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An Update from the National Institute of Mental Health

Research findings, clinical experience, and family accounts provide substantial evidence that bipolar disorder, also called manic-depressive illness, can occur in children and adolescents. Bipolar disorder is difficult to recognize and diagnose in youth, however, because it does not fit precisely the symptom criteria established for adults, and because its symptoms can resemble or co-occur with those of other common childhood-onset mental disorders. In addition, symptoms of bipolar disorder may be initially mistaken for normal emotions and behaviors of children and adolescents. But unlike normal mood changes, bipolar disorder significantly impairs functioning in school, with peers, and at home with family. Better understanding of the diagnosis and treatment of bipolar disorder in youth is urgently needed. In pursuit of this goal, the National Institute of Mental Health (NIMH) is conducting and supporting research on child and adolescent bipolar disorder.

A Cautionary Note

Effective treatment depends on appropriate diagnosis of bipolar disorder in children and adolescents. There is some evidence that using antidepressant medication to treat depression in a person who has bipolar disorder may induce manic symptoms if it is taken without a mood stabilizer. In addition, using stimulant medications to treat attention deficit hyperactivity disorder (ADHD) or ADHD-like symptoms in a child with bipolar disorder may worsen manic symptoms. While it can be hard to determine which young patients will become manic, there is a greater likelihood among children and adolescents who have a family history of bipolar disorder. If manic symptoms develop or markedly worsen during antidepressant or stimulant use, a physician should be consulted immediately, and diagnosis and treatment for bipolar disorder should be considered.

Symptoms and Diagnosis

Bipolar disorder is a serious mental illness characterized by recurrent episodes of depression, mania, and/or mixed symptom states. These episodes cause unusual and extreme shifts in mood, energy, and behavior that interfere significantly with normal, healthy functioning.

Manic symptoms include:

  • Severe changes in mood-either extremely irritable or overly silly and elated
  • Overly-inflated self-esteem; grandiosity
  • Increased energy
  • Decreased need for sleep-ability to go with very little or no sleep for days without tiring
  • Increased talking-talks too much, too fast; changes topics too quickly; cannot be interrupted
  • Distractibility-attention moves constantly from one thing to the next
  • Hypersexuality-increased sexual thoughts, feelings, or behaviors; use of explicit sexual language
  • Increased goal-directed activity or physical agitation
  • Disregard of risk-excessive involvement in risky behaviors or activities

Depressive symptoms include:

  • Persistent sad or irritable mood
  • Loss of interest in activities once enjoyed
  • Significant change in appetite or body weight
  • Difficulty sleeping or oversleeping
  • Physical agitation or slowing
  • Loss of energy
  • Feelings of worthlessness or inappropriate guilt
  • Difficulty concentrating
  • Recurrent thoughts of death or suicide

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