Katy Perry’s Hot ‘n Cold describes your teen’s mood swings perfectly.

Your teenager goes through major ups-and-downs.

They vacillate between episodes of enthusiasm and joy and periods of sadness and lethargy.

Yes, of course, everyone tells you that adolescent mood swings are common, but how do you know whether your teen’s symptoms are typical or require intervention?

Bipolar Disorder in Teens

Bipolar disorder was formerly referred to as manic-depressive disorder or manic depression. It’s a serious, lifelong psychiatric illness that usually develops in early adulthood, though it can also develop in childhood or adolescence. Teens with bipolar disorder typically experience persistent feelings of irritability and depression, interspersed with pronounced episodes of mania. There are also different types of bipolar disorder. If a teen experiences exclusively manic episodes, without the depressive phases, it means they meet the criteria for a bipolar I, which does not require depressive phases for diagnosis.

The Manic Phase

During the manic phase, teens display over-the-top elation and enthusiasm. They stay up all night working on a specific project. They may stay up for days on end. Their energy levels are through the roof. They may speak quickly, have racing thoughts, and display unusually high levels of optimism. In certain cases, they may also experience hallucinations and delusions. This is called hypomania.

Other symptoms of the manic phase include:

• Extreme optimism
• Increased activity, excitement, and energy
• Heightened sense of self-importance
• Overconfidence
• Talking a lot, often very quickly
• Extreme distractibility
• Abnormally risky behavior

If your teen displays any of those symptoms or behaviors – and you think they’re related to the manic part of bipolar disorder, ask yourself the following series of questions.

During your teen’s manic stage, do they usually…

…have lots of exciting, new ideas?
…spend money excessively or give a lot away?
…display an exaggerated sense of self-importance (grandiosity)?
…multitask excessively?
…have difficulty concentrating?
…engage in casual/risky sex?
…make angry or aggressive outbursts?
…act impatient or intrusive towards others?

Answering yes to these questions indicates your teen may benefit from a clinical assessment to determine whether they have bipolar disorder.

The Depressive Phase

Depressive episodes are the exact opposite of manic episodes.

During depressive episodes, teens may be extremely negative or pessimistic and feel hopeless about everything. They may stay in bed for hours and avoid family and friends. Also, they’ll withdraw from certain activities they once found pleasurable. Falling grades, trouble sleeping, changes in appetite and lack of hygiene are all common during a bipolar teen’s depressive phase.

Other symptoms of the depressive episodes associated with bipolar disorder include:

• Feelings of sadness, emptiness, hopelessness
  • Children or adolescents may express sadness, emptiness, and hopelessness as anger or irritability
• Inability to enjoy or participate in activities that were previously interested in and enjoyed doing
• Inability to sleep
• Sleeping too much
• Inability to concentrate
• Poor decision making
• Suicidal ideation*

*Call 911 immediately if you suspect your teen is considering suicide

If your teen displays any of those symptoms or behaviors – and you think they’re relative to the depressive part of bipolar disorder, ask yourself the following series of questions.

During your teen’s depressive stage, do they usually…

…have low energy or fatigue?
…get very sensitive to criticism and rejection?
…get very teary?
…have low self-esteem and self-confidence?
…complain of physical aches and pains (e.g. headaches or stomachaches)?
…display excessive guilt or self-blame?
…engage in self-harm tendencies?
…engage in suicidal ideation? (see above)

Answering yes to these questions indicates that your teen may benefit from a clinical assessment to determine whether they have bipolar disorder.

The Difference Between Mood Swings and Bipolar Disorder

It’s likely that every teen will experience several of these symptoms throughout different periods of adolescence. That doesn’t mean they have bipolar disorder. The difference between regular adolescent mood swings and bipolar disorder is that in bipolar disorder, their manic/depressive episodes will persist for several days or even weeks at a time. Also, their episodes will incorporate many of the manic or depressive symptoms simultaneously, not just one or two at a time.

Treatment for Bipolar Disorder

Generally speaking, bipolar disorder in teens requires residential treatment. If a full, professional mental health assessment indicates bipolar disorder, and residential treatment is recommended, look for an evidence-based adolescent residential treatment center (RTC) that incorporates psychiatric consultations (including medication management), family therapy, and lifestyle practices that support recovery and symptom management. Lifestyle supports should include things like sleep hygiene, healthy nutrition, exercise, and complementary therapies. In less acute circumstances, a partial hospitalization (PHP) or intensive outpatient program (IOP) may be sufficient to manage your teen’s bipolar symptoms and teach them how to cope with the sources that trigger their manic and depressive episodes.