Bipolar disorder in teen?

[Anonymous]

I don't want to go into detail but we are getting a psychiatric evaluation done for my young teen. She has always been a bit quirky and awkward but has had a pretty bad year and school counselors have recommended that she be evaluated, with bipolar disorder as a possible issue. We've known since she was very small that something was going on (we had suspected ADHD) but did our best to help her without involving doctors. However, that isn't going to work anymore -- she is having episodes of bizarre behavior and mood swings, lying to get out of immediate trouble when it is guaranteed to be caught (she very much lives in the present), among other significant problems.

I have a feeling that whatever was going on with her is being aggravated by normal teenage development and hormones. I also think something new is going on now that is expressing itself. Either way, she has an appointment to visit a psychiatrist. There is some history of mental illness in my family but we aren't the closest and I don't feel able to reach out for guidance from relatives to work through this.

I wanted to ask if anyone else has dealt with bipolar disorder in teens and what symptoms you've seen. The psychiatrist office, when we made the appointment, asked about very extreme behaviors that we are blessed not to be dealing with and this made us question the school perspective. I would also like to know a little more about the process -- what should I expect, what questions should I ask?

[Anonymous]

I know several people who have teens and early twenties children with bi-polar, and/or ADHD. All recommend NAMI as a resource.


https://www.nami.org/

[Anonymous]

Sometimes kids who were perceived to be ADHD as children show symptoms more in line with bipolar -- either during teen years or during early adulthood (i.e. 20s).

NAMI is great. I highly recommend their 12 week Family to Family course to learn about mental illness. It can help you with your daughter as well as other family members.

The Bipolar Child is a considered the bible for child-onset bipolar -- but that often has a component of more rage-filled behavior than you might see in a teen.

For teens, it can be hard to differentiate between what is the "normal" risky behavior of teenage years and the "risky" behavior that is due to the mania or hypomania of bipolar. Note that mania is not always frank (i.e. disconnected from reality) nor is it always euphoric (happy). Dysphoric mania can be quite irritable.

The good news is that involvement with a supportive psychiatrist and psychologist and family education can help a bipolar person maintain stability. IMO, the keys are finding a good medication (one of the gold standard mood stabilizers like lithium or Depakote) and a good psychologist to help with the adjustment to the diagnosis and focus on maintaining habits that promote stability (like proper sleep).

[Anonymous]

Bipolar is not always about extreme behaviors. My husband is bipolar and he presents in hypomanic moods instead of full on mania.

I'd suggest you read up on bipolar and to keep an open mind. My child had eval last year with psychiatrist and they interviewed me and husband first, then she had us fill in questionnaires while she talked to son alone. Then she pulled us in and gave us some info on some initial observations. Then we went back for second visit to discuss findings and treatment suggestions. Sometimes they will ask to have a teachers fill in a questionnaire so that the school behavior can be teased out. Kids can act very different in school than home.

My only advice to you is that you sound not onboard with the eval. Get up to speed on the issue so you are more comfortable and understand the likely options if your child is bipolar. It is not a death sentence but she will likely need medication to function. Whatever happens she is the same daughter you love and helping her will be the best gift you can give her as she embarks on the rest of her teen life and into adulthood. If its not bipolar and just teenage stuff, than great, you can address that stuff with come therapy perhaps. But no harm in finding out what the issue is.

Good luck!

[Anonymous]

I second the need for a good psychologist.

[Anonymous]

Anonymous wrote:Bipolar is not always about extreme behaviors. My husband is bipolar and he presents in hypomanic moods instead of full on mania.
Kids can act very different in school than home.

Yes, this is one of the issues at play here. At home we see a bizarre euphoria to the point where I could almost think she was high (and I do know that she is not) and the school sees anger and irritability. The euphoria is new this year and.... very weird.

I am definitely on board with the evaluation at this point. It may or may not be bipolar but we have no doubt that something is going on in her brain. We can't live like this for another four years and if she doesn't get help she will derail pretty soon on the path she has set on. She is also a pretty smart kid and I am really hoping that we can get her straightened out but we definitely need help to do it. I am, however, very worried about the school suggestion of bipolar. My husband made the appointment and they seemed confused and were asking about violence and suicidal behaviors (we've seen nothing like that). In addition, I have a friend who is bipolar and she tends towards irrational anger and has not been able to succeed professionally. So my husband and I are very concerned that our daughter might have this, based upon our experience with this (very loved) friend, and very much want to support her in finding a more positive path.

I want to thank everyone for the advice and comments. I am reading with interest and am researching suggested resources.

[Anonymous]

I'm PP with bipolar husband. Anger and irritability are part of the bipolar when he is in the depressive side. While my husband was hypomanic (euphoric) he'd take out thousands with credit card cash advance and gamble, quit a job, tell someone off at work, you name it. Now he is on meds and stable. I swear it is the most amazing thing ever to watch a person return to their normal self.

With the meds for bipolar (if that is what it turns out to be), it an take a while to find right one. The third combination is what my husband said finally worked. That stage of finding the right meds is very hard. The person with bipolar uses it as excuse to not do meds. Keep at it! Good luck mama.

[Anonymous]

I have a DC who has had serious depression and anxiety (not bipolar disorder) and it definitely kicked into high gear with the hormones of puberty.

[Anonymous]

My sister was/is bipolar. She wasn't diagnosed until she was 19, and was an inpatient briefly in a mental health facility at that time, but many symptoms were there years earlier. As a young teen she would have weird highs and really stormy lows. She evened out really well on medications, and is so even-keeled now that most people outside the family would never dream that she was ever anything but. Looking back at photos from when she was around 14/15 it jumps out at you; there she is, looking at the camera with a look of murder on her face while I sit beside her trying to act normal but obviously very uncomfortable. In another photo from the same timeframe she is running by the camera, face beet red, with a look that would best be described as "out of control happy." Between that time and her diagnosis, life was pretty rocky around her. I was afraid of her (I was a year younger and a lot smaller, shared a room with her) because she could be super nasty and sometimes didn't talk to me for a week at a time. She stole my mother's credit card, pawned my mother's engagement ring, and used up her scholarship money the month she got it by taking friends to the beach and keeping them well stocked in pot. I remember my mother teary one Christmas morning, and it turns out she thought we had all forgotten her because my sister had returned her gift that we all bought together and kept the money. She dropped out (or was kicked out) of college her first semester because of *something* she did, worked for a bit and then ran off with some random guy we had never heard of. He called my parents and told them that something was wrong with her mentally. We drove 7 hours to pick her up and went straight to the mental health center.

Whew. The good news is that once she was on medication it was like a switch was flipped. She went back to college, then got a graduate degree and has 2 good kids who are young adults now, with no obvious mental health issues. I have always wondered how different those awful years would have been if my parents had realized earlier that my sister wasn't just a "wild child" but in serious need of help. Your daughter is lucky to have you.

[Anonymous]

Some other great books to read on bipolar -- not necessarily teen-specific, but still really helpful -- "I'm not sick, I don't need help" by Xavier Amador. Bipolar Disorder: A Guide for Patients and Families by Francis Mondimore (who has also written a book on adolescent depression which includes bipolar depression). Similar types of guides have also been written by E. Fuller Torey and David Miklowitz, each leaders in the field for different reasons. For personal experiences, read Kay Redfield Jamison's, "An Unquiet Mind" which will also give you hope that a bipolar person can be highly functional.

We are lucky that we live in a major urban area where good treatment for bipolar is available. Look for a psychiatrist who specializes in mood disorders, more specifically bipolar if possible. Look for a PhD clinical psychologist also specializing in mood disorders for weekly therapy. (I don't recommend PsyDs or therapists who are LICSW or MSWs or other non-PhDs, they simply don't have enough experience or clinical/medical training to offer appropriate support.) Major university hospital systems are often good sources of treating doctors because they usually accept a lot of different insurances. John Hopkins is a national leader in the mood disorder treatment field. Georgetown also has a good program, I've heard.

BTW, the questions the psych's offices asks on the phone are probably only about more serious behaviors, not because those serious behaviors define the illness, but because these more serious symptoms are indicators that the patient seeking an appointment can't safely wait the several weeks it may take to get an appointment. A responsible psychiatrist doesn't want to be liable for missing these serious symptoms and thus becoming liable for a negative incident that happens during the wait for the appointment to roll around.

Also, don't let the lack of presence of these serious symptoms undermine the value of what the school is saying to you by making the recommendation for a psych referral. School counselors see zillions of kids, if they are suggesting this, then they are telling you that the behavior is NOT "normal" teenage behavior -- not even the kind stupid and risky behavior that is normal for teens. I can tell you, as the parent of a child with an IEP (for a learning disability that presented with some anxiety), that it takes a LOT for a school system to admit there is a problem, because admitting there is a problem often means that the school system has to provide (by law) accommodations and special instruction which basically costs them money. If your child is ultimately diagnosed and put on medications, she will likely qualify for at a minimum a 504 plan to provide accommodations and support for her emotional/behavioral problems at school and to mitigate any effects of medication which make school harder (sleepiness, anxiety, slow thinking, nausea, etc. are possibilities).

[Anonymous]

OP here. Thank you again for all the wonderful resources. I will look into the books and a 504 plan. PP at 19:09, I worry that some of the behaviors could escalate like that with the issues of "living in the moment," etc.

I came home from work yesterday and it was like I had a different child. I've felt like I was living with Tigger this past week and she is speaking normally again, interacting with parents and sister appropriately, gave me a nice normal hug, acted with normal regard for people's physical space and boundaries. I don't know how to explain it but her eyes seem calmer -- they were wide and almost wild. Like I said, if I didn't know any better I would think she was on drugs. The normalcy of her behavior yesterday and just how completely pleasant she was to be around (normal grumbly teen) really underscored how bizarre her behavior was these few days. My husband said, and I agree, that he thought she was trying to control the more euphoric affect that she had. But I'm not sure how much of it she is able to control or even recognized was "off" in the moment -- I know she thought we were mean when we tried to tell her to calm down.

We are starting through our health insurance (Kaiser) but I am assuming we will be going through multiple visits. There have been so many resources and suggestions made and I can't say how grateful I am. I am feeling pretty overwhelmed at the moment.