A good friend will talk to a friend showing these symptoms.
Alexa cradled the phone against her ear and sighed. "Look, all
I know is that Jamie's been really weird lately. A couple months
ago she could hardly drag herself to school and now she's running
around like the Road Runner cartoon. What's with her?"
Alexa listened for a minute, then continued. "Yeah, you're
right. It's like Jamie has a permanent caffeine fix. She never
stops talking, and then she gets so crabby! Did you hear her
with Michael? But then she's off and running again. And did
you see all that stuff she got at the mall? I know she can't
pay for it. Jamie told me she doesn't even know why she bought
Alexa hung up with a worried frown. Should she talk to her
dad about Jamie? Say something to Jamie's mom? Go talk to
her guidance counselor at school? If Jamie sat still long enough,
maybe she could talk things over with her. Or maybe she should
just ignore Jamie's behavior altogether. I mean, it's not like she's
sick or anything, Alexa thought.
Understanding Depressive Disorders
Alexa's right to be concerned about her friend because Jamie
actually is sick. She has a serious medical condition called
a depressive disorder, which affects the way the brain functions.
Depressive disorders are widespread. In the United States
alone, it's estimated that more than 17.4 million adults have
a depressive disorder each year. That works out to about
one out of every seven people, so there's a good chance
that you or someone you know will have to deal with this
Out of that total number of people with depressive disorders,
it's thought that about 1% to 2% have bipolar disorder. Jamie
is part of this small group.
What Is Bipolar Disorder?
Bipolar disorder goes by many names: manic depression,
manic-depressive disorder, manic-depressive illness, bipolar
mood disorder, and bipolar affective disorder are other medical
terms for this condition. Mental health professionals such as
psychologists and psychiatrists use a manual called the DSM-IV
(Diagnostic and Statistical Manual of Mental Disorders) to
determine which type of bipolar disorder a person has. The
disorder is classified into four types - Bipolar I, Bipolar II,
Cyclothymic Disorder, and Bipolar Disorder Not Otherwise
Specified. These names were determined because symptoms
of the disorder vary in severity and presentation in different
people. By determining which type a person has, a doctor
can tailor treatment to her specific needs.
Bipolar disorder affects men and women about equally. Doctors
now realize that children can have bipolar disorder, as well as
teens and adults. For many people, the first symptoms show
up in their early 20s.
Recent research suggests that kids and teens with bipolar
disorder don't always have the same behavioral patterns that
are often seen in adults. For example, kids who have bipolar
disorder may experience particularly rapid mood changes
and may have other mood-related symptoms listed below, such
as irritability and high levels of anxiety, but they may not display
other symptoms that are more commonly seen in adults.
Alcohol and drug abuse are often involved in bipolar disorder.
Some teens try to "treat" their condition this way, often with
disastrous results. Although getting high may make a teen feel
better temporarily, alcohol and drugs can make the symptoms
of bipolar disorder worse, as well as making diagnosis very difficult.
Because brain function is involved, the ways people with bipolar
disorder think, act, and feel are all affected. This can make it
especially difficult for other people to understand this condition.
It can be incredibly frustrating if other people act as though the
teen should just "snap out of it," as if a person who is sick can
become well simply by wanting to. This disorder isn't a sign of
weakness or a character flaw, but a serious medical condition that
requires treatment, just like any other condition.
What Are the Signs and Symptoms?
Bipolar disorder is characterized by recurring episodes of mania
(highs) and depression (lows). These aren't the normal periods of
happiness and sadness that everyone experiences from time to time.
Instead, the episodes are intense or severe mood swings, like a
pendulum that keeps arcing higher and higher.
Symptoms of mania include:
- racing speech and thoughts
- increased energy
- decreased need for sleep
- elevated mood and exaggerated optimism
- increased physical and mental activity
- excessive irritability, aggressive behavior,
- poor judgment
- reckless behavior like excessive spending,
rash decisions, and erratic driving
- inflated sense of self-importance
Symptoms of depression include:
Episodes of mania or depression usually last for weeks or months,
although they can be much shorter in length. They may happen
irregularly and follow an unpredictable pattern. Or episodes may
be linked, with a manic episode always following depression, or
vice versa. Sometimes episodes have a seasonal pattern. Mania
in the spring, for example, may be followed by depression in the
Between episodes, a person usually returns to normal (or near
-normal) functioning. It can happen, though, that there is little
or no "break period" between these cycles. These mood swing
cycles can fluctuate slowly or rapidly, with rapid cycling much more
common in women. Jamie is in the midst of a manic episode.
What Causes Bipolar Disorder?
Doctors and scientists don't know the exact cause of bipolar
disorder, but think that biochemical, genetic, and environmental
factors may all be involved. It's believed this condition results from
imbalances of certain brain chemicals called neurotransmitters.
Their function is to send messages between the nerve cells and
to the muscles. However, if the neurotransmitters aren't in balance,
the brain's mood-regulating system won't work the way it should.
Genetics also play a role in bipolar disorder, which means that
some people may have a genetic predisposition to this condition.
For example, if a close relative has bipolar disorder, your risk of
developing it is higher than in the general population. (This doesn't
mean, though, that you will develop it!) Researchers are now
working on identifying the gene or genes involved in bipolar disorder.
Environmental factors may also be involved. For some teens,
stresses such as a death in the family, their parents' divorce,
or other traumatic events could trigger a first episode of mania
or depression. Sometimes, going through the changes of puberty
can set off an episode. In girls, symptoms can be tied to their
monthly menstrual cycle.
How Is Bipolar Disorder Diagnosed?
The good news is that most people with bipolar disorder can be
helped. A fulfilling, productive life is quite possible - but the
disorder must first be properly diagnosed. Sadly, many people
with bipolar disorder are never diagnosed, or are diagnosed
improperly. Without proper diagnosis and treatment, the disorder
can become worse. Possible results could be placement in a
psychiatric hospital or residential treatment center, sentencing
in the juvenile justice system, drug abuse, accidents, and suicide.
For Jamie to be diagnosed, she'll need to see a psychiatrist for
a mental health evaluation. This involves giving the doctor a
thorough history of past and present experiences. Although a
lot of this information will come from Jamie, family members and
friends can also provide helpful insights. The doctor will also want
Jamie to have a medical exam, to rule out other conditions.
Diagnosing bipolar disorder can be difficult. As yet, there aren't
any laboratory tests like a brain scan or blood test that will diagnose
this condition. In teens, bipolar disorder can be mistaken for mental
illnesses such as schizophrenia and post-traumatic stress disorder.
That's why a complete, detailed history is so important.
How Do Doctors Treat It?
Once Jamie is diagnosed, she and her family will need to understand
that although there's no cure for bipolar disorder, treatment can help
stabilize her moods and help her manage and control her symptoms.
Like other teens with chronic medical conditions (like asthma, diabetes,
or epilepsy), Jamie will need to work closely with her doctor and with
other medical professionals who specialize in treating these mental
This team, together with the teen, develops what is called a treatment
plan. Jamie will probably receive medication, such as antidepressants
and mood stabilizers, from a psychiatrist or other medical doctor. A
psychologist or other type of counselor will provide counseling or
psychotherapy for Jamie and her family. Her symptoms will be closely
watched, and Jamie and her family will be educated about her condition.
Reducing stress, eating well, getting enough sleep and exercise, and
participating in a support network such as a local support group for
people with bipolar disorder are also important parts of her plan.
Dealing With Bipolar Disorder
Teens normally face ups and downs with school, family, work, and friends.
Dealing with bipolar disorder at the same time is a very difficult challenge.
Jamie's cooperation in developing and following her treatment plan will
make all the difference - taking her medications as prescribed, reporting
any changes in how she feels or functions, and participating in therapy
will be among her key issues. Finding a support group can also be a
The good news is that with appropriate diagnosis and treatment, Jamie
can look forward to enjoying her teen years - and beyond.
dedicated to improving the health and spirit of children. Today, as part of its
continuing mission, the Foundation supports the operation of a number of renowned
children's health facilities throughout the nation, including the Alfred I. duPont
Hospital for Children in Wilmington, Delaware, and the Nemours Children's Clinics
throughout Florida. Visit The Nemours Foundation to find out more about them and
Date reviewed: April 2001