Dr. Burmaher noted that young people with bipolar disorder tend to have recurrent major depressive episodes, but that “depressive episodes are not necessary for diagnosis”. For some, mania is the main symptom.
When depression is the symptom that draws the patient to professional attention, proper diagnosis can be especially difficult. Like Dr. Ketter explained, people who are depressed may not be able to recall previous episodes of mania that occurred when they were not depressed.
Dr. Miklowitz said one of the first signs of bipolar disorder is “mood disorder – the child is angry or depressed for a moment, then excited and happy, and moments later full of ideas”.
He listed features of mania that can help parents distinguish it from normal teenage highs and lows. Symptoms, some of which should be noticeable to other people, can include: “Great thinking, decreased need for sleep, speaking quickly or under pressure and / or fleeing thoughts, racing thoughts, distractibility, excessive goal-oriented activity, and impulsive or reckless behavior,” said Dr. Miklowitz.
In the case of depressive symptoms, he suggests looking for “dysfunctions – suddenly not going to school or being late, not finishing homework, staying asleep in class, losing grades, not wanting to eat with others, over suicide talk about cutting yourself. “
Depending on the severity of a child’s impairment, if non-life-threatening symptoms occur in their early teens, according to Dr. Miklowitz it will be possible to start psychotherapy and avoid drugs that have side effects. “But when the child’s life is at risk, when they can’t function at home or at school, medication can be the answer,” he said. “There are risks in not taking medication.”
If medication is necessary, the dosage should be just high enough to control symptoms and not be overly sedating.