In bipolar disorder (sometimes called manic-depressive illness), periods of intense elation and excitation (mania) alternate with periods of depression and despair. Mood may be normal in between these periods.

• Children may rapidly go from being excited, happy, and active to being depressed, withdrawn, and sluggish or full of rage and violent.
• Doctors base the diagnosis on symptoms and results of psychiatric tests.
• The diagnosis of bipolar disorder in young children is very controversial.
• Mood-stabilizing drugs to treat mania, antidepressants to treat depression, and psychotherapy can help.

Children normally have fairly rapid mood swings, going from happy and active to glum and withdrawn. These swings rarely indicate a mental health disorder. Bipolar disorder is far more severe than these normal mood changes, and the moods last much longer, often for weeks or months. Bipolar disorder is rare in children, although it is more common than previously thought. Some experts believe that young children (aged 4 to 11 years) who have intense mood swings many times a day may have a variation of bipolar disorder. This idea is a very controversial and is currently under study. Bipolar disorder typically begins during adolescence or early adulthood (see Mood Disorders: Bipolar Disorder (Manic-Depressive Illness)). Bipolar disorder in adolescents is similar to bipolar disorder in adults.

The cause is unknown, but a tendency to develop bipolar disorder can be inherited. Chemical abnormalities in the brain may be involved. Bipolar disorder may begin after a stressful life event, such as incest, although the event itself does not cause the disorder. In children with the disorder, such an event may trigger an episode. Rarely, drugs with stimulant effects, such as amphetamines, which are sometimes used to treat attention-deficit/hyperactivity disorder (ADHD—see Learning and Developmental Disorders: Attention-Deficit/Hyperactivity Disorder), cause symptoms similar to those of bipolar disorder. Also, certain other disorders, including ADHD and an overactive thyroid gland, can cause similar symptoms.

Symptoms

The main symptoms are episodes of feeling intense elation and excitement (mania). Sometimes there are episodes of depression. Mania is a state of elation, excitation, racing thoughts, irritability, and grandiosity (in which children feel they have some great talent or have made an important discovery). During manic episodes, sleep is disturbed, and children may become aggressive. School performance often deteriorates.

During an episode of depression, children with bipolar disorder, like those with depression alone, feel excessively sad and lose interest in their usual activities. They may think and move slowly and sleep more than usual. Feelings of hopelessness and guilt may overwhelm them.

Children with bipolar disorder appear normal between episodes, in contrast to children with ADHD, who are in a constant state of increased activity.

Diagnosis

Doctors base the diagnosis on a description of typical episodes by children and their parents. Because ADHD can cause similar symptoms, differentiating between the two is important. Doctors determine whether children are taking any drugs that could contribute to the symptoms. Doctors may also check for signs of other disorders that may contribute to or cause the symptoms. For example, they may do blood tests to check for an overactive thyroid gland.

Treatment

Bipolar disorder is treated with mood-stabilizing drugs, such as lithiumSome Trade Names
LITHOBID
and certain anticonvulsants such as carbamazepineSome Trade Names
TEGRETOL
and valproateSome Trade Names
DEPACON
. In most cases, an antipsychotic drug is also used.

Individual and family psychotherapy helps children and their families cope with the consequences of the disorder. Psychotherapy can help adolescents, who are prone to not follow their drug regimen, continue to do so.

Last full review/revision February 2009 by Hugh F. Johnston, MD