Bipolar in Teens: What Do Manic and Depressive Episodes Look Like?

Teens are often known for their erratic, dramatic, or irrational behavior and unpredictable mood swings. In most cases, this is natural behavior and simply part of the hormone-fueled adolescent experience. In other cases, ongoing behavior that is extreme, alarming, or disruptive might indicate the presence of a mental health condition. Bipolar disorder in teens is such a condition.

What is bipolar?

Bipolar disorder is often first noticeable in the teen years, making it a reasonable concern for parents and caregivers. It is a chronic mood disorder that causes periods of intense moods called episodes.

These episodes typically last for 4-7 days and may be either low (depressive) or high (manic). These episodes are typically triggered by stressful events, or periods of intense stress, such as the end of a relationship, the death of a loved one, or exam stress.

Depressive episodes commonly precede manic ones and inevitably follow them. Bipolar in teens is frequently misdiagnosed as Attention Deficit Hyperactivity Disorder (ADHD), and vice versa.

ADHD often presents with unpredictable mood swings, irritability, depression, and at times manic energy, but medical professionals need to monitor a teen’s behavior to get a correct diagnosis. Besides being misdiagnosed as ADHD, bipolar in teens is frequently misdiagnosed as schizophrenia, due to the prevalence of psychosis during mania.

A psychotic episode, or psychosis, is where a person becomes confused about what is real and what is not. This may be in the form of delusions or hallucinations. A delusion is a strong, irrational belief that they cannot be convinced is untrue, like believing they are a member of a royal family, a celebrity, or possess unnatural strength. Hallucinations are where they believe they are hearing or seeing something that is not there.

Experts cannot accurately say what causes bipolar disorder, but genetics do play a role. Bipolar disorder is frequently diagnosed in teens who have family members with the disorder, but there are no discernible or predictable patterns with it, and certainly no gene responsible for it.

Some scientists have managed to link bipolar disorder to head injuries and brain trauma, but these instances are uncommon. Traumatic events and environmental stressors can affect stress hormones, which can trigger a manic or depressive episode, but these factors are not necessarily the disorder’s origin.

There are three types of bipolar which are bipolar I, bipolar II, and cyclothymia. Each type has slightly different symptoms

What does bipolar in teens look like?

Manic and depressive episodes typically last for up to a week but can last for as long as two weeks, depending on the individual. The symptoms of bipolar episodes often blend with a teen’s natural emotions and behaviors, making diagnosis tricky. For example, it is not uncommon for teens to experience giddy highs and dramatic lows, to be melodramatic on occasion, or to have low self-esteem that causes them to become withdrawn.

Behavior that changes noticeably or alarmingly should be a cause for concern. For example, a teen might be experiencing high amounts of stress in school, resulting in their behavior being “on edge”, tense, constantly on the verge of tears, or snappy and irritable. These characteristics, and the stressful situation, are commonly a precursor to a manic episode.

Manic episodes.

In adults, mania typically presents as euphoric excitement, incredibly high energy, and a good mood that is impervious to almost everything. Notably in teens, manic episodes do not have quite the same positivity to them. Instead of the frantic happiness that adults feel during mania, teens tend to typically experience anger, aggression, and even rage.

During a manic episode, a teen may experience huge amounts of confidence, and high energy, have frantic thoughts, and be unable to settle or concentrate. The first noticeable change is often their sleep schedule and diet. Teens who typically struggle to wake in the mornings will wake early during a manic episode, after having not slept very much the night before.

They will generally lose interest in food, or only eat very small amounts. They might experience other extreme behavioral changes, like taking an interest in cleaning, being overly polite or apologetic for the behaviors, or being overly generous with their possessions, giving many things away as gifts.

The high energy and general positivity of a manic episode may appear quite harmless, and it is genuinely pleasurable to the one with bipolar experiencing the mania. The only cause for alarm for those observing them may be their out-of-character behavior.

After a few days of generally harmless behavior, it often turns violent or aggressive, and signs of fatigue begin showing. Frequently the individual may appear out of breath, with unfocused eyes, and foam at the corners of their mouth.

Psychosis is common during mania, where teens may declare that they have superpowers, possess intimate knowledge of the universe, have connections to celebrities, or some other outlandish claim. Some might attempt to show their unique powers by lifting furniture or attempting to forecast the future.

They cannot be discouraged from these feats, or be made to see rational thought. Their confidence in themselves and their abilities during a manic episode is buoyed by the psychosis.

Teens who experience manic episodes will frequently engage in high-risk behavior that is otherwise quite out of their character. They might not engage in unprotected sex, drive recklessly, or experiment with substances at any other time, but during a manic episode, these risky behaviors might be commonplace. These behaviors are about chasing or maintaining a high, and they often come at a cost that the manic mind cannot calculate rationally.

A depressive episode sometimes leads to a manic one, but more commonly a depression follows mania. As they say, what goes up must come down. And when a manic episode runs its course, the depressive drop often hits hard.

Depressive episodes.

Teens frequently experience unipolar depression in connection with life events and may become easily stressed and anxious in response to the pressures and expectations they face. In a 2022 survey, it was discovered that just over 15% of youth aged between twelve and seventeen had experienced at least one major depressive episode (MDE) in the past year. This is significant because bipolar in teens will most often present first as depression.

Some mental health professionals classify bipolar disorder as a type of depression in and of itself. Bipolar disorder used to be called manic depression and is often listed as the third type of depressive disorder, along with major depression disorder (clinical depression), and persistent depressive disorder (dysthymia). The intensity of the depression that follows a manic episode is all the more intense for following all the energy of a manic episode.

A depressive episode affects a person’s body, thoughts, and attitude. They will often experience a sudden drop in energy and enthusiasm, not just for enjoyable pursuits, but for daily tasks. During this time their sleep schedule, hygiene, and diet are usually affected, and their self-esteem may plummet.

They will often avoid social interactions wherever they can because the energy demanded of them for even the smallest of interactions is more than they have to spare. During this time, they may become stuck in their negative self-speech and may believe they have done something to warrant the sadness they feel.

Lurking within depression is often a lot of fear and anxiety, all the more so for teenagers. Teens often nurse fears of not being good enough, of not meeting their parent’s or peer’s expectations, and of failing important people in their life.

They regularly have anxiety about the future or regret their past actions, which turns into feelings of despair and hopelessness in the context of a depressive episode. Suicidal thoughts are often never far from someone in a depressive episode.

It is very hard as a parent to watch your child go through this very difficult condition. The purpose of this article was to help you understand what your teen might be going through. As difficult a condition it is, there is hope. Although bipolar cannot be cured, it can be managed.

Additional help for bipolar in teens.

If your teen exhibits signs of possibly having bipolar disorder, you may want to book an appointment with a counselor for help with formulating a treatment plan. If your teen is resistant to going, it may still be beneficial for you to speak with a counselor yourself.

Contact us to book an appointment with a Christian counselor in Texas and find the support you need to cope with the situation.