Bipolar Disorders

Bipolar disorders are mental health conditions that causes significant changes in mood, energy, and activity levels. Children and teenagers with bipolar disorder experience periods of extreme happiness and energy, known as mania, and periods of deep sadness, known as depression. During manic episodes, kids might feel overly confident, talk quickly, and take risks without thinking about the consequences. In some cases, they may have a less intense form of mania called hypomania. Depression, on the other hand, can make them feel very sad, lose interest in activities they once enjoyed, and have trouble concentrating. Bipolar disorder often starts in the teenage years, but it can also begin in childhood or later in adulthood. Recognizing the symptoms early and getting the right treatment can help manage the condition and improve the child’s quality of life.

What are the symptoms of Bipolar Disorders?

Feeling happy and energetic is a normal part of growing up. Children often experience changes in their mood based on what’s happening around them. These feelings usually come and go and are related to events like playing with friends or doing well in school. It’s normal for kids and teens to feel down when bad things happen—we all do. Usually, they feel better when things get better. But if kids stay sad even when good things happen, that’s a sign of concern.

Bipolar I disorder:

Bipolar I disorder is marked by episodes of mania that last at least a week or require hospitalization. During a manic episode, a child might:

– Feel extremely energetic and active, more than usual.

– Experience a very happy or excited mood, sometimes feeling overly silly.

– Talk much faster than usual or feel like they can’t stop talking.

– Have racing thoughts that are hard to keep up with.

– Feel more confident than usual, as if they can do anything.

– Engage in risky behaviors without thinking about the consequences.

– Need much less sleep than usual but still feel energetic.

Bipolar II disorder:

Bipolar II disorder involves episodes of hypomania and depression. Hypomania is less severe than mania and doesn’t cause major problems in daily life. Symptoms include:

– Feeling more energetic and active than usual.

– Being more talkative or having racing thoughts.

– Feeling more confident or special.

– Needing less sleep but not feeling tired.

Depressive episodes in both types of bipolar disorder include:

– Feeling very sad or hopeless.

– Losing interest in activities they used to enjoy.

– Changes in appetite or weight.

– Sleeping too much or too little.

– Feeling tired or having low energy.

– Having trouble concentrating or making decisions.

– Thinking about death or suicide.

Understanding these symptoms can help caregivers recognize when a child might need help. It’s important to remember that these symptoms can vary in intensity and duration.

How are Bipolar Disorders diagnosed?

Diagnosing bipolar disorder involves a thorough evaluation by a mental health professional. To receive a diagnosis, a child must have experienced at least one manic or hypomanic episode. These episodes are periods of extreme behavior that are very different from their usual behavior and make it hard for them to participate in normal activities like school or spending time with friends. Sometimes, severe manic episodes can include psychotic features, where the child loses touch with reality.

If a child only experiences depressive episodes, they may be diagnosed with depression rather than bipolar disorder. It’s important to distinguish between bipolar I disorder, which includes full manic episodes, and bipolar II disorder, which involves hypomanic episodes and depression.

In the past, children who were easily irritated and had frequent tantrums might have been diagnosed with bipolar disorder, even without manic episodes. Now, these children are often diagnosed with disruptive mood dysregulation disorder (DMDD) instead. If you suspect your child might be experiencing a manic episode, it’s crucial to seek medical attention promptly. Early intervention and a comprehensive treatment plan can help manage symptoms and improve the child’s well-being.

Bipolar Disorder facts

Worldwide frequency of the condition:
Bipolar disorder is estimated to affect between 1.02% and 2.6% of the global population, although prevalence varies between different groups and studies. Among children and adolescents, prevalence ranges from 1.8% to 3.9%.

Burden of the condition in Brazil:
The estimated prevalence of Bipolar Disorder is 0.9% in adolescents aged 10 to 19 in Brazil. National prevalence studies among children are even more limited.

Gender ration:
Available data indicate that bipolar I disorder does not present significant differences in diagnosis rates between boys and girls. Bipolar II disorder, however, has a higher prevalence in girls in some samples.

Peak age of onset:

– Genetic and physiological factors:* Bipolar disorder has a strong genetic component, with heritability estimates around 90% in some studies. The risk is higher among first-degree relatives of individuals with bipolar disorder. Emerging research suggests that mania and depression may have separate genetic influences.

What other disorders co-occur with Bipolar Disorders?

Bipolar disorders often occur alongside other mental health conditions. In children and adolescents, common co-occurring disorders include attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). Anxiety disorders, such as generalized anxiety disorder and social anxiety, are also prevalent. Substance use disorders, including alcohol and drug use, can complicate the course of bipolar disorder. Additionally, personality disorders like borderline personality disorder may co-occur with bipolar I disorder. Recognizing and managing these co-occurring conditions is crucial for improving overall functioning and treatment outcomes.

How are Bipolar Disorders treated?

Treating bipolar disorders typically involves a combination of medication and therapy. Early treatment is crucial to manage symptoms and prevent episodes. Family involvement is also important to support the child and ensure adherence to the treatment plan.

Psychotherapy plays a key role in managing bipolar disorder. Cognitive Behavioral Therapy (CBT) helps children understand what triggers their episodes and how their thoughts affect their feelings. Family-focused therapy involves the whole family in learning about the disorder, improving communication, and developing problem-solving skills. Other therapies, like social rhythm therapy, help establish a regular daily routine to prevent mood episodes.

Medications are essential in treating bipolar disorder. Mood stabilizers, and anticonvulsants, are commonly used to manage manic and depressive symptoms and reduce the frequency of episodes. Antipsychotic medications may be prescribed to address severe manic symptoms or psychosis. In some cases, antidepressants might be used alongside mood stabilizers to treat depressive episodes, but they must be carefully monitored to avoid triggering mania. It’s important for children and adolescents to have regular check-ups with their healthcare provider to monitor the effectiveness of medications and manage any side effects. A comprehensive treatment plan that includes both medication and therapy can help children with bipolar disorder lead fulfilling lives.

References

Clinical description, symptoms, and diagnostic information

– American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

– Child Mind Institute. (n.d.). Identifying Mania in Kids and Teens. Retrieved March 6, 2025, from _https://childmind.org/article/identifying-mania-in-kids-and-teens/_

– Child Mind Institute. (2024a, January). Quick Facts on Bipolar Disorder. _https://childmind.org/article/quick-facts-on-bipolar-disorder/_

– Child Mind Institute. (2024b, October). Bipolar Disorder in Kids—A Quick Guide. _https://childmind.org/guide/bipolar-disorder-in-kids-quick-guide/_

– Child Mind Institute. (2024c, October). Depression in Kids—A Quick Guide. _https://childmind.org/guide/depression-in-kids-quick-guide/_

– World Health Organization. (2025a, January). ICD-11 for Mortality and Morbidity Statistics. 6A60 Bipolar Type I Disorder. _https://icd.who.int/browse/2025-01/mms/en#1456478153_

– World Health Organization. (2025b, January). ICD-11 for Mortality and Morbidity Statistics. 6A61 Bipolar Type II Disorder. _https://icd.who.int/browse/2025-01/mms/en#199053300_

– World Health Organization. (2025c, January). ICD-11 for Mortality and Morbidity Statistics. 6A62 Cyclothymic Disorder. Retrieved March 6, 2025, from _https://icd.who.int/browse/2025-01/mms/en#1427638883_

Facts

– American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

– Institute for Health Metrics and Evaluation (IHME). (2019). GBD Compare Data Visualization. Seattle, WA: IHME, University of Washington. Available from _http://vizhub.healthdata.org/gbd-compare_. (Accessed 11/15/2022)

– McClellan, J., Kowatch, R., & Findling, R. L. (2007). Practice Parameter for the Assessment and Treatment of Children and Adolescents With Bipolar Disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 46(1), 107–125. _https://doi.org/10.1097/01.chi.0000242240.69678.c4_

– Moreira, A. L. R., Van Meter, A., Genzlinger, J., & Youngstrom, E. A. (2017). Review and Meta-Analysis of Epidemiologic Studies of Adult Bipolar Disorder. The Journal of Clinical Psychiatry, 78(9), e1259–e1269. _https://doi.org/10.4088/JCP.16r11165_

– Solmi, M., Radua, J., Olivola, M., Croce, E., Soardo, L., Salazar de Pablo, G., Il Shin, J., Kirkbride, J. B., Jones, P., Kim, J. H., Kim, J. Y., Carvalho, A. F., Seeman, M. V., Correll, C. U., & Fusar-Poli, P. (2022). Age at onset of mental disorders worldwide: Large-scale meta-analysis of 192 epidemiological studies. Molecular Psychiatry, 27(1), 281–295. _https://doi.org/10.1038/s41380-021-01161-7_

– Van Meter, A., Moreira, A. L. R., & Youngstrom, E. (2019). Updated Meta-Analysis of Epidemiologic Studies of Pediatric Bipolar Disorder. The Journal of Clinical Psychiatry, 80(3). _https://doi.org/10.4088/JCP.18r12180_

– Van Meter, A. R., Moreira, A. L. R., & Youngstrom, E. A. (2011). Meta-Analysis of Epidemiologic Studies of Pediatric Bipolar Disorder. The Journal of Clinical Psychiatry, 72(09), 1250–1256. _https://doi.org/10.4088/JCP.10m06290_

Associated factors

– American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

– Bortolato, B., Köhler, C. A., Evangelou, E., León‐Caballero, J., Solmi, M., Stubbs, B., Belbasis, L., Pacchiarotti, I., Kessing, L. V., Berk, M., Vieta, E., & Carvalho, A. F. (2017). Systematic assessment of environmental risk factors for bipolar disorder: An umbrella review of systematic reviews and meta‐analyses. Bipolar Disorders, 19(2), 84–96. _https://doi.org/10.1111/bdi.12490_

– Daruy‐Filho, L., Brietzke, E., Lafer, B., & Grassi‐Oliveira, R. (2011). Childhood maltreatment and clinical outcomes of bipolar disorder. Acta Psychiatrica Scandinavica, 124(6), 427–434. _https://doi.org/10.1111/j.1600-0447.2011.01756.x_

– Estrada‐Prat, X., Van Meter, A. R., Camprodon‐Rosanas, E., Batlle‐Vila, S., Goldstein, B. I., & Birmaher, B. (2019). Childhood factors associated with increased risk for mood episode recurrences in bipolar disorder—A systematic review. Bipolar Disorders, 21(6), 483–502. _https://doi.org/10.1111/bdi.12785_

– Faedda, G. L., Serra, G., Marangoni, C., Salvatore, P., Sani, G., Vázquez, G. H., Tondo, L., Girardi, P., Baldessarini, R. J., & Koukopoulos, A. (2014). Clinical risk factors for bipolar disorders: A systematic review of prospective studies. Journal of Affective Disorders, 168, 314–321. _https://doi.org/10.1016/j.jad.2014.07.013_

– Rodriguez, V., Alameda, L., Trotta, G., Spinazzola, E., Marino, P., Matheson, S. L., Laurens, K. R., Murray, R. M., & Vassos, E. (2021). Environmental Risk Factors in Bipolar Disorder and Psychotic Depression: A Systematic Review and Meta-Analysis of Prospective Studies. Schizophrenia Bulletin, 47(4), 959–974. _https://doi.org/10.1093/schbul/sbaa197_

– Shintani, A. O., Rabelo-da-Ponte, F. D., Marchionatti, L. E., Watts, D., Ferreira De Souza, F., Machado, C. D. S., Pulice, R. F., Signori, G. M., Luzini, R. R., Kauer-Sant’Anna, M., & Passos, I. C. (2023). Prenatal and perinatal risk factors for bipolar disorder: A systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews, 144, 104960. _https://doi.org/10.1016/j.neubiorev.2022.104960_

Co-occurring disorders

– American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

– Fahrendorff, A. M., Pagsberg, A. K., Kessing, L. V., & Maigaard, K. (2023). Psychiatric comorbidity in patients with pediatric bipolar disorder – A systematic review. Acta Psychiatrica Scandinavica, 148(2), 110–132. _https://doi.org/10.1111/acps.13548_

– Léda-Rêgo, G., Studart-Bottó, P., Abbade, P., Rabelo-Da-Ponte, F. D., Casqueiro, J. S., Sarmento, S., Dallalana, C., Troesch, M., Prates, S., & Miranda-Scippa, Â. (2024). Lifetime prevalence of psychiatric comorbidities in patients with bipolar disorder: A systematic review and meta-analysis. Psychiatry Research, 337, 115953. _https://doi.org/10.1016/j.psychres.2024.115953_

Interventions

– Child Mind Institute. (n.d.). Identifying Mania in Kids and Teens. Retrieved March 6, 2025, from _https://childmind.org/article/identifying-mania-in-kids-and-teens/_

– Child Mind Institute. (2024a, January). Quick Facts on Bipolar Disorder. _https://childmind.org/article/quick-facts-on-bipolar-disorder/_

– Child Mind Institute. (2024b, October). Bipolar Disorder in Kids—A Quick Guide. _https://childmind.org/guide/bipolar-disorder-in-kids-quick-guide/_

– Child Mind Institute. (2024c, October). Depression in Kids—A Quick Guide. _https://childmind.org/guide/depression-in-kids-quick-guide/_

– Fristad, M. A., & MacPherson, H. A. (2014). Evidence-Based Psychosocial Treatments for Child and Adolescent Bipolar Spectrum Disorders. Journal of Clinical Child & Adolescent Psychology, 43(3), 339–355. _https://doi.org/10.1080/15374416.2013.822309_

– Liu, H. Y., Potter, M. P., Woodworth, K. Y., Yorks, D. M., Petty, C. R., Wozniak, J. R., Faraone, S. V., & Biederman, J. (2011a). Pharmacologic Treatments for Pediatric Bipolar Disorder: A Review and Meta-Analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 50(8), 749-762.e39. _https://doi.org/10.1016/j.jaac.2011.05.011_

– Liu, H. Y., Potter, M. P., Woodworth, K. Y., Yorks, D. M., Petty, C. R., Wozniak, J. R., Faraone, S. V., & Biederman, J. (2011b). Pharmacologic Treatments for Pediatric Bipolar Disorder: A Review and Meta-Analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 50(8), 749-762.e39. _https://doi.org/10.1016/j.jaac.2011.05.011_

– McClellan, J., Kowatch, R., & Findling, R. L. (2007). Practice Parameter for the Assessment and Treatment of Children and Adolescents With Bipolar Disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 46(1), 107–125. _https://doi.org/10.1097/01.chi.0000242240.69678.c4_

– Tural Hesapcioglu, S., Kasak, M., Abursu, H., Kafali, S., Ceylan, M. F., & Akyol, M. (2024). A systematic review and network meta-analysis on comparative efficacy, acceptability, and safety of treatments in acute bipolar mania in youths. Journal of Affective Disorders, 349, 438–451. _https://doi.org/10.1016/j.jad.2024.01.067_