Bipolar in teens & young adults

These years are full of changes that can break up sleep and routines. Sleep and mood are closely linked in bipolar: needing much less sleep is one of the signs of a high.

If one or both parents have bipolar, the chances are greater that their children may develop it. Having a relative with bipolar doesn’t mean you will get it, but it’s worth knowing.

If you have a family history, tell your doctor. It helps them understand changes in your mood.

Treatment works best when young people, families and health care providers work together, and when it is steady rather than starting and stopping.

In young people, a high can look like having much more energy than usual, needing little sleep, feeling unusually important, and doing risky or reckless things that show poor judgment.

It can also look like a very short temper rather than happiness.

A low can bring low energy, poor concentration and feelings of hopelessness and worthlessness. Some young people think about death or suicide.

Teens can have mixed episodes, with signs of a high and a low together. These can feel especially confusing and distressing.

When bipolar begins with a low, it can look like depression at first. Starting with a low has been linked with a higher risk of suicidal thoughts and actions, so it deserves close attention.

If a young person with depression also has times of unusual energy and little sleep, mention it. It changes what help fits best.

A first high can come on over days. Families often notice a teen sleeping very little, talking constantly, or taking big risks.

A severe high can include psychosis, such as seeing or hearing things or holding beliefs that don’t match reality. Earlier onset has been linked with a higher chance of psychotic symptoms.

Bipolar symptoms can overlap with other conditions common in young people, such as ADHD, conduct problems, depression and anxiety. Drug use can also cause similar changes.

This is one reason careful assessment by an experienced professional matters so much.

A primary care provider or pediatrician is a good first step. They can rule out other causes and refer you to a child and adolescent psychiatrist or another trained mental health professional.

A few weeks of notes on sleep, energy and mood can help a lot, because assessment often involves looking at patterns over time.

Because symptoms overlap with other conditions, a professional may want to watch how things change before giving a diagnosis. That can feel slow, but it helps get it right.

Family-focused therapy teaches the whole family about mood, better ways to communicate and practical problem-solving. NIMH notes it has been shown to help both adolescents and adults.

In a U.S. trial with young people at high risk of bipolar, those who had family-focused therapy went longer between mood episodes than those who had standard education.

Therapies based on research, including cognitive behavioural approaches and family-focused therapy, offer support, education and guidance to young people and their families.

Therapy can also help a young person understand themselves, handle stress, rebuild self-esteem and improve relationships.

Care for bipolar usually combines several kinds of support. For anything medical, talk with your clinical provider.

In U.S. public schools, a 504 plan provides accommodations for students with a physical or mental impairment that substantially limits a major life activity, like concentrating or sleeping.

Examples of accommodations

• Breaks when needed
• Extra time on exams
• Shorter assignments during hard patches

Families can decide what to share with teachers or counselors. Many find it helps to name early warning signs and agree on who to contact if things change.

A school counselor or nurse can be a steady point of contact.

Moving away often means late nights, new stress and new people, all at the age when bipolar most often starts. Planning ahead helps.

Before you go

• Find the campus counseling and disability services offices
• Know who your care team will be, at home and at college
• Plan a sleep routine that survives exams and parties
• Share your early warning signs with someone you trust there

Keeping wake-up times steady, even on weekends, protects your body clock. Charging your phone outside your bedroom can make that easier.

Young people with bipolar may be at risk of misusing alcohol or drugs. Some drugs can copy or worsen mood symptoms, and NIMH advises avoiding drugs and alcohol.

Among people treated for bipolar, alcohol and cannabis are the most common substance problems. Substance use problems were linked with bipolar starting earlier.

Routines help the body keep time. Regular wake-ups, meals and activity give your moods a steadier base.

• Be patient
• Listen carefully, without rushing to fix
• Look after your own wellbeing too
• Make time for fun things together
• Understand triggers and calm ways to handle big emotions
• Watch for big mood changes and note them for the care team

Family-focused therapy teaches communication and problem-solving skills, because calmer family talk can help moods stay steadier.

Try “I’ve noticed you’ve been up most nights this week. How are you doing?” rather than “What’s wrong with you?”

Siblings may feel worried, confused or left out. A simple, honest explanation and some one-to-one time can help them feel included.

Learning your own early warning signs is a core part of psychoeducation for bipolar. Common early clues include sleeping less and feeling unusually energetic.

Write down questions beforehand. It’s fine to ask to talk with your provider alone for part of the visit.

The Depression and Bipolar Support Alliance (DBSA) runs free peer support groups in person and online across the U.S.

You don’t have to tell everyone. One or two trusted friends who know what to look for can make a big difference.