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It’s normal for teens to have mood swings, but bipolar disorder is more than typical ups and downs. If your teen’s “highs” feel unusually intense and their “lows” deeply exhausting, and these changes are disrupting school, friendships, or home life, it may be time to take a closer look. This guide shares what bipolar disorder can look like in teens, why it happens, and how you can help.
What is bipolar disorder?
Bipolar disorder is a chronic mood disorder marked by episodes of mania or hypomania and depression, often with periods of stable mood in between. Bipolar disorder involves mood and energy swings far beyond normal, usually lasting days to weeks.
Symptoms of bipolar disorder
These signs can show up in different ways:
- Periods of mania or hypomania: Unusually high energy, rapid speech, racing thoughts, little need for sleep, grandiosity, or goal-directed overactivity.
- Depressive episodes: Low mood, loss of interest in activities, fatigue, changes in appetite or weight, or thoughts of death/self-harm.
- Teen-specific patterns: Irritability, rapid mood shifts, or mixed states where highs and lows overlap.
- Risky behavior: Impulsivity, distractibility, or a sudden drop in school performance.
What causes bipolar disorder
There’s rarely just one cause. bipolar disorder often develops from a mix of biological, environmental, and emotional factors.
Genetic and brain chemistry factors
One study found that having a close relative with bipolar disorder raises a teen’s lifetime risk.
Emerging research has found possible associations between the DAT-1 dopamine transporter gene variations and altered glutamatergic activity in the brain and a higher vulnerability to bipolar disorder.
These findings are still early and are not used to diagnose the condition, but they help scientists understand possible biological pathways. These factors can lead to:
- Stronger emotional swings: Mood shifts feel more intense and are harder to settle once started.
- Lower stress tolerance: Everyday changes (sleep loss, schedule shifts) can trigger bigger reactions.
- Earlier onset in some families: Symptoms may appear in mid-teens when there’s a strong family history.
Environmental stressors
Research shows that experiences like childhood trauma, low emotional support, or early cannabis or alcohol use are linked to more severe symptoms in teens already vulnerable to bipolar disorder. This can result in:
- Less predictable routines: Irregular sleep and schedules can make mood swings more likely.
- Lower emotional safety: Conflict or low support can slow recovery from episodes.
- More severe episodes in vulnerable teens: Stress or substance use can lengthen or intensify symptoms when risk is already present.
How bipolar disorder develops over time
Early signs in childhood
Some early signs can be subtle but important to notice:
- Sleep changes lasting weeks: Not just a few restless nights, but ongoing disruption.
- Intense mood swings for age: More extreme than what’s typical for the stage of development.
- High energy followed by extreme fatigue: Sudden changes that last more than a day or two.
- Unpredictable behavior: Actions or reactions that seem out of proportion to the situation.
Changes during adolescence
- More defined episodes: Sometimes rapid-cycling between highs and lows; hypomanic periods often last at least 4 days, and manic episodes usually last a week or require urgent care.
- Higher impulsivity and risk-taking: Decisions made without thinking of consequences.
- Impact on school and friendships: Declining grades, missed school, or social withdrawal.
- Possible co-occurring issues: ADHD, anxiety, substance use, or sleep disorders.
How bipolar disorder is diagnosed
Around one-third of bipolar cases begin between ages 13 and 18, but diagnosis is often delayed by 2–5 years because early symptoms can look like depression. Diagnosis usually involves:
- Comprehensive assessment: Conversations with your teen, structured behavior checklists, and input from family members help build a complete picture.
- Screening tools: Parent and teen checklists like the MDQ-A (Mood Disorder Questionnaire – Adolescent version), and in some studies, the Mood Disorder Assessment Schedule (MDAS), which may detect at-risk teens earlier than standard interviews.
- Medical rule-outs: Providers check for sleep deprivation, substance use, thyroid or other medical causes, and medication effects.
Treatment for bipolar disorder in teens
Medications
One review found that lithium, valproate, and certain antipsychotics can help reduce the severity and frequency of episodes. Some clinicians use long-acting injectables when daily pills are hard to manage. To keep treatment safe and effective, doctors usually:
- Start with a mood stabilizer: Lithium or valproate helps smooth out extreme highs and lows by balancing brain chemistry.
- Add an antipsychotic if needed: Risperidone, quetiapine, aripiprazole, or olanzapine can calm manic symptoms and stabilize mood.
- Consider long-acting injections: These may help with adherence in teens; a prescriber can discuss benefits, risks, and fit.
- Monitor regularly: For lithium/valproate, labs track levels and organ health; for antipsychotics, providers check weight, glucose, and lipids.
Therapeutic programs
Research shows that family-focused therapy, psychoeducation, CBT for bipolar, and DBT can lower relapse risk and improve daily life.
At home, you can turn therapy concepts into clear actions you and your teen can do together. Think of them as small, repeatable steps that build on what they’re learning in sessions:
- Spot early warning signs: Keep a shared journal or visual chart to track mood, sleep, and energy so you can catch patterns before episodes worsen.
- Make coping plans: Work together to write down go-to calming strategies for highs (like quiet time, reducing stimulation) and lows (like light activity, connection with friends or family).
- Family sessions: Practice skills from therapy at home, such as active listening and using “I” statements to reduce misunderstandings and tension.
- Routine-focused planning: Help your teen set and stick to consistent sleep and wake times, meal schedules, and activity blocks, as steady rhythms can reduce episode risk.
Lifestyle and support matter
Studies link steady routines, good sleep, and consistent care with fewer and less severe episodes. You can help your teen by:
- Prioritize sleep: Aim for consistent bedtimes and wake times; quality rest regulates mood and reduces relapse risk.
- Avoid substances: Alcohol and cannabis can worsen symptoms, interfere with treatment, and raise relapse risk.
- Keep routines steady: Regular meal times, study habits, and activities provide a sense of security and predictability.
- Coordinate with school: Partner with teachers or counselors to create support plans, accommodations, or flexible deadlines when needed.
- Stay connected to care: Schedule regular check-ins with providers often every 4–12 weeks early on to track progress and adjust treatment as needed.
Sources
- Kamińska, K., Bień, M., Dąbrowska, K., Janas-Kozik, M., Cichoń, L., & Wilczyński, K. (2024). Influence of genetic background on the clinical picture of bipolar affective disorder in a population of children and adolescents. European Psychiatry, 67, S463 – S463. https://doi.org/10.1192/j.eurpsy.2024.959.
- Menculini, G., Balducci, P., Attademo, L., Bernardini, F., Moretti, P., & Tortorella, A. (2020). Environmental Risk Factors for Bipolar Disorders and High-Risk States in Adolescence: A Systematic Review. Medicina, 56. https://doi.org/10.3390/medicina56120689.
- Liu, L., Meng, M., Zhu, X., & Zhu, G. (2022). Research Status in Clinical Practice Regarding Pediatric and Adolescent Bipolar Disorders. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.882616.
- Parikh, P., Sood, K., Bansal, L., Abraham, J., Eichbaum, A., Shoda, E., Buddhavarapu, M., Oza, M., Chandra, A., Simanowitz, C., Witriol, M., & Nasrallah, H. (2025). Long-Acting Injectable Antipsychotics in Adolescents with Bipolar Disorder.. Journal of child and adolescent psychopharmacology. https://doi.org/10.1089/cap.2024.0088.
- Singh, M., Post, R., Miklowitz, D., Birmaher, B., Youngstrom, E., Goldstein, B., Soutullo, C., Axelson, D., Chang, K., & DelBello, M. (2021). A commentary on youth onset bipolar disorder. Bipolar Disorders, 23. https://doi.org/10.1111/bdi.13148.
- Stepan, M., Teresi, G., Franzen, P., Rode, N., & Goldstein, T. (2023). 0644 Poor Sleep Quality Predicts Worse Mood Symptoms in Adolescents with Bipolar Disorder: A Longitudinal Randomized Controlled Trial. SLEEP. https://doi.org/10.1093/sleep/zsad077.0644.
Residential Treatment for Bipolar Disorder in Teens
Our Residential Treatment Program offers a safe, steady environment where teens can find balance, understand their mood patterns, and build healthy coping skills.
With caring counselors, family support, and practical tools, we help teens manage the challenges of bipolar disorder and move toward a more stable, hopeful future. Families living in Arizona and Idaho can access our Teen Programs: