08265 Bipolar Children_Final.indd i 08265 Bipolar Children_Final.indd i 

p

in Children and Teen

A Parent’s Guide 

National Institute of Mental Health 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES • National Institutes 
Contents

What is bipolar disorder? _____________________________________

What are common symptoms of bipolar disorder in 

children and teens? __________________________________________

What affects a child’s risk of getting bipolar disorder? ___________

How does bipolar disorder affect children and teens 

differently than adults? _______________________________________

How is bipolar disorder detected in children and teens? _________

What illnesses often co-exist with bipolar disorder in 

children and teens? __________________________________________

What treatments are available for children and teens with 

bipolar disorder? _____________________________________________

Medications ______________________________________________

Psychotherapy ___________________________________________

What can children and teens with bipolar disorder expect 

from treatment? ______________________________________________

Where can families of children with bipolar disorder get help? ____

Where can I go for help? ______________________________________

What if my child is in crisis? ___________________________________

Citations ____________________________________________________

For more information on bipolar disorder _______________________

08265 Bipolar Children_Final.indd iii 
08265 Bipolar Children_Final.indd iv 08265 Bipolar Children_Final.indd iv 

All parents can relate to the many changes 

their kids go through as they grow up. 

But sometimes it’s hard to tell if a child is 

just going through a “phase,” or perhaps 

showing signs of something more serious. 

Recently, doctors have been diagnosing 

more children with bipolar disorder,1 

sometimes called manic-depressive illness. 

But what does this illness really mean for a 

child? 

This booklet is a guide for parents who think 

their child may have symptoms of bipolar 

disorder, or parents whose child has been 

diagnosed with the illness. 

This booklet discusses bipolar disorder in children and teens. For information on bipolar dis

see the National Institute of Mental Health (NIMH) booklet “Bipolar Disorder.”
08265 Bipolar Children_Final.indd Sec1:1 08265 Bipolar Children_Final.indd Sec1:1 

What is bipolar disorder? 

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in 

mood and energy. It can also make it hard for someone to carry out day-to-day tasks, such as going to 

school or hanging out with friends. Symptoms of bipolar 

disorder are severe. They are different from the normal 

ups and downs that everyone goes through from time 

to time. They can result in damaged relationships, poor school perform

even suicide. But bipolar disorder can be treated, and people with this 

lead full and productive lives. 

Bipolar disorder often develops in a person’s late teens or early adult ye

some people have their first symptoms during childhood. At least half o

start before age 25.2 

What are common symptoms of bipolar 

disorder in children and teens? 

Youth with bipolar disorder experience unusually intense emotional states that occur in distinct 

periods called “mood episodes.” An overly joyful 

or overexcited state is called a manic episode, 

and an extremely sad or hopeless state is called a 

depressive episode. Sometimes, a mood episode 

includes symptoms of both mania and depression. 

This is called a mixed state. People with bipolar 

disorder also may be explosive and irritable during 

a mood episode. 

Extreme changes in energy, activity, sleep, and behavior go along with 

changes in mood. Symptoms of bipolar disorder are described on the f

page. 

Bipolar Disorder in Children and Teens: A Parent
08265 Bipolar Children_Final.indd Sec1:2 08265 Bipolar Children_Final.indd Sec1:2 

Symptoms of mania include: 

Mood Changes 

• Being in an overly silly or joyful 

mood that’s unusual for your child. 

It is different from times when he 

or she might usually get silly and 

have fun. 

• Having an extremely short temper. 

This is an irritable mood that is 

unusual. 

Behavioral Changes 

• Sleeping little but not feeling tired 

• Talking a lot and having racing 

thoughts 

• Having trouble concentrating, 

attention jumping from one thing 

to the next in an unusual way 

• Talking and thinking about sex 

more often 

• Behaving in risky ways more often, 

seeking pleasure a lot, and doing 

more activities than usual. 

Symptoms of depressio

Mood Changes 

• Being in a sad mood tha

long time 

• Losing interest in activit

once enjoyed 

• Feeling worthless or gui

Behavioral Changes 

• Complaining about pain 

often, such as headache

ach aches, and muscle 

• Eating a lot more or less 

ing or losing a lot of wei

• Sleeping or oversleeping 

these were not problems 

• Losing energy 

• Recurring thoughts of de

suicide. 

It’s normal for almost every child or teen to have some of these sympto

times. These passing changes should not be confused with bipolar dis

Symptoms of bipolar disorder are not like the normal changes in mood 

that everyone has now and then. Bipolar symptoms are more extreme a

last for most of the day, nearly every day, for at least one week. Also, d

or manic episodes include moods very different from a child’s normal m

the behaviors described in the chart above may start at the same time. 

the symptoms of bipolar disorder are so severe that the child needs to 

in a hospital. 

2 • National Institute of Mental Health 
08265 Bipolar Children_Final.indd Sec1:3 08265 Bipolar Children_Final.indd Sec1:3 

In addition to mania and depression, bipolar disorder can cause a rang

as shown on the scale below. One side of the scale includes severe de

moderate depression, and mild low mood. Moderate depression may c

extreme symptoms, and mild low mood is called dysthymia when it is c

long-term. In the middle of the scale is normal or balanced mood. 

normal or 

balanced mood 

 

severe depression, 

moderate depression, and 

mild low mood 

hypomania an

severe mania 

Sometimes, a child may have more energy and be more active than no

not show the severe signs of a full-blown manic episode. When this ha

called hypomania, and it generally lasts for at least four days in a row. H

causes noticeable changes in behavior, but does not harm a child’s abi

tion in the way mania does. 

What affects a child’s risk of getting bip

disorder? 

Bipolar disorder tends to run in families. 

Children with a parent or sibling who has 

bipolar disorder are four to six times more 

likely to develop the illness, compared with 

children who do not have a family history of 

bipolar disorder.3 However, most children with 

a family history of bipolar disorder will not 

develop the illness. Compared with children 

whose parents do not have bipolar disorder, 

children whose parents have bipolar disorder may be more likely to hav

toms of anxiety disorders and attention deficit hyperactivity disorder (A

Several studies show that youth with anxiety disorders are more likely t

bipolar disorder than youth without anxiety disorders. However, anxiety 

are very common in young people. Most children and teens with anxiet

do not develop bipolar disorder.5, 6 

Bipolar Disorder in Children and Teens: A Parent’
08265 Bipolar Children_Final.indd Sec1:4 08265 Bipolar Children_Final.indd Sec1:4 

At this time, there is no way to prevent bipolar disorder. NIMH is curren

ing how to limit or delay the first symptoms in children with a family his

illness. 

Also see the section in this booklet called “What illnesses often co-exis

lar disorder in children and teens?” 

How does bipolar disorder affect childre

teens differently than adults? 

Bipolar disorder that starts during childhood or during the teen years is called early-onset bipolar disorder. 

Early-onset bipolar disorder seems to be more severe 

than the forms that first appear in older teens and 

adults.7, 8 Youth with bipolar disorder are different from 

adults with bipolar disorder. Young people with the illness appear to have more frequent mood switches, are 

sick more often, and have more mixed episodes.8 

Watch out for any sign of suicidal thinking or behaviors. Take these 

seriously. On average, people with early-onset bipolar disorder have g

for attempting suicide than those whose symptoms start in adulthood.7

study on bipolar disorder in children and teens found that more than on

of study participants made at least one serious suicide attempt.10 Some 

attempts are carefully planned and others are not. Either way, it is impo

understand that suicidal feelings and actions are symptoms of an illnes

be treated. 

For more information on suicide, see the NIMH publication, Suicide in t

Statistics and Prevention on the NIMH Web site at http://www.nimh.nih

publications/suicide-in-the-us-statistics-and-prevention.shtml. 

4 • National Institute of Mental Health 
08265 Bipolar Children_Final.indd Sec1:5 08265 Bipolar Children_Final.indd Sec1:5 

How is bipolar disorder detected 

in children and teens? 

No blood tests or brain scans can diagnose bipolar disorder. However, a doctor may use tests like these to help rule 

out other possible causes for your child’s symptoms. For 

example, the doctor may recommend testing for problems 

in learning, thinking, or speech and language.11 A careful medical exam 

detect problems that commonly co-occur with bipolar disorder and nee

treated, such as substance abuse. 

Doctors who have experience with diagnosing early-onset bipolar disor

psychiatrists, psychologists, or other mental health specialists, will ask 

about changes in your child’s mood. They will also ask about sleep pat

ity or energy levels, and if your child has had any other mood or behavi

ders. The doctor may also ask whether there is a family history of bipol

or other psychiatric illnesses, such as depression or alcoholism. 

Doctors usually diagnose mental disorders using guidelines from the Di

and Statistical Manual of Mental Disorders, or DSM. According to the D

are four basic types of bipolar disorder: 

1. Bipolar I Disorder is mainly defined by manic or mixed episodes tha

least seven days, or by manic symptoms that are so severe that the 

needs immediate hospital care. Usually, the person also has depress

sodes, typically lasting at least two weeks. The symptoms of mania 

sion must be a major change from the person’s normal behavior. 

2. Bipolar II Disorder is defined by a pattern of depressive episodes s

and forth with hypomanic episodes, but no full-blown manic or mixe

3. Bipolar Disorder Not Otherwise Specifi ed (BP-NOS) is diagnosed 

person has symptoms of the illness that do not meet diagnostic crite

either bipolar I or II. The symptoms may not last long enough, or the 

may have too few symptoms, to be diagnosed with bipolar I or II. Ho

symptoms are clearly out of the person’s normal range of behavior. 

4. Cyclothymic Disorder, or Cyclothymia, is a mild form of bipolar dis

People who have cyclothymia have episodes of hypomania that shif

forth with mild depression for at least two years (one year for childre

lescents). However, the symptoms do not meet the diagnostic requir

any other type of bipolar disorder. 

Bipolar Disorder in Children and Teens: A Parent’
08265 Bipolar Children_Final.indd Sec1:6 08265 Bipolar Children_Final.indd Sec1:6 

When children have manic symptoms that last for less 

than four days, experts recommend that they be diagnosed with BP-NOS. Some scientific evidence indicates 

that about one-third of these young people will develop 

longer episodes within a few years. If so, they meet the 

criteria for bipolar I or II.12 

Also, researchers are working on whether certain 

symptoms mean a child should be diagnosed with 

bipolar disorder. For example, scientists are studying 

children with very severe, chronic irritability and symptoms of ADHD, but no clear episodes of mania. Some experts think the

should be diagnosed with mania. At the same time, there is scientific ev

suggests these irritable children are different from children with bipolar 

in the following key areas: the outcome of their illness, family history, an

function.13-16 

When you talk to your child’s doctor or a mental health specialist, be su

questions. Getting answers helps you understand the terms they use to 

your child’s symptoms. 

What illnesses often co-exist with bipola

disorder in children and teens? 

Several illnesses may develop in people with bipolar disorder. 

Alcoholism. Adults with bipolar disorder are at very high risk of developi

stance abuse problem. Young people with bipolar disorder may have the 

ADHD. Many children with bipolar disorder 

have a history of ADHD.17 One study showed 

that ADHD is more common in people 

whose bipolar disorder started during childhood, compared with people whose bipolar 

disorder started later in life.7 Children who 

have co-occurring ADHD and bipolar disorder may have difficulty concentrating and 

controlling their activity. This may happen 

even when they are not manic or depressed. 

6 • National Institute of Mental Health 
08265 Bipolar Children_Final.indd Sec1:7 08265 Bipolar Children_Final.indd Sec1:7 

Anxiety Disorders. Anxiety disorders, such as separation anxiety and g

anxiety disorder, also commonly co-occur with bipolar disorder. This m

in both children and adults. Children who have both types of disorders 

develop bipolar disorder at a younger age and have more hospital stays 

mental illness.18 

Other Mental Disorders. Some mental disorders cause symptoms sim

bipolar disorder. Two examples are major depression (sometimes called 

depression) and ADHD. If you look at symptoms only, there is no way to 

difference between major depression and a depressive episode in bipo

For this reason, be sure to tell a diagnosing doctor of any past manic sy

or episodes your child may have had. In contrast, ADHD does not have 

ADHD symptoms may resemble mania in some ways, but they tend to 

constant than in a manic episode of bipolar disorder. 

What treatments are available for childr

teens with bipolar disorder? 

To date, there is no cure for bipolar disorder. However, 

treatment with medications, psychotherapy (talk therapy), or both may help people get better. 

It’s impor

you to kno

children s

respond d

ently to p

medicatio

adults do

To treat children and teens with bipolar disorder, doctors often rely on information about treating adults. This 

is because there haven’t been many studies on treating 

young people with the illness, although several have 

been started recently. 

One large study with adults funded by NIMH is the Systematic Treatme

Enhancement Program for Bipolar Disorder (STEP-BD—more informatio

http://www.nimh.nih.gov/health/trials/practical/step-bd/index.shtml). Th

found that treating adults with medications and intensive psychotherap

nine months helped them get better. These adults got better faster and 

well longer than adults treated with less intensive psychotherapy for six 

Combining medication treatment and psychotherapies may help young 

early-onset bipolar disorder as well.11 However, it’s important for you to 

children sometimes respond differently to psychiatric medications than 

Bipolar Disorder in Children and Teens: A Parent’
08265 Bipolar Children_Final.indd Sec1:8 08265 Bipolar Children_Final.indd Sec1:8 

Medications 

Before starting medication, the doctor will 

want to determine your child’s physical and 

mental health. This is called a “baseline” 

assessment. Your child will need regular 

follow-up visits to monitor treatment progress 

and side effects. Most children with bipolar 

disorder will also need long-term or even 

lifelong medication treatment. This is often the 

best way to manage symptoms and prevent 

relapse, or a return of symptoms.11 

It’s better to limit the number and dose of medications. A good way to 

ber this is “start low, go slow.” Talk to the psychiatrist about using the s

amount of medication that helps relieve your child’s symptoms. To judg

tion’s effectiveness, your child may need to take a medication for sever

or months. The doctor needs this time to decide whether to switch to a 

medication. Because children’s symptoms are complex, it’s not unusua

to need more than one type of medication.20 

Keep a daily log of your child’s most troublesome symptoms. Doing so 

easier for you, your child, and the doctor to decide whether a medicatio

Also, be sure to tell the psychiatrist about all other prescription drugs, o

counter medications, or natural supplements your child is taking. Takin

medications and supplements together may cause unwanted or dange

Some of the types of medications generally used to treat bipolar disord

below. Information on medications can change. For the most up to dat

mation on use and side effects contact the U.S. Food and Drug Admini

(FDA) at http://www.fda.gov. You can also find more information in the N

Medications booklet at http://www.nimh.nih.gov/health/publications/me

complete-publication.shtml. 

To date, lithium (sometimes known as Eskalith), risperidone (Risperda

iprazole (Abilify) are the only medications approved by the U.S. Food a

Administration (FDA) to treat bipolar disorder in young people. 

8 • National Institute of Mental Health 
08265 Bipolar Children_Final.indd Sec1:9 08265 Bipolar Children_Final.indd Sec1:9 

Lithium is a type of medication called 

a mood stabilizer. It can help treat and 

prevent manic symptoms11 in children 

ages 12 and older.21 In addition, there 

is some evidence that lithium might 

act as an antidepressant and help 

prevent suicidal behavior.22 However, 

FDA’s approval of lithium was based 

on treatment studies in adults. In fact, 

some experts say the FDA might not 

approve giving lithium to bipolar youth 

if the agency were to review this treatment today. 

Risperidone and aripiprazole are a 

type of medication called an atypical, 

or second-generation, antipsychotic. 

These medications are called “atypical” to set them apart from earlier 

types of medications, called conventional or first generation antipsychotics. Short-term treatment with risperidone can help reduce symptoms o

mixed mania in children ages 10 and up. Aripiprazole is approved to tre

symptoms in children 10–17 years old who have bipolar I.21 

Your child’s psychiatrist may recommend other types of medication, wh

listed below. Studies in adults with bipolar disorder show these medica

be helpful. However, these medications have not been approved by the 

treat bipolar disorder in children. 

Anticonvulsant medications are commonly prescribed to treat seizure

medications can help stabilize moods too. They may be very helpful for 

to-treat bipolar episodes. For some children, anticonvulsants may work 

lithium. Not every child can take lithium. Examples of anticonvulsant m

include: 

• Valproic acid or divalproex sodium (Depakote) 

• Lamotrigine (Lamictal). 

Lithium Poisoning 

Children may be showing early sig

lithium poisoning if they develop t

• Diarrhea 

• Drowsiness 

• Muscle weakness 

• Lack of coordination 

• Vomiting. 

Take your child to the emergency 

he or she is taking lithium and has 

symptoms. You should know that t

of lithium poisoning goes up when 

becomes dehydrated. Make sure y

has enough to drink when he or sh

fever or sweats, such as when pla

in the hot summer. 

Bipolar Disorder in Children and Teens: A Parent’
08265 Bipolar Children_Final.indd Sec1:10 08265 Bipolar Children_Final.indd Sec1:10 

Should girls take valproic acid? 

Young girls taking valproic acid should be monitored carefully 

by a doctor. Valproic acid may increase levels of testosterone 

(a male hormone) in teenage girls and lead to polycystic ovary 

syndrome (PCOS) in women who begin taking the medication before 

age 20.23, 24 PCOS is a serious condition that causes a woman’s eggs 

to develop into cysts, or fluid-filled sacs. The cysts then collect in the 

ovaries instead of being released by monthly periods. 

If PCOS is linked to treatment with valproic acid, the doctor will take 

the person off this medication. Most PCOS symptoms will improve after switching or s

treatment with valproic acid.25 

Valproic acid, lamotrigine, and other anticonvulsant medications have a

warning. The warning states that their use may increase the risk of suic

thoughts and behaviors. People taking anticonvulsant medications for 

other illnesses should be closely monitored for new or worsening symp

depression, suicidal thoughts or behavior, or any unusual changes in m

behavior. People taking these medications should not make any chang

talking to their health care professional. 

Atypical antipsychotic medications are sometimes used to treat sym

bipolar disorder in children. These medications are called “atypical” to 

apart from earlier types of medications, called conventional or fi rst-gen

antipsychotics. In addition to risperidone and aripiprazole, atypical anti

medications include: 

• Olanzapine (Zyprexa) 

• Quetiapine (Seroquel) 

• Ziprasidone (Geodon). 

Antidepressant medications are sometimes used to treat symptoms o

sion in bipolar disorder. Doctors who prescribe antidepressants for bipo

usually prescribe a mood stabilizer or anticonvulsant medication at the 

If your child takes only an antidepressant, he or she may be at risk of s

to mania or hypomania. He or she may also be at risk of developing rap

symptoms.26 Rapid cycling is when someone has four or more episode

depression, mania, hypomania, or mixed symptoms within a year.27 

10 • National Institute of Mental Health 
08265 Bipolar Children_Final.indd Sec1:11 08265 Bipolar Children_Final.indd Sec1:11 

Some antidepressants that may be prescribed to treat symptoms of bip

depression are: 

• Fluoxetine (Prozac) 

• Paroxetine (Paxil) 

• Sertraline (Zoloft). 

However, results on effectiveness of antidepressants for treating bipola

sion are mixed. The STEP-BD study showed that, in adults, adding an a

sant to a mood stabilizer is no more effective in treating depression tha

mood stabilizer alone.28 

FDA Warning on Antidepressants 

Antidepressants are safe and popular, but some studies have suggested that they ma

tentional effects on some people, especially in adolescents and young adults. The FDA 

says that patients of all ages taking antidepressants should be watched closely, espe

the first few weeks of treatment. Possible side effects to look for are depression that 

suicidal thinking or behavior, or any unusual changes in behavior such as trouble slee

agitation, or withdrawal from normal social situations. Families and caregivers should 

changes to the doctor. The latest information from the FDA can be found at http://ww

Some medications are better at treating one type of bipolar symptom t

For example, lamotrigine (Lamictal) seems to be helpful in controlling d

symptoms of bipolar disorder.11 

What are the side effects of these medications? 

Before your child starts taking a new medication, talk with the doctor o

cist about possible risks and benefits of taking that medication. 

The doctor or pharmacist can also answer questions about side effects

last decade, treatments have improved, and some medications now ha

or more tolerable side effects than past treatments. However, everyone 

differently to medications, and in some cases, side effects may not app

person has taken a medication for some time. 

Bipolar Disorder in Children and Teens: A Parent’s 
08265 Bipolar Children_Final.indd Sec1:12 08265 Bipolar Children_Final.indd Sec1:12 

If your child develops any severe side effects from a medication, talk to 

who prescribed it as soon as possible. The doctor may change the dos

scribe a different medication. Children and teens being treated for bipo

should not stop taking a medication without talking to a doctor fi rst. Su

stopping a medication may lead to “rebound,” or worsening of bipolar 

symptoms or other uncomfortable or potentially dangerous withdrawal 

The following sections describe some common side 

effects of the different types of medications used to treat 

bipolar disorder. 

1. Mood Stabilizers 

In some cases, lithium can cause side effects such as: 

• Restlessness 

• Frequent urination 

• Dry mouth 

• Bloating or indigestion 

• Acne 

• Joint or muscle pain 

• Brittle nails or hair.

29 

Lithium may cause other side effects not listed here. Tell the doctor 

ersome or unusual side effects as soon as possible. 

If your child is being treated with lithium, it is important for him or he

treating doctor regularly. The doctor needs to check the levels of lith

child’s blood, as well as kidney function and thyroid function. 

Each mood stabilizing medication is different and can cause different 

side effects. Some common side effects of lamotrigine and valproic a

• Drowsiness 

• Dizziness 

• Headache 

• Diarrhea 

• Constipation 

• Heartburn 

• Mood swings 

• Stuffed or runny nose, or other cold-like symptoms.30, 31 

12 • National Institute of Mental Health 
08265 Bipolar Children_Final.indd Sec1:13 08265 Bipolar Children_Final.indd Sec1:13 

 

 

These medications may also be linked with rare but serious side effe

with the treating doctor or a pharmacist to make sure you understan

serious side effects for the specific medications your child is taking. 

2. Atypical Antipsychotics 

Some people have side effects when they start taking atypical antip

Most side effects go away after a few days and often can be manag

fully. People who are taking antipsychotics should not drive until the

their new medication. Side effects of many antipsychotics include: 

• Drowsiness 

• Dizziness when changing positions 

• Blurred vision 

• Rapid heartbeat 

• Sensitivity to the sun 

• Skin rashes 

• Menstrual problems for girls 

• Weight gain. 

Atypical antipsychotic medications can cause major weight gain and 

metabolism. This may increase a person’s risk of getting diabetes an

lesterol.32 While taking an atypical antipsychotic medication, your ch

glucose levels, and lipid levels should be monitored regularly by a d

In rare cases, long-term use of atypical antipsychotic drugs may lead 

dition called tardive dyskinesia (TD). The condition causes muscle mo

that commonly occur around the mouth. A person with TD cannot con

movements. TD can range from mild to severe, and it cannot always b

Sometimes people with TD recover partially or fully after they stop tak

3. Antidepressants 

The antidepressants most commonly prescribed for treating sympto

lar disorder can also cause mild side effects that usually do not last 

can include: 

• Headache, which usually goes away within a few days. 

• Nausea (feeling sick to your stomach), which usually goes away w

few days. 

Bipolar Disorder in Children and Teens: A Parent’s 
08265 Bipolar Children_Final.indd Sec1:14 08265 Bipolar Children_Final.indd Sec1:14 

 

 

• Sleep problems, such as sleeplessness or drowsiness. This may 

ing the first few weeks but then goes away. To help lessen these 

sometimes the medication dose can be reduced, or the time of d

taken can be changed. 

• Agitation (feeling jittery). 

• Sexual problems, which can affect both men and women. These 

reduced sex drive and problems having and enjoying sex. 

Some antidepressants are more likely to cause certain side effects t

antidepressants. Your doctor or pharmacist can answer questions a

medications. Any unusual reactions or side effects should be reporte

tor immediately. 

For the most up-to-date information on medications 

for treating bipolar disorder and their side effects, 

please see the online NIMH Medications booklet at 

http://www.nimh.nih.gov/health/publications/medications/ 

complete-publication.shtml. 

Sexual Activity, Pregnancy, and Teens with Bipolar 

Disorder 

Many teens make risky choices about sex. The U.S. Centers for Disease Control and P

(CDC) recently reported that 26 percent of teenage girls in the United States have at l

the four most common sexually transmitted diseases.33 This suggests that many teen

unprotected sex or taking part in other risky behaviors. 

Bipolar disorder is also linked with impulsive and risky choices. Teenage girls with bip

der who are pregnant or may become pregnant face special challenges because med

the illness may have harmful effects on a developing fetus or nursing infant.34 Specifi

and valproic acid should not be used during pregnancy. Also, some medications may r

effectiveness of birth control pills.35 For more information on managing bipolar disord

and after pregnancy, see the NIMH booklet Bipolar Disorder. 

14 • National Institute of Mental Health 
08265 Bipolar Children_Final.indd Sec1:15 08265 Bipolar Children_Final.indd Sec1:15 

 

Psychotherapy 

In addition to medication, psychotherapy (“talk” therapy) can be an effective treatment for bipolar disorder. 

Studies in adults show that it can provide support, 

education, and guidance to people with bipolar disorder 

and their families. Psychotherapy may also help children keep taking their medications to stay healthy and 

prevent relapse. 

Children a

may also 

from thera

address p

at school, 

in the com

Some psychotherapy treatments used for bipolar disorder include: 

1. Cognitive behavioral therapy helps young people with bipolar diso

to change harmful or negative thought patterns and behaviors. 

2. Family-focused therapy includes a child’s family members. It helps 

family coping strategies, such as recognizing new episodes early an

their child. This therapy also improves communication and problem-

3. Interpersonal and social rhythm therapy helps children and teens 

disorder improve their relationships with others and manage their da

Regular daily routines and sleep schedules may help protect agains

episodes. 

4. Psychoeducation teaches young people with bipolar disorder abou

illness and its treatment. This treatment helps people recognize sign

relapse so they can seek treatment early, before a full-blown episod

Psychoeducation also may be helpful for family members and careg

Other types of therapies may be tried as well, or used along with those 

above. The number, frequency, and type of psychotherapy sessions sh

based on your child’s treatment needs. 

A licensed psychologist, social worker, or counselor typically provides t

therapies. This professional often works with your child’s psychiatrist to 

care. Some may also be licensed to prescribe medications; check the l

your state. For more information, see the Substance Abuse and Mental 

Services Administration Web page on choosing a mental health therapi

http://mentalhealth.samhsa.gov/publications/allpubs/KEN98-0046/defa

In addition to getting therapy to reduce symptoms of bipolar disorder, c

teens may also benefit from therapies that address problems at school

Bipolar Disorder in Children and Teens: A Parent’s 
08265 Bipolar Children_Final.indd Sec1:16 08265 Bipolar Children_Final.indd Sec1:16 

the community. Such therapies may target communication skills, proble

skills, or skills for school or work. Other programs, such as those provid

social welfare programs or support and advocacy groups, can help as w

Some children with bipolar disorder may also have learning disorders o

problems.36 Your child’s school may need to make accommodations tha

the stresses of a school day and provide proper support or intervention

What can children and teens with bipola

disorder expect from treatment? 

There is no cure for bipolar disorder, but it can be treated 

effectively over the long term. Doctors and families of children with bipolar disorder should keep track of symptoms 

and treatment effects to decide whether changes to the 

treatment plan are needed. 

Sometimes a child may switch from one type of bipolar 

disorder to another. This calls for a change in treatment. 

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 roughly one 

out of three children with BP-NOS later switched to bipolar I or II (see d

page 5). Also, roughly one out of five children who started out with a di

bipolar II switched to bipolar I.8

 Because different medications may be 

for one type of symptom than another (manic or depressive), your child 

to change medications or try different treatments if his or her symptom

The COBY study also showed that treatment helped around 70 percent 

dren with bipolar disorder recover from their most recent episode (eithe

or depressive). In this study, recovery meant having two or fewer sympt

at least eight weeks in a row. On average, it took a little over a year and 

recover. However, within the next year or so, symptoms returned in half 

dren who recovered. Children with bipolar I or II tended to recover faste

with BP-NOS, but their symptoms returned more frequently as well. 

If your child has other psychiatric illnesses, such as an anxiety disorder

disorder, or substance abuse disorder, he or she may be more likely to 

a relapse — especially depressive symptoms.37 Scientists are unsure ho

co-existing illnesses increase the chance of relapse. 

16 • National Institute of Mental Health 
08265 Bipolar Children_Final.indd Sec1:17 08265 Bipolar Children_Final.indd Sec1:17 

Working closely with your child’s doctor and 

therapist 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. 

For more informati

psychotherapy, vis

NIMH Web site at h

www.nimh.nih.gov/

topics/treatment/ind

Also, you may wish to keep a chart of your child’s daily mood symptom

ments, sleep patterns, and life events, which can help you and your ch

understand the illness. Sometimes this is called a mood chart or a daily 

It can help the doctor track and treat the illness more effectively. Examp

mood charts can be found on the Internet. 

Where can families of children with bipo

disorder get help? 

As with other serious illnesses, taking care of a child with bipolar disord

incredibly hard on the parents, family, and other caregivers. Caregivers 

tend to the medical needs of their child while dealing with how it affects 

health. The stress that caregivers are under may lead to missed work o

time. It can strain relationships with people who do not understand the 

and lead to physical and mental exhaustion. 

Stress from caregiving can make it hard to cope with your child’s bipola

toms. One study shows that if a caregiver is under a lot of stress, his or 

one has more trouble sticking to the treatment plan, which increases th

for a major bipolar episode.38 It is important to take care of your own ph

mental health. You may also find it helpful to join a local support group. 

child’s illness prevents you from attending a local support group, try an 

support group. 

Bipolar Disorder in Children and Teens: A Parent’s 
08265 Bipolar Children_Final.indd Sec1:18 08265 Bipolar Children_Final.indd Sec1:18 

Where can I go for help? 

If you are unsure where to go for help, ask your family 

doctor. Others who can help are listed below. 

• Mental health specialists, such as psychiatrists, 

psychologists, social workers, or mental health 

counselors 

• Health maintenance organizations 

• Community mental health centers 

• Hospital psychiatry departments and outpatient clinics 

• Mental health programs at universities or medical 

schools 

• State hospital outpatient clinics 

• Family services, social agencies, or clergy 

• Peer support groups 

• Private clinics and facilities 

• Employee assistance programs 

• Local medical and/or psychiatric societies. 

You can also check the phone book under “mental health,” “health,” “s

vices,” “hotlines,” or “physicians” for phone numbers and addresses. A

gency room doctor can also provide temporary help and can tell you w

how to get further help. 

What if my child is in crisis? 

If you think your child is in crisis: 

• Call your doctor 

• Call 911 or go to a hospital emergency room to get immediate help o

friend or family member to help you do these things 

• Call the toll-free, 24-hour hotline of the National Suicide Prevention 

1–800–273–TALK (1–800–273–8255); TTY: 1–800–799–4TTY (4889) t

trained counselor 

• Make sure your child is not left alone. 

18 • National Institute of Mental Health 
08265 Bipolar Children_Final.indd Sec1:19 08265 Bipolar Children_Final.indd Sec1:19 

 

 

Citations 

1. Moreno C, Laje G, Blanco C, Jiang H, Schmidt AB, Olfson M. National Trends in th

Treatment of Bipolar Disorder in Youth. Arch Gen Psychiatry. 2007 Sep;64(9):1032

2. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime pre

age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey 

Arch Gen Psychiatry. 2005 Jun;62(6):593-602. 

3. Nurnberger JI, Jr., Foroud T. Genetics of bipolar affective disorder. Curr Psychiatry 

Apr;2(2):147-157. 

4. Chang K, Steiner H, Ketter T. Studies of offspring of parents with bipolar disorder. A

Genet C Semin Med Genet. 2003 Nov 15;123(1):26-35. 

5. Johnson JG, Cohen P, Brook JS. Associations between bipolar disorder and other 

disorders during adolescence and early adulthood: a community-based longitudina

Am J Psychiatry. 2000 Oct;157(10):1679-1681. 

6. Bruckl TM, Wittchen HU, Hofler M, Pfister H, Schneider S, Lieb R. Childhood sepa

and the risk of subsequent psychopathology: Results from a community study. Psy

Psychosom. 2007 76(1):47-56. 

7. Perlis RH, Miyahara S, Marangell LB, Wisniewski SR, Ostacher M, DelBello MP, Bo

Sachs GS, Nierenberg AA. Long-term implications of early onset in bipolar disorde

the first 1000 participants in the systematic treatment enhancement program for b

(STEP-BD). Biol Psychiatry. 2004 May 1;55(9):875-881. 

8. Birmaher B, Axelson D, Strober M, Gill MK, Valeri S, Chiappetta L, Ryan N, Leonar

Iyengar S, Keller M. Clinical course of children and adolescents with bipolar spectr

Arch Gen Psychiatry. 2006 Feb;63(2):175-183. 

9. Bellivier F, Golmard JL, Henry C, Leboyer M, Schurhoff F. Admixture analysis of ag

bipolar I affective disorder. Arch Gen Psychiatry. 2001 May;58(5):510-512. 

10. Goldstein TR, Birmaher B, Axelson D, Ryan ND, Strober MA, Gill MK, Valeri S, Chi

Leonard H, Hunt J, Bridge JA, Brent DA, Keller M. History of suicide attempts in p

disorder: factors associated with increased risk. Bipolar Disord. 2005 Dec;7(6):525

11. McClellan J, Kowatch R, Findling RL. Practice parameter for the assessment and t

of children and adolescents with bipolar disorder. J Am Acad Child Adolesc Psych

Jan;46(1):107-125. 

12. Axelson D, Birmaher B, Strober M, Gill MK, Valeri S, Chiappetta L, Ryan N, Leonar

Iyengar S, Bridge J, Keller M. Phenomenology of children and adolescents with bip

disorders. Arch Gen Psychiatry. 2006 Oct;63(10):1139-1148. 

13. Tillman R, Geller B. Definitions of rapid, ultrarapid, and ultradian cycling and of epis

in pediatric and adult bipolar disorders: a proposal to distinguish episodes from cy

Adolesc Psychopharmacol. 2003 Fall;13(3):267-271. 

Bipolar Disorder in Children and Teens: A Parent’s 
08265 Bipolar Children_Final.indd Sec1:20 08265 Bipolar Children_Final.indd Sec1:20 

14. Brotman MA, Kassem L, Reising MM, Guyer AE, Dickstein DP, Rich BA, Towbin KE

McMahon FJ, Leibenluft E. Parental diagnoses in youth with narrow phenotype bip

or severe mood dysregulation. Am J Psychiatry. 2007 Aug;164(8):1238-1241. 

15. Brotman MA, Schmajuk M, Rich BA, Dickstein DP, Guyer AE, Costello EJ, Egger H

Pine DS, Leibenluft E. Prevalence, clinical correlates, and longitudinal course of se

dysregulation in children. Biol Psychiatry. 2006 Nov 1;60(9):991-997. 

16. Rich BA, Schmajuk M, Perez-Edgar KE, Fox NA, Pine DS, Leibenluft E. Different 

psychophysiological and behavioral responses elicited by frustration in pediatric bi

and severe mood dysregulation. Am J Psychiatry. 2007 Feb;164(2):309-317. 

17. Tillman R, Geller B, Bolhofner K, Craney JL, Williams M, Zimerman B. Ages of ons

syndromal and subsyndromal comorbid DSM-IV diagnoses in a prepubertal and ea

bipolar disorder phenotype. J Am Acad Child Adolesc Psychiatry. 2003 Dec;42(12

18. Dickstein DP, Rich BA, Binstock AB, Pradella AG, Towbin KE, Pine DS, Leibenluft 

anxiety in phenotypes of pediatric bipolar disorder. J Child Adolesc Psychopharma

Aug;15(4):534-548. 

19. Miklowitz DJ, Otto MW, Frank E, Reilly-Harrington NA, Wisniewski SR, Kogan JN, 

Calabrese JR, Marangell LB, Gyulai L, Araga M, Gonzalez JM, Shirley ER, Thase M

Psychosocial treatments for bipolar depression: a 1-year randomized trial from the 

Treatment Enhancement Program (STEP). Arch Gen Psychiatry. 2007 Apr;64(4):41

20. Bhangoo RK, Lowe CH, Myers FS, Treland J, Curran J, Towbin KE, Leibenluft E. M

use in children and adolescents treated in the community for bipolar disorder. J Ch

Psychopharmacol. 2003 Winter;13(4):515-522. 

21. U.S. Food and Drug Administration. Pediatric Exclusivity Labeling Changes http://w

cder/pediatric/labelchange.htm. Accessed on August 19, 2008. 

22. Freeman MP, Freeman SA. Lithium: clinical considerations in internal medicine. Am 

Jun;119(6):478-481. 

23. Vainionpaa LK, Rattya J, Knip M, Tapanainen JS, Pakarinen AJ, Lanning P, Tekay A

Isojarvi JI. Valproate-induced hyperandrogenism during pubertal maturation in girls 

Ann Neurol. 1999 Apr;45(4):444-450. 

24. Joffe H, Cohen LS, Suppes T, McLaughlin WL, Lavori P, Adams JM, Hwang CH, H

GS. Valproate is associated with new-onset oligoamenorrhea with hyperandrogeni

with bipolar disorder. Biol Psychiatry. 2006 Jun 1;59(11):1078-1086. 

25. Joffe H, Cohen LS, Suppes T, Hwang CH, Molay F, Adams JM, Sachs GS, Hall JE

follow-up of reproductive and metabolic features of valproate-associated polycysti

syndrome features: A preliminary report. Biol Psychiatry. 2006 Dec 15;60(12):1378

26. Thase ME, Sachs GS. Bipolar depression: pharmacotherapy and related therapeu

Biol Psychiatry. 2000 Sep 15;48(6):558-572. 

27. Akiskal HS. “Mood Disorders: Clinical Features.” in Sadock BJ, Sadock VA (ed). (2

Sadock’s Comprehensive Textbook of Psychiatry. Lippincott Williams & Wilkins:Ph

20 • National Institute of Mental Health 
08265 Bipolar Children_Final.indd Sec1:21 08265 Bipolar Children_Final.indd Sec1:21 

28. Sachs GS, Nierenberg AA, Calabrese JR, Marangell LB, Wisniewski SR, Gyulai L, 

ES, Bowden CL, Fossey MD, Ostacher MJ, Ketter TA, Patel J, Hauser P, Rapport 

JM, Allen MH, Miklowitz DJ, Otto MW, Dennehy EB, Thase ME. Effectiveness of ad

antidepressant treatment for bipolar depression. N Engl J Med. 2007 Apr 26;356(1

29. MedlinePlus Drug Information: Lithium. http://www.nlm.nih.gov/medlineplus/drugin

medmaster/a681039.html. Accessed on Nov 19, 2007. 

30. MedlinePlus Drug Information: Lamotrigine. http://www.nlm.nih.gov/medlineplus/d

medmaster/a695007.html. Accessed on February 12, 2008. 

31. MedlinePlus Drug Information: Valproic Acid. http://www.nlm.nih.gov/medlineplus/

medmaster/a682412.html. Accessed on February 12, 2008. 

32. Lieberman JA, Stroup TS, McEvoy JP, Swartz MS, Rosenheck RA, Perkins DO, Ke

SM, Davis CE, Lebowitz BD, Severe J, Hsiao JK. Effectiveness of antipsychotic dr

with chronic schizophrenia. N Engl J Med. 2005 Sep 22;353(12):1209-1223. 

33. Nationally Representative CDC Study Finds 1 in 4 Teenage Girls Has a Sexually Tra

Disease. http://www.cdc.gov/stdconference/2008/media/release-11March2008.ht

on March 31, 2008. 

34. Llewellyn A, Stowe ZN, Strader JR, Jr. The use of lithium and management of wom

bipolar disorder during pregnancy and lactation. J Clin Psychiatry. 1998 59(Suppl 

35. Yonkers KA, Wisner KL, Stowe Z, Leibenluft E, Cohen L, Miller L, Manber R, Vigue

T, Altshuler L. Management of bipolar disorder during pregnancy and the postpartu

J Psychiatry. 2004 Apr;161(4):608-620. 

36. McClure EB, Treland JE, Snow J, Dickstein DP, Towbin KE, Charney DS, Pine DS, 

Memory and learning in pediatric bipolar disorder. J Am Acad Child Adolesc Psych

May;44(5):461-469. 

37. Perlis RH, Ostacher MJ, Patel JK, Marangell LB, Zhang H, Wisniewski SR, Ketter T

DJ, Otto MW, Gyulai L, Reilly-Harrington NA, Nierenberg AA, Sachs GS, Thase ME

recurrence in bipolar disorder: primary outcomes from the Systematic Treatment E

Program for Bipolar Disorder (STEP-BD). Am J Psychiatry. 2006 Feb;163(2):217-2

38. Perlick DA, Rosenheck RA, Clarkin JF, Maciejewski PK, Sirey J, Struening E, Link B

family burden and affective response on clinical outcome among patients with bipo

Psychiatr Serv. 2004 Sep;55(9):1029-1035. 

Bipolar Disorder in Children and Teens: A Parent’s 
08265 Bipolar Children_Final.indd Sec1:22 08265 Bipolar Children_Final.indd Sec1:22 

For more information on bipolar disorde

Visit the National Library of Medicine’s: 

MedlinePlus 

http://medlineplus.gov 

En Español 

http://medlineplus.gov/spanish 

For information on clinical trials for bipolar disorder: 

NIMH supported clinical trials 

http://www.nimh.nih.gov/health/trials/index.shtml 

National Library of Medicine Clinical Trials Database 

http://www.clinicaltrials.gov 

Clinical trials at NIMH in Bethesda, MD 

http://patientinfo.nimh.nih.gov 

Information from NIMH is available in multiple formats. You can browse 

download documents in PDF, and order materials through the mail. Che

NIMH Web site at http://www.nimh.nih.gov for the latest information o

and to order publications. 

If you do not have Internet access please contact the NIMH Information 

the numbers listed below. 

National Institute of Mental Health 

Science Writing, Press & Dissemination Branch 

6001 Executive Boulevard 

Room 8184, MSC 9663 

Bethesda, MD 20892-9663 

Phone: 301-443-4513 or 

1-866-615-NIMH (6464) toll-free 

TTY: 301-443-8431 

TTY: 866-415-8051 toll-free 

FAX: 301-443-4279 

E-mail: nimhinfo@nih.gov 

Web site: http://www.nimh.nih.gov 

22 • National Institute of Mental Health 
08265 Bipolar Children_Final.indd Sec1:23 08265 Bipolar Children_Final.indd Sec1:23 

Reprints: 

This publication is in the public domain and may be reproduced or cop

permission from NIMH. We encourage you to reproduce it and use it in 

to improve public health. Citation of the National Institute of Mental Hea

source is appreciated. However, using government materials inappropr

raise legal or ethical concerns, so we ask you to use these guidelines: 

• NIMH does not endorse or recommend any commercial products, p

services, and our publications may not be used for advertising or en

purposes. 

• NIMH does not provide specific medical advice or treatment recomm

or referrals; our materials may not be used in a manner that has the 

of such information. 

• NIMH requests that non-Federal organizations not alter our publicat

that will jeopardize the integrity and “brand” when using the publica

• Addition of non-Federal Government logos and Web site links may n

the appearance of NIMH endorsement of any specific commercial p

services or medical treatments or services. 

If you have questions regarding these guidelines and use of NIMH publ

please contact the NIMH Information Center at 1–866–615–6464 or e-m

nimhinfo@nih.gov. 

The photos in this publication are of models and are used for illustrative purposes only. 
08265 Bipolar Children_Final.indd Sec1:24 08265 Bipolar Children_Final.indd Sec1:24 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

National Institutes of Health 

NIH Publication No. 08-6380