcy’ can be shorter or difficult to see.
Symptoms during a ‘high’ or manic episode
- feeling incredibly happy or
'high' in mood, uncontrolled excitement
- irritability
- increased talkativeness
- very rapid speech with lots
of changes of subject
- racing thoughts
- increased activity and
restlessness
- difficulty in concentrating
or easily distracted, constant changes in plans
- over-confidence and inflated
ideas about themselves or their abilities
- needing little sleep
- neglect of personal
care
- increased sociability or
over-familiarity
- increased sexual energy
- overspending of money or other
types of reckless or extreme behaviour.
‘Hypomania’ is a milder form of mania (less
severe and for shorter periods). During these periods, people can
actually become very productive and creative and so see these
experiences as positive and valuable. However, hypomania, if left
untreated, can become more severe, and may be followed by an
episode of depression.
At the extreme end, some people also develop
something called psychosis. This is when someone has strong,
bizarre beliefs e.g. that they have superhuman powers or are being
watched or followed.
Symptoms during a depressive
episode
- feeling very sad
- decreased energy and
activity
- not being able to enjoy
anything
- decreased appetite
- disturbed sleep
- thoughts of suicide or self
harm.
On the milder end, one may just feel sad and
gloomy all the time. Here too, at the extreme end some people can
develop psychotic symptoms.
Symptoms during mixed
episodes
A mixture of manic symptoms and depressive
symptoms at the same time.
What effects can it have?
The exaggeration of thoughts, feelings and
behaviour affects many areas of the young person's life. For
example, it can lead to:
- problems in relationships
with friends and family
- interference with
concentration at school or work
- behaviour that places the
young person's health or life at risk
- a loss of confidence and a
loss of the sense of control the person feel over their life.
The longer the condition continues without
treatment, the more harmful it is likely to be to the life of the
young person and to their family.
Where can I get help?
The first step towards getting help is to
recognise that there might be a problem. Seeking medical advice
early on is very important. If the bipolar illness can be
identified and treated quickly, this reduces its harmful
effects.
You should contact your GP first. If
necessary, they can then make a referral to your local child and
adolescent mental health service (CAMHS), who can offer more
specialist help.
How is it treated?
The goal of treatment is to improve the
symptoms, prevent the illness from returning and help the young
person lead a normal life. Families play an important role in
preventing the illness from coming back, and also seeking help
early before it comes severe. It is therefore very important that
you understand the condition.
Depending on whether the child is having a
manic or a depressive episode and how severe it is, they may need
different treatments. When they have severe symptoms they may need
medications, and also sometimes admission to hospital.
Psychological or talking treatments and
medication, both may have an important role in treatment of this
condition.
Medication
Medication usually plays an important role in
the treatment of bipolar disorder, especially if episodes are
severe. In the initial stages of the illness, medication helps to
reduce the symptoms.
The choice of medication can depend upon the
type of episode (manic or depressed). Everyone is different and so
the type of medication that is recommended will also be
different.
The three main types of medication that are
helpful are:
(1) antipsychotic medication: risperidone,
olanzapine and aripiprazole are types of antipsychotics.
(2) mood stabilizers: Lithium is a type of
mood stabiliser.
(3) antidepressants: fluoxetine is a
type of antidepressant.
It is important that medications are not taken
only when the problems are serious. If your child has had more than
one severe episode of illness, staying on medication is important
to reduce the risk of further episodes.
Medication may be needed for months or even
years. Some people may, under medical supervision, be able to stop
their medication when they have recovered and have felt well for a
while.
They may need physical examinations and tests
(like blood test) before starting or while on medication. It is
important that if prescribed medication, you are regularly seen by
your doctor or psychiatrist.
Side-effects of the medication can occur, some
of which are quite serious. The psychiatrist will be able to advise
about what they are and about what can be done to help. The risk of
side-effects needs to be balanced against the risk of the damaging
effects of the illness on a person's life.
No young person should be taking medication
unless they are reviewed by a health professional regularly. This
is to monitor the dose of the drug and to check for
side-effects.
Talking treatments (also known as
‘psychotherapies’)
It is crucial that drug treatments are
combined with practical help for the young person and their
family.
- Help with understanding the
illness (psycho education)
It is very important that the young person
with bipolar disorder and their family are helped to understand the
condition, how best to cope and what to do to reduce the chances of
it recurring.
The young person and their family may notice
particular ‘triggers’ to their episodes and/or early warning signs
that an episode may be starting - being aware of these can help
reduce the chance of episodes occurring, and getting help in the
earliest stages of an episode can stop it from escalating.
Stress at home can worsen the situation and
can even trigger an episode of the illness. Talking therapy in
which the whole family is helped to find ways of reducing stress,
solving problems and communicating more effectively has been shown
to help young people with BD get better, and stay well.
- Cognitive-behavioural therapy
(CBT)
This is another type of talking therapy in
which the young person, sometimes with their family, learns to
understand the links between their feelings and thoughts and how
this affects their behaviour.
Hospital care
Some young people may need to go into hospital
for intensive support if the symptoms are severe.
Recovery
It is important for the young person to
recognise that they are not alone and to keep up hope.
Many people only have a few mood swings and
then the problem goes away. For others, it becomes a lifelong
pattern which they learn to live with and manage.
An episode of bipolar disorder can interfere
with education because it is difficult to learn when they are
unwell. An important part of recovery is to begin to plan returning
to education or to think about work.
Further information
Bipolar UK
Supports people with a diagnosis of bipolar
disorder and their families.
Rethink mental illness
A national charity that helps people affected
by a severe mental illness to recover a better quality of life.
SANE
A national charity which improves the quality
of life for people affected by mental illness.
YoungMinds
Provides information and advice on child
mental health issue and a Parents'Helpline:0800 802 5544.
Further reading
National Institute for Health and Clinical
Excellence (2006). The management of bipolar disorder in adults,
children and adolescents, in primary and secondary care. Patient
version. www.nice.org.uk
References
Leibenluft E & Dickstein DP (2008).
Bipolar disorder in Children and Adolescents. In: Rutter M et al.
(eds) (2008) Rutter’s Child and Adolescent Psychiatry (5th
edn). Oxford: Blackwell. pp894-905.
Merikangas KR, Akiskal HS, Angst J, Greenberg
PE, Hirschfeld RMA, Petukhova M & Kessler RC (2007). Lifetime
and 12-month prevalence of bipolar spectrum disorder in the
national comorbidity survey replication. Arch Gen
Psychiatry; 64:543-552.
Fristad MA (2006). Psychoeducational treatment
for school-aged children with bipolar disorder. Development and
Psychopathology: 18:1289–1306.
Miklowitz DJ, Axelson DA, Birmaher B, George
EL,Taylor DO, Schneck CD, Beresford CA, Dickinson LM, Craighead WE,
Brent DA (2008). Family-focused treatment for adolescents with
bipolar disorder: results of a 2-year randomized trial.
Archives of General Psychiatry; 65(9):1053–1061.
Carr A (2009). Bipolar disorder in young
people: description, assessment and evidence-based treatment.
Developmental Neurorehabilitation; 12(6): 427–441.
Fristad MA, Verducci JS, Walters K, Young ME
(2009). Impact of multifamily psychoeducational psychotherapy in
treating children aged 8 to 12 years with mood disorders.
Archives of General Psychiatry; 66(9):1013-1021.
- Revised by the Royal College of
Psychiatrists’ Child and Family Public Education Editorial
Board.
- Series Editor: Dr Vasu Balaguru
- With grateful thanks to Dr Sarah Bates.
This leaflet reflects the best possible
evidence at the time of writing.
© March 2012. Due for review March 2014. Royal College
of Psychiatrists. This leaflet may be downloaded, printed out,
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