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Experts coach parents to expect the worst during the teen years: defiance, acting out, drug experimentation, even minor criminal activity. With friends moaning about their children’s attitudes and outrageous stunts, it’s easy to assume your teenager’s behavior falls in line with the norm. It may and it may not.
It can be difficult to separate teenage moodiness from a more serious mood disorder like bipolar disorder or clinical depression.
Look over the following characteristics associated with bipolar disorder. If your teen’s behavior matches four or more, you should have him or her evaluated for bipolar disorder with a doctor.
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explosive and frequent outbursts
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chronic irritability—more irritability than peace or joy
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cravings for carbohydrates and sweets
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lack of interest in socializing with friends
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rapidly changing moods lasting a few hours to a few days (a few days up and a few days down)
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rapid jumps from project to project
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excited speech patterns and chronic talking
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chronic defiance
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hyperactivity, agitation
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inability to focus
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aggression above and beyond that typical for age-level
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impulsivity and reckless behaviors (such as jumping from the top of the stairs or trying to fly)
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exaggerated beliefs about their own importance or skills extreme beliefs (e.g. I’m more connected to God than others.)After this period ends, your teen may either return to a calm and rational state or go into a depression. Sometimes, bipolar disorder is misdiagnosed as depression because the teen and parents don’t report the above symptoms as problematic. As some bipolar individuals will tell you, the high or mania can feel good. They often accomplish much and even feel their ideas jump to a new level of sophistication. It’s the low mood that brings them down, preventing them from attending school and getting done what they need to. Bouncing down to a depression after an extreme high signals possible bipolar disorder. A teen constantly in a low mood may be suffering from uni-polar mood disorder, depression or dysthymia.
Some or all of the following characteristics indicate depression:
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lack of interest in activities once enjoyed
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persistent sadness
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intense feelings of emptiness, worthlessness or guilt
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restlessness
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exhaustion, fatigue
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sleep changes: insomnia or oversleeping
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loss of focus or concentration
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inability to make decisions
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persistent thoughts of death or suicide
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unexplained aches and pains suicidal thoughts
If that person only exhibits/reports the symptoms listed above, the doctor typically suspects depression (a uni-polar or mood disorder concentrated on the one end of the mood spectrum).
What If We Don’t Even Want to Know?
Denial works, but only in the short term. Your life and those of everyone in the family will improve once the ill individual receives an accurate diagnosis. Why?
One family member’s mood disorder can throw the dynamics of the entire family. Siblings and parents can interpret the irritability, mood swings and sluggishness that accompany mood disorders as rudeness, lack of consideration and laziness, among other classifications. Sometimes, alliances emerge that further destabilize the family.
Once a doctor diagnoses the mood disorder, parents and siblings understand the basis of the ill individual’s behavior, changing their understanding of his or her motivations, comments and actions. More, once treatment with medication, counseling and lifestyle changes begin, the individual improves, further alleviating stress in the home. Families begin to function with fewer hurt feelings and resentments. They can even pull together with a common goal: coping with a treatable illness.
Can a Mood Disorder Underlie My Teenager’s Terrible Behavior?
Absolutely. The lives of teens struggling with mood disorders can be marred by poor decisions and/or ineffective, misguided attempts to cope. Mood disordered teens may experience or perpetrate:
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academic failure
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destruction of property
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school suspension or expulsion
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social isolation
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drug and alcohol use
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frequent misunderstandings
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inability to finish projects
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reckless behavior (speeding, unprotected sex, over-spending)
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extreme defiance
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poor social relations
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suicide attempts
If you or a loved one expresses thoughts of suicide, contact a medical professional, clergy member, family member or friend immediately or call 1-800-273-TALK. Suicidal thoughts result from biochemical imbalances that can be rectified.
The Diagnosis is In . . .
A diagnosis of bipolar disorder or depression can throw teens and their parents for a loop when it first arrives. Psychiatric terms can shake an individual’s sense of identity. The teen may begin to see himself or herself as “sick” or “crazy.” And how could a “sick” or “crazy” person ever have a normal, happy life?
The truth is: they do, all the time, every day—BUT only when their issues are addressed. Yes: it takes accommodations. Yes: it takes a willingness to reserve a lot of time and effort for symptom management and illness research. But those with treated mood disorders generally find ways to contribute to society and to their families.
Your teen will most likely work. They will most likely have friends and even spouses,
but only if they and you fully accept the diagnosis and work to manage symptoms with medication, therapy and lifestyle changes.
American doctors now prescribe more anti-depressants than any other class of drugs. While a full ten percent of all Americans benefit from anti-depressant medication, most of them keep this fact quiet.
Once you finish this article, please also read the “Helping a Child with Bipolar Disorder?” and scan the blogs which address teen concerns.
When your teenager is diagnosed with bipolar disorder, you as the parent will have to assume responsibility. Luckily, support groups and healthcare providers stand ready to help you with information, education, and even counseling for yourself.
Once you have the diagnosis, follow these effective steps:
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Help yourself and the doctor understand what’s going on by keeping a journal of the child’s behavior. This journal should document the time and date of the symptom (e.g. temper tantrum, impulsivity, defiance, etc.) and how long it lasted. Jot down where you were and what might have triggered it. Get as detailed as you can: did the child destroy anything? Did he or she act incredibly rudely or anti-social? Did the child spend days with very low energy?
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Find a pediatrician or child psychiatrist (or pediatric psychiatrist) who specializes in mood disorders. Be persistent in finding someone who has had extensive experience with children manifesting symptoms of all kinds of mood disorders. Ask the doctor or pediatric psychiatrist whether they’ve treated any children with pediatric bipolar disorder before. Ask them their opinion of the debate surrounding this mood disorder.
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Once you have your child’s diagnosis, read as much as you can about it. Share hopeful information and case studies with your child. Explain that you’ll both be going forward a little differently than perhaps you expected, but you all will still enjoy each other and have happy, fulfilling lives.
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Explore the possibility of medication. If you doctor recommends one, know that you will “start low, go slow” as they say in the psychiatric communities. In other words, your doctor will first prescribe a very low dose of the medication, increasing it very gradually over several months. You will be instructed to watch for signs of side effects and improvements. It will help you if you write down both of these, so that you can see any progression or change.
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Explore the possibility of psychotherapy for your child. Studies have shown that therapy in conjunction with medication are very effective and more effective than either one by itself.
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Research support groups to which you can belong. Discussing your challenges with others will do wonders for your emotional health. Further, you’ll learn from others about treatments, coping skills, routines to have at home and many other ways to handle having a child with bipolar disorder.
What Else Can I Expect From a Teen with a Mood Disorder?
Young adults with bipolar disorder act differently from adults with the same illness. Young adults cycle from high to low more frequently. They also tend to have more either manic or depressive episodes than adults. They can have more “mixed episodes”, which means they have periods where they have symptoms both of a manic high and depression at the same time.
Keep in mind that the above characteristics are generalities. A child can be quite functional for weeks when suddenly they’re thrown into an extreme mood. When these moods result in extreme behaviors, those around them can react with fear or repugnance.
Bipolar teens often fail to gauge how their emotions and behavior impact others. Once their mood has passed, they don’t understand why others draw away. Eventually, however, they discover that they are different from others. This discovery leads to feelings of disconnection and shame. At this point, the bipolar teen may attempt to “fake” his or her way through life.
Bipolar or depressed teens fake in various ways. Some become avoidant and isolated, depending on one trustworthy individual to meet their needs. This individual is often a parent.
Other bipolar or depressed teens can become unnaturally social. Underlying this intensity, however, lies a desperate need for control. Basically, since they can’t understand others’ moods, they can’t predict those moods or behavior, putting the ill individual in a precarious position. Without the ability to understand or predict, they choose to control others. Some bipolar individuals cannot simply let a relationship unfold naturally. These behaviors further isolate them.
Medications for the Teen with a Mood Disorder
Once your teen receives a diagnosis, your doctor may suggest some medications. Currently only lithium (sometimes called Eskalith), risperidone (Risperdal), and aripiprazole (Abilify) have FDA approval for use in young adults.
Lithium Known as a “mood stabilizer,” lithium can prevent manic symptoms in children ages 12 and older. It also acts as an antidepressant and lessens suicidal inclinations. Since these findings resulted from studies with adults, the effects are not guaranteed in those under 18. In fact, some researchers claim that the FDA may not even approve lithium today if it had to review the case studies.
Risperidone (Risperdal) and aripiprazol (Abilify) and Olanzapine (Zyprexa), Quetiapine (Seroquel) and Ziprasidone (Geodone) are classified as “atypical” (or second generation) anti-psychotics. The word “atypical” refers only to the fact that these medicines came after researchers developed the first medicines (like lithium) to treat mood. Doctors sometimes prescribe risperidone short term to help reduce manic symptoms. Aripiprazol (Abilify) has proven effective in children ages 10 -17.
Valproic acid, lamotrigine (Lamictal) or divalproex sodium (Depakote), known as “anti- convulsants” have proven to help stabilize moods. In fact, they have proven effective in treating moods that do not respond to the medications mentioned above. Initially developed to treat seizures, some anti-convulsants have proven more effective in children than lithium. These medications have not been approved by the FDA to treat bipolar disorder in children, YET, but if you keep checking at the FDA site, something similar may. Further, doctors can sometimes get around these restrictions if the situation warrants it.
Fluoxetine (Prozac), Paroxetine (Paxil) and Sertraline (Zoloft), all “antidepressant medications” are used both for depression and for bipolar disorder. When doctors prescribe one of these in cases of bipolar, it’s likely the recipient takes a mood stabilizer or anti-convulsant as well to control the manias. A bipolar child only on an antidepressant risks switching to mania and/or developing “rapid cycling symptoms.” Rapid cycling symptoms are defined as having four or more epidsodes of major depression, mania or mixed symptoms over the course of one year.
New medications are being developed and approved for this age group all the time, however. Make sure you keep checking the U.S. Food and Drug Administration FDA) website. The National Institute of Mental Health also has a Medications Booklet (). These two sites cover all the side effects of the medications as well as contraindications.
Special Precautions for Teens Taking Bipolar Medication
Lithium Poisoning: Particularly when young adults become dehydrated, lithium can build up to unhealthy levels in the body. Make sure that your teen drinks plenty of water while taking lithium, particularly on hot days or when your teen is very active and sweating or when experiencing a fever. Early signs of lithium poisoning include:
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diarrhea
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lack of coordination
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vomiting
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drowsiness
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muscle fatigue
If you child demonstrates these signals, go straight to the emergency room.
Special Precautions for Teens Taking Antidepressants
Antidepressant Side Effects While antidepressants remain the #1 class of drugs prescribed in the United States, some studies have reported that SOME young adults experience negative side effects when taking them. The biggest concern revolves around whether antidepressants lead to greater suicidal thoughts.
In 2003, as a result of some studies, the FDA required that anti-depressant manufacturers include a “black box” on their products. The black box warned people that antidepressants could cause an increase in suicidal thoughts among those aged 10-24. Up until that point, the suicide rate in that population had dropped from 1990 – 2003 by an amazing 28%. Many attributed this decrease to the increased use of anti-depressants.
After the “black box” was added to anti-depressant labeling, anti-depressant use dropped off and the teen suicide rate rose by 8% from 2004 – 2005. Some blamed the decreased use of anti-depressants for this uptick. (see: http://online.wsj.com/article/SB122038021590991599.html ).
Most doctors and researchers agree that anti-depressants do more good than harm in the adolescent population. The key is to “start low, go slow”; in other words, start at a low dose, go in for monitoring by the doctor regularly, and increase the dosage slowly. All doctors will want to see a teen or anyone just starting a new medication once each week or two. Also, it’s important to inform you teen that suicidal thoughts may crop up. Reassure him or her that these may occur and that they are simply a result of the medication, a side effect so to speak. They are not “real.” Encourage your teen to tell you if they’re having these feelings.
Other negative side-effects of anti-depressants include:
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trouble sleeping
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agitation
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isolation
Valproic Acid An anti-convulsant, valproic acid may increase levels of the male hormone testosterone in young women under 20. Increased testosterone can lead to polycystic ovarian syndrome (PCOS) in women. Because PCOS causes a woman’s eggs to turn into cysts (fluid filled sacks), infertility can result. Unlike the process in a woman without PCOS, eggs are not released monthly, but remain in the ovaries.
When doctors and families determine that valproic acid is the best medication for the individual, the doctor will monitor the ovaries for the onset of PCOS. If indeed PCOS does result, the doctor will most likely stop treatment with valproic acid. Most PCOS symptoms improve and/or disappear after stopping valproic acid use.
Valproic Acid and Lamotrigine (Lamictal) Like anti-depressants, these and other anti- convulsants carry a FDA warning on their labels stating that their use may cause an increase in suicidal thoughts and behaviors. For this reason, the doctor will insist on monitoring the patient closely as treatment begins. The doctor will also look for an intensification of the feelings of depression or other unusual changes in behavior.
Can I Help Make the Medication More Effective?
Yes! Adding psychotherapy and lifestyle changes to your treatment regimen helps maximize your chances for recovery.
The National Institute of Mental Health (NIMH) sponsored an often-quoted study called the “Systematic Treatment Enhancement Program for Bipolar Disorder” (see www.step- bd.com). As the title suggests, researchers were looking to enhance the effectiveness of treatment. First, they found that treating adults with mediation and intensive psychotherapy for nine months was effective; these people got better. More importantly, those who used medication and had just six weeks of less intensive therapy did not make the gains those with the longer-term therapy did. Keep in mind that researchers used adults in this study, but other smaller studies have shown that children also benefit from psychotherapy when used in concert with medication. Children and teens can benefit from the therapies that teach them to cope with stresses at school, home and in the community.