Bipolar I Disorder, also known as manic depression, is a medical illness characterized by extreme changes in mood, energy, and behavior. Affected teens may experience cycling of mood that swings from excessive highs (mania) to profound lows (depression), usually with periods of normal mood in between.
Bipolar I Disorder typically begins in adolescence or early adulthood and continues throughout life. A traumatic experience may trigger onset of the disorder in youth. Although Bipolar I Disorder strikes a significant percentage of adolescents, the illness is often untreated or misdiagnosed among teens. In fact, for this group, the average time between first symptoms and treatment is approximately 10 years.
In Bipolar I Disorder, teens experience alternating episodes of intense mania and depression. As with teens with depression, teens with Bipolar I Disorder are likely to have a family history of the illness. The list below provides possible signs and symptoms.
Manic symptoms
- Elevated mood and irritability
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- Easily distracted
- Destructive outbursts
- Racing speech and pressure to keep talking
- Increased energy, motor and mental activity—hyperactivity
- Excessive involvement in multiple projects, especially pleasurable but risky activities
- Poor judgment
Depressive symptoms
- Sad mood or crying spells
- Diminished interest or pleasure in almost all activities
- Sleeping too much or inability to sleep
- Agitation and irritability
- Fatigue or decreased energy level
- Drop in grades and inability to think and concentrate
- Feelings of worthlessness or guilt
- Significant change in appetite, weight loss or weight gain
Not all teens with Bipolar I Disorder will experience all of these symptoms.
Early diagnosis and medical treatment are important. Parents should ask their family physician or pediatrician to refer them to a psychiatrist that specializes in the diagnosis and treatment of Bipolar I Disorder. A combination of medication, individual therapy, family therapy and specialized programs may be useful.
Your answers indicate the possibility of bipolar disorder. We recommend you print a copy of this completed questionnaire (using the print key on your Internet toolbar) and share the results with your physician and/or a mental health professional and that you request a comprehensive evaluation for bipolar spectrum disorder.
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1. Has there ever been a period of time when you were not your usual self and…
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…you felt so good or so hyper that other people thought you were not your normal self or you were so hyper that you got into trouble?
YES |
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…you were so irritable that you shouted at people or started fights or arguments?
YES |
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…you felt much more self-confident than usual?
YES |
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…you got much less sleep than usual and found you didn’t really miss it?
NO |
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…you were much more talkative or spoke much faster than usual?
YES |
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…thoughts raced through your head or you couldn’t slow your mind down?
YES |
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…you were so easily distracted by things around you that you had trouble concentrating or staying on track?
YES |
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…you had much more energy than usual?
YES |
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…you were much more active or did many more things than usual?
NO |
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…you were much more social or outgoing than usual, for example, you telephoned friends in the middle of the night?
NO |
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…you were much more interested in sex than usual?
YES |
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…you did things that were unusual for you or that other people might have thought were excessive, foolish, or risky?
YES |
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…spending money got you or your family into trouble?
YES
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2. If you checked YES to more than one of the above, have several of these ever happened during the same period of time?
YES
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3. How much of a problem did any of these cause you – like being unable to work; having family, money or legal troubles; getting into arguments or fights?
Serious Problem
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Depression
This is the most severe category of depression. In a major depression, more of the symptoms of depression are present, and they are usually more intense or severe. A major depression can result from a single traumatic event in your life, or may develop slowly as a consequence of numerous personal disappointments and life problems. Some people appear to develop the symptoms of a major depression without any obvious life crisis causing it. Other individuals have had less severe symptoms of depression for a long time (such as Dysthymic disorder), and a life crisis results in increased symptom intensity.
Major depression can occur once, as a result of a significant psychological trauma, respond to treatment, and never occur again within your lifetime. This would be a single episode depression. Some people tend to have recurring depression, with episodes of depression followed by periods of several years without depression, followed by another episode, usually in response to another trauma. This would be a recurrent depression. In general, the treatment is similar, except that treatment usually is over a longer time period for recurrent depression.
Professional debate continues regarding whether some people develop “endogenous depression” without any identified psychological causes. An endogenous depression is a biologically caused depression, due presumably to either genetic causes or a malfunction in the brain chemistry. But, all depression involves some changes in brain chemistry, even when the cause is clearly a psychological trauma. After psychological treatment and recovery from depression, the brain chemistry returns to normal, even without medication. To date, there is no hard research evidence to support the notion of endogenous depression. Sometimes this term is used to describe people who do not respond well to treatment, and sometimes it is a rationale to prescribe medication alone, and not to offer any psychological treatment for the depression. In general, the majority of people who require antidepressant medication for their depression respond to treatment better when psychotherapy, particularly cognitive-behavioral psychotherapy, is provided in addition to the medication. Medication treats the symptoms of depression, and is often a vital part of the treatment program, but it is essential to treat the psychological problems that caused the depression.
Research has shown that cognitive therapy is the best treatment for depression, as compared to medication and other forms of psychotherapy. However, many people respond better to a combination of medication and cognitive therapy. It does not make sense to only prescribe medication, without offering psychotherapy as well, because of the added benefits shown in research studies. There are some people who respond positively to psychotherapy, but plateau at a mild level of depression, without complete recovery from all of the symptoms. Often, these individuals are maintained on antidepressant medication after they have completed psychological treatment. Remember, only physicians are qualified to prescribe medication. Your psychologist will refer you to your primary care physician, or to a psychiatrist, for a medication evaluation, if it appears to be indicated.
It’s not unusual for young people to experience “the blues” or feel “down in the dumps” occasionally. Adolescence is always an unsettling time, with the many physical, emotional, psychological and social changes that accompany this stage of life.
Unrealistic academic, social, or family expectations can create a strong sense of rejection and can lead to deep disappointment. When things go wrong at school or at home, teens often overreact. Many young people feel that life is not fair or that things “never go their way.” They feel “stressed out” and confused. To make matters worse, teens are bombarded by conflicting messages from parents, friends and society. Today’s teens see more of what life has to offer — both good and bad — on television, at school, in magazines and on the Internet. They are also forced to learn about the threat of AIDS, even if they are not sexually active or using drugs.
Teens need adult guidance more than ever to understand all the emotional and physical changes they are experiencing. When teens’ moods disrupt their ability to function on a day-to-day basis, it may indicate a serious emotional or mental disorder that needs attention — adolescent depression. Parents or caregivers must take action.
Dealing With Adolescent Pressures
When teens feel down, there are ways they can cope with these feelings to avoid serious depression. All of these suggestions help develop a sense of acceptance and belonging that is so important to adolescents.
- Try to make new friends. Healthy relationships with peers are central to teens’ self-esteem and provide an important social outlet.
- Participate in sports, job, school activities or hobbies. Staying busy helps teens focus on positive activities rather than negative feelings or behaviors.
- Join organizations that offer programs for young people. Special programs geared to the needs of adolescents help develop additional interests.
- Ask a trusted adult for help. When problems are too much to handle alone, teens should not be afraid to ask for help.
But sometimes, despite everyone’s best efforts, teens become depressed. Many factors can contribute to depression. Studies show that some depressed people have too much or too little of certain brain chemicals. Also, a family history of depression may increase the risk for developing depression. Other factors that can contribute to depression are difficult life events (such as death or divorce), side-effects from some medications and negative thought patterns.
Recognizing Adolescent Depression
Adolescent depression is increasing at an alarming rate. Recent surveys indicate that as many as one in five teens suffers from clinical depression. This is a serious problem that calls for prompt, appropriate treatment. Depression can take several forms, including bipolar disorder (formally called manic-depression), which is a condition that alternates between periods of euphoria and depression.
Depression can be difficult to diagnose in teens because adults may expect teens to act moody. Also, adolescents do not always understand or express their feelings very well. They may not be aware of the symptoms of depression and may not seek help.
These symptoms may indicate depression, particularly when they last for more than two weeks:
- Poor performance in school
- Withdrawal from friends and activities
- Sadness and hopelessness
- Lack of enthusiasm, energy or motivation
- Anger and rage
- Overreaction to criticism
- Feelings of being unable to satisfy ideals
- Poor self-esteem or guilt
- Indecision, lack of concentration or forgetfulness
- Restlessness and agitation
- Changes in eating or sleeping patterns
- Substance abuse
- Problems with authority
- Suicidal thoughts or actions
Teens may experiment with drugs or alcohol or become sexually promiscuous to avoid feelings of depression. Teens also may express their depression through hostile, aggressive, risk-taking behavior. But such behaviors only lead to new problems, deeper levels of depression and destroyed relationships with friends, family, law enforcement or school officials.
Treating Adolescent Depression
It is extremely important that depressed teens receive prompt, professional treatment. Depression is serious and, if left untreated, can worsen to the point of becoming life-threatening. If depressed teens refuse treatment, it may be necessary for family members or other concerned adults to seek professional advice.
Therapy can help teens understand why they are depressed and learn how to cope with stressful situations. Depending on the situation, treatment may consist of individual, group or family counseling. Medications that can be prescribed by a psychiatrist may be necessary to help teens feel better.
Some of the most common and effective ways to treat depression in adolescents are:
- Psychotherapy provides teens an opportunity to explore events and feelings that are painful or troubling to them. Psychotherapy also teaches them coping skills.
- Cognitive-behavioral therapy helps teens change negative patterns of thinking and behaving.
- Interpersonal therapy focuses on how to develop healthier relationships at home and at school.
- Medication relieves some symptoms of depression and is often prescribed along with therapy.
When depressed adolescents recognize the need for help, they have taken a major step toward recovery. However, remember that few adolescents seek help on their own. They may need encouragement from their friends and support from concerned adults to seek help and follow treatment recommendations.
Facing The Danger Of Teen Suicide
Sometimes teens feel so depressed that they consider ending their lives. Each year, almost 5,000 young people, ages 15 to 24, kill themselves. The rate of suicide for this age group has nearly tripled since 1960, making it the third leading cause of death in adolescents and the second leading cause of death among college-age youth.
Studies show that suicide attempts among young people may be based on long-standing problems triggered by a specific event. Suicidal adolescents may view a temporary situation as a permanent condition. Feelings of anger and resentment combined with exaggerated guilt can lead to impulsive, self-destructive acts.
Recognizing The Warning Signs
Four out of five teens who attempt suicide have given clear warnings. Pay attention to these warning signs:
- Suicide threats, direct and indirect
- Obsession with death
- Poems, essays and drawings that refer to death
- Dramatic change in personality or appearance
- Irrational, bizarre behavior
- Overwhelming sense of guilt, shame or rejection
- Changed eating or sleeping patterns
- Severe drop in school performance
- Giving away belongings
REMEMBER!!! These warning signs should be taken seriously. Obtain help immediately. Caring and support can save a young life.
Helping Suicidal Teens
- Offer help and listen. Encourage depressed teens to talk about their feelings. Listen, don’t lecture.
- Trust your instincts. If it seems that the situation may be serious, seek prompt help. Break a confidence if necessary, in order to save a life.
- Pay attention to talk about suicide. Ask direct questions and don’t be afraid of frank discussions. Silence is deadly!
- Seek professional help. It is essential to seek expert advice from a mental health professional who has experience helping depressed teens. Also, alert key adults in the teen’s life — family, friends and teachers.
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