Bipolar Disorder

Bipolar disorders are one of several medical conditions called depressive disorders. Depressive disorders affect the way a person's brain functions.

Depressive disorders are widespread. In the United States alone, it's estimated that more than 17.4 million adults have a depressive disorder each year. That works out to about 1 out of every 7 people, so there's a good chance that you or someone you know is dealing with a depressive disorder.

What Is Bipolar Disorder?
Bipolar disorder goes by many names: manic depression, manic-depressive disorder, manic-depressive illness, bipolar mood disorder, and bipolar affective disorder are medical terms for the same condition.

Bipolar disorder is classified into four different types: Bipolar I, Bipolar II, Cyclothymic Disorder, or Bipolar Disorder Not Otherwise Specified. Mental health experts separate the condition into these four types because the symptoms of bipolar disorder show up differently in different people. When doctors know what type someone has, they can tailor treatment to that person's specific needs.

Bipolar disorder affects both men and women. For many people, the first symptoms show up in their early twenties. However, research has shown that the first episode of bipolar disorder is occurring earlier: It often shows up in adolescence, and even children can have the disorder.

Recent research suggests that kids and teens with bipolar disorder don't always have the same behavioral patterns that adults with bipolar disorder do. For example, kids who have bipolar disorder may experience particularly rapid mood changes and may have some of the other mood-related symptoms listed below, such as irritability and high levels of anxiety. But they may not show other symptoms that are more commonly seen in adults.

Because brain function is involved, the ways people with bipolar disorder think, act, and feel are all affected. This can make it especially difficult for other people to understand their condition. It can be incredibly frustrating if other people act as though someone with bipolar disorder should just "snap out of it," as if a person who is sick can become well simply by wanting to. Bipolar disorder isn't a sign of weakness or a character flaw; it's a serious medical condition that requires treatment, just like any other condition.

What Are the Signs and Symptoms?
A person with bipolar disorder will go through episodes of mania (highs) and at other times experience episodes of depression (lows). These aren't the normal periods of happiness and sadness that everyone experiences from time to time. Instead, the episodes are intense or severe mood swings, like a pendulum that keeps arcing higher and higher.

Symptoms of mania include:

racing speech and thoughts
increased energy
decreased need for sleep
elevated mood and exaggerated optimism
increased physical and mental activity
excessive irritability, aggressive behavior, and impatience
poor judgment
reckless behavior, like excessive spending, making rash decisions, and erratic driving
difficulty concentrating
inflated sense of self-importance
Symptoms of depression include:

loss of interest in usual activities
prolonged sad or irritable mood
loss of energy or fatigue
feelings of guilt or worthlessness
sleeping too much or inability to sleep
drop in grades and inability to concentrate
inability to experience pleasure
appetite loss or overeating
anger, worry, and anxiety
thoughts of death or suicide
In adults, episodes of mania or depression usually last for weeks or months, although they can be shorter in length. In children and adolescents, though, these episodes can be much shorter, and a kid or teen can even go back and forth between mania and depression throughout the day. Episodes of mania or depression may happen irregularly and follow an unpredictable pattern or they may be linked, with a manic episode always following a period of depression, or vice versa. Sometimes episodes have a seasonal pattern. Mania in the spring, for example, may be followed by depression in the winter.

Between episodes, a person with bipolar disorder usually returns to normal (or near-normal) functioning. For some people, though, there is little or no "break period" between their cycles. These mood swing cycles can change slowly or rapidly, with rapid cycling between mania and depression being much more common in women, children, and adolescents.

Some people with bipolar disorder turn to alcohol and drugs because they feel temporarily better when they're high. But using alcohol and drugs can have disastrous results for people with bipolar disorder. Substance abuse can actually make the symptoms worse, as well as making the condition hard for doctors to diagnose.

What Causes Bipolar Disorder?
Doctors and scientists don't know the exact cause of bipolar disorder, but they think that biochemical, genetic, and environmental factors may all be involved. It's believed this condition is caused by imbalances in certain brain chemicals called neurotransmitters. If the neurotransmitters aren't in balance, the brain's mood-regulating system won't work the way it should.

Genes also play a role. If a close relative has bipolar disorder, a person's risk of developing the condition is higher. This doesn't mean, though, that if you have a relative with bipolar disorder you will automatically develop it! Even in studies involving identical twins raised in the same home, one twin sometimes had bipolar disorder whereas the other did not. Researchers are now working on identifying the gene or genes involved in bipolar disorder.

Environmental factors may play a role in bipolar disorder. For some teens, stresses such as a death in the family, their parents' divorce, or other traumatic events could trigger a first episode of mania or depression. Sometimes, going through the changes of puberty can set off an episode. In girls, symptoms can be tied to their monthly menstrual cycle.

How Is Bipolar Disorder Diagnosed?
Most people with bipolar disorder can be helped — but a psychiatrist or psychologist must first diagnose the disorder. Sadly, many people with the condition are never diagnosed or are not diagnosed properly. Without proper diagnosis and treatment, the disorder can become worse. Some teens with undiagnosed bipolar disorder can end up in a psychiatric hospital or residential treatment center, in the juvenile justice system, abusing drugs, or committing suicide.

Because children and teens with bipolar disorder do not usually show the same patterns of behavior as adults who have the condition, a mental health professional will observe a teen's behavior carefully before making a diagnosis. This includes getting a complete history of a person's past and present experiences. Family members and friends can also provide helpful insights into the person's behavior. The doctor may also want a teen to have a medical exam to rule out other conditions.

Diagnosing bipolar disorder can be difficult. As yet, there aren't any laboratory tests like a brain scan or blood test that will diagnose it. In teens, bipolar disorder can sometimes be mistaken for illnesses like schizophrenia and posttraumatic stress disorder, attention deficit hyperactivity disorder (ADHD), and other depressive disorders. That's why a complete, detailed history is so important.

How Do Doctors Treat It?
Although there's no cure for bipolar disorder, treatment can help stabilize a person's moods and help the person manage and control symptoms. Like other teens with long-lasting medical conditions (such as asthma, diabetes, or epilepsy), teens with bipolar disorder need to work closely with their doctors and other medical professionals to treat it.

This team of medical professionals, together with the teen and family, develop what is called a treatment plan. Teens with bipolar disorder will probably receive medication, such as a mood stabilizer, from a psychiatrist or other medical doctor. A psychologist or other type of counselor will provide counseling or psychotherapy for the teen and his or her family. Doctors will watch the symptoms closely and offer additional treatment advice if necessary.

Living With Bipolar Disorder
Teens normally face ups and downs with school, family, work, and friends. Dealing with bipolar disorder at the same time is a very difficult challenge. One 16-year-old reader who was diagnosed with bipolar disorder at 14 wrote to us about the experience:

"I had mood swings that were the worst anyone could have ever seen. My poor parents thought I hated them, but really I was sick and didn't even realize it. But now I am on medications for my disorder and I live a pretty normal life. My family and friends support me, and they, along with my therapist, have helped me get to the point where I am today. I just want other teens to know that even though it is hard at times to be bipolar, things will get better."

If you've been diagnosed with bipolar disorder, taking your medications as prescribed, reporting any changes in how you feel or function, and participating in therapy will be key to living a successful life. In addition to treatment, making a few lifestyle changes, such as reducing stress, eating well, and getting enough sleep and exercise can help someone who is living with the condition. And many teens find it helps to join a support network such as a local support group for people with bipolar disorder.