Successfully Treating Bipolar Disorder in Teens

Bipolar disorder (BPD) – which used to be referred to as manic-depressive disorder – is a brain disorder that causes unusual shifts in energy, activity, motivation, mood and ability to carry out day to day tasks. It is an illness that is highly influenced by environmental stressors. There are a variety of types of bipolar disorders, including Bipolar I, Bipolar II, and Atypical Bipolar. Bipolar is characterized by shifts in mood ranging from mild to extreme that vary according to the particular subtype of bipolar disorder one has.

What Causes Bipolar Disorder

No one is certain of the causes of bipolar disorder. However, it does tend to run in families.

Children with a parent, grandparent, or sibling who has suffered from BPD are at least four times more likely to develop the disorder than children without such a family history. Accordingly, geneticists are looking for genes that may increase a person’s chances of developing the illness.

This being said, most children with a family history of bipolar disorder do not develop the illness. And studies suggest that a complex interplay of factors, including genes, environmental stressors and differences in brain structures contribute to bipolar conditions.

But, again, scientists do not yet fully understand how genetic and environmental factors interact to cause bipolar disorder.

Co-Occurring Disorders

To make matters more complicated, several illnesses often occur conjointly with bipolar disorder:

  • Anxiety Disorders – Both teens and adults with bipolar disorder also commonly suffer from anxiety disorders, such as generalized anxiety disorder and separation anxiety. And teens with both types of disorders tend to develop BPD at a younger age and have more hospital stays related to mental illness.
     
  • ADHD – It’s not uncommon for teens with bipolar disorder to have a history of ADHD. Teens who have co-occurring ADHD and bipolar disorder tend to have difficulties with self-control and concentrating on activities even when not manic or depressed.
     
  • Substance Abuse – Adults and teens with bipolar disorder are at very high risk of developing a substance abuse problem. About 70 percent of bipolar patients are abusing drugs and alcohol and substance abuse in the family background may indicate an underlying bipolar disorder.

Unfortunately, some mental disorders cause symptoms very similar to those of bipolar disorder. For example, if one is only looking at symptoms, it can be difficult to tell the difference between a depressive bipolar episode and major (unipolar) depression. Likewise, ADHD symptoms may resemble a manic episode but, since ADHD is not episodic, the symptoms tend to be more constant. How can you tell the difference? Well, two of the most prominent symptoms in teens and adults with bipolar are feelings of grandiosity and patterns of talking too rapidly, neither of which are characteristics of ADHD.

Regardless, if you think your teen is suffering from bipolar disorder (or any mental health problems), be sure to tell the psychologist or psychiatrist diagnosing them of any past manic or depressive symptoms or episodes your child’s had. Also if you are concerned about your child and notice a cluster of symptoms such as depression, irritability, anxiety, swings into irritability, or variations in mood, by all means get an evaluation and talk to your doctor.

What Types of Treatments Are Available for Teens with Bipolar Disorder?

While bipolar disorder can be treated effectively, there is no cure. At least not yet…

The most common – and typically most effective – treatment for BPD involves a combination of prescription medications, professional counseling or psychotherapy, and diet and exercise.

We know that a diet rich in green leafy vegetables and foods with Omega3s can help with the symptoms of bipolar. Likewise, exercise has a significant positive effect on mood disorders and creates endorphins that can greatly help one’s mood. And cognitive therapy has been found to be particularly helpful for those suffering from bipolar disorder and depression.

One large study conducted by the National Institute of Mental Health (NIMH) – the Systematic Treatment Enhancement Program for Bipolar Disorder – found adults suffering from bipolar disorder who received around nine months’ worth of intensive psychotherapy and medications got better faster and stayed well longer than adults treated with less intensive psychotherapy for shorter periods of time.

Logically, it would seem that combining medications and longer-term psychotherapy would help teens and adolescents with early-onset bipolar disorder as well. However, it is the quality of therapy that makes a big difference and finding a therapist to work with who has a “feel” for the disorder can be critical.

In addition to meds and psychotherapy, it is crucial for people with bipolar disorder to set and stick to a routine in their daily lives… Exercising around five times a week, eating a healthy diet, learning cognitive therapy tools, and developing a good social network can all go along way to helping treat this illness. Practicing good sleep hygiene is crucial, particularly getting up at the same time each day.

When it comes to medications, as a parent it’s important for you to know that children respond differently to meds than adults. And, although several studies have been recently begun, there’s a lack of research when it comes to the most effective treatments for teens.

What You Need to Know About Bipolar Medications

Before starting any treatment, your teen’s psychologist or psychiatrist will need to conduct a “baseline” assessment of your teen’s physical and mental health.

When it comes to the types of meds your teen is likely to need, mood-stabilizing medications are usually the first choice for treating bipolar disorder. However, because children’s symptoms are complex, it’s not unusual for them to need more than one type of medication.

It’s also very important to rule out the possibility of a thyroid problem with any type of mood disorder. If a thyroid problem is detected, necessary medications need to be provided to treat it as well. Fortunately, most teens with bipolar do not have a thyroid disorder.

If you can’t afford a psychiatrist, find a doctor who is comfortable prescribing a mood stabilizer and treating BPD.

Sometimes a cocktail of medications is needed to treat more severe cases of BPD, which are gradually introduced over a period of months. Most physicians start with a mood stabilizer, and add on an antidepressant if depression is a primary symptom. If the diagnosis is Bipolar I, often an anti-psychotic is added if hallucinations or a thought disorder is present.

When it comes to meds, it’s almost always best to “start low, and go slow.” Talk to your teen’s psychiatrist about starting with the smallest amount of medication that can help reduce the child’s side effects. The biggest reason teens quit meds is that they find themselves grappling with the side effects of large dosages.

Once your teen’s doctor determines the best course of meds to start with, your child will need regular follow-up visits to monitor their progress and any side effects of the meds. It’s also important to know that it can take several weeks or months to judge a medication’s effectiveness before switching to a different prescription.

Keep a daily log of your child’s most troublesome symptoms. Doing so can make it easier for you, your child, and your teen’s psychiatrist to decide whether a medication is helpful. Also, be sure to tell the psychiatrist about all other prescription drugs, over-the-counter medications, or natural supplements your child is taking, as taking certain supplements and medications together can cause unwanted or dangerous effects.

If your child develops any severe side effects from a medication, talk to the prescribing physician as soon as possible. But, no matter what, a teen should not stop taking their meds until talking with a doctor. Suddenly stopping a medication may lead to a severe relapse, more severe manic or depressive episodes, or potentially dangerous withdrawal effects.

This being said, one very rare side effect of some mood stabilizers is a life-threatening skin rash. Again, this is a VERY RARE side effect and generally the medication is a life-saver. But, should it occur, call your teen’s doctor immediately, as most will recommend your teen stop the medication and get to the physicians that same day.

Most adolescents and teens with bipolar disorder continue treatment with mood stabilizers for years, as this is often the best way to manage symptoms and prevent a relapse or return of symptoms. Fortunately, drug treatments have continued to improve, and the numbers of side effects that come with such prescriptions have decreased greatly over the past couple of decades.

Why Psychotherapy?

In addition to medication, professional counseling and psychotherapy – commonly known as “talk” therapy – can be an effective treatment for bipolar disorder.

Studies have shown that psychotherapy can be an effective means of providing support, education, and guidance to people with bipolar disorder as well as their families and caregivers. And psychotherapy can help teens understand the importance of taking their meds to prevent relapse and stay healthy.

Additionally, psychotherapy helps adolescents and teens cope with the problems that BPD can cause in their relationships and at school. Specifically, professional counseling and psychotherapy with a therapist well-versed in treating BPD can help your teen learn positive coping tools that reduce the moods swings, help with relationships, build on strengths, and help develop self-esteem.

Counseling and psychotherapy are typically provided by a licensed psychologist, social worker, counselor, or therapist. However, most mental health professionals have different specialties, so be sure to find one who has experience treating people with bipolar disorder, especially teens, and be sure they’re willing to work closely with your child’s psychiatrist to monitor care.

Some common forms of psychotherapy used to treat bipolar disorder include:

  • Interpersonal Therapy – Interpersonal therapy helps teens and adolescents suffering from bipolar disorder manage their daily routines, their emotions, and their relationships with others.
     
  • Family-Focused Therapy – Family-focused therapy typically includes most, if not all, of a teen’s immediate family members and helps families to improve their communication, problem-solving, and coping skills.
     
  • Cognitive Behavioral Therapy (CBT) – CBT helps teens and adolescents with BPD learn to recognize and transform negative, distorted or harmful thought patterns and behaviors into more positive ones.
     
  • Psychoeducation – Psycho education helps teens, family members, and caregivers better understand bipolar disorder and its treatments as well as recognize signs of relapse before full-blown episodes occur.

Bare in mind, none of these psychotherapeutic techniques is mutually exclusive and other types of psychotherapy may be used in conjunction with those listed above. The type, frequency, and number of psychotherapy sessions your teen attends should be based on your child’s treatment needs.

What Can Your Child and You Expect from Treatment?

As we discussed, there is no cure for bipolar disorder at the current time. But it can be treated effectively over the long term. Many famous people have some form of BPD and highly successfully people make great contributions when treated effectively.

Working closely with your teen’s doctors and mental health professionals and talking openly about treatment choices can make treatment more effective. You may need to talk about changing the treatment plan occasionally to help your child manage the illness most effectively.

Also, it’s wise to keep a chart of your child’s daily mood symptoms, treatments, sleep patterns, and life events, as doing so will help your teen, your teen’s doctor, and you better understand the illness.

In the largest study to date on childhood bipolar disorder – the NIMH-funded Course and Outcome of Bipolar Illness in Youth (COBY) study – researchers found that treatment helped approximately 70 percent of children with bipolar disorder recover from their most recent episode. On average, it took a little over a year and a half to recover. However it is important to note that the participants in this study were largely kids with the most severe type of bipolar.

NIMH continues to fund research studies on which combinations of bipolar disorder treatments are most effective for children, teens, and adults in order to help people with BPD recover from episodes more quickly and live symptom-free for longer periods of time.

If you believe your child may be suffering from bipolar disorder and are unsure where to turn for help, ask your family doctor, visit a local hospital’s psychiatry department or a community mental health center, or search online for mental health professionals in your area that specialize in treating children and teens with bipolar disorder.

While there’s still much work to be done and much to be learned when it comes to diagnosing and treating bipolar disorder, it is an illness that can be treated effectively. So, if you believe your adolescent or teen is suffering from bipolar disorder, seek a professional diagnosis and know that your child and you have every chance in the world of moving forward in relationships and life with confidence and optimism for the future.

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