Bipolar disorder in teens can look like extreme versions of typical teen behaviors — but this is more than just teenage hormones.

While the average age of onset for bipolar disorder is the mid-20s, symptoms can begin in adolescence.

According to the National Institute of Mental Health (NIMH), an estimated 2.9% of adolescents ages 13 to 18 years old will be diagnosed with bipolar disorder in their lifetime.

It can be challenging to accurately diagnose bipolar disorder in teens. Symptoms can seem like typical teenage behavior, though more extreme in some cases.

Symptoms may also overlap with other conditions such as attention deficit hyperactivity disorder (ADHD), anxiety, and depression.

A teen’s bipolar disorder diagnosis can seem overwhelming and scary. But with the right support and treatment, the symptoms can be managed.

Bipolar disorder is a mental health condition characterized by extreme shifts in mood, energy, and behavior. There are three types of bipolar disorder, and each has its own set of symptoms.

The primary features of each type include manic and depressive episodes or a combination of both.

It’s estimated that about 3.3% of adolescent females and 2.6% of adolescent males live with bipolar disorder.

Bipolar disorder has a strong genetic component and runs in families. The American Psychiatric Association (APA) reports that 80% to 90% of people with bipolar disorder have one relative living with bipolar disorder or depression.

If your teen has a first-degree relative (e.g., parent or sibling) with bipolar disorder, their chance of having the condition is about 10 times greater than that of another person. The chance is the same whether it’s on the dad’s or mom’s side of the family.

A 2015 study shows that if there’s a family history of bipolar disorder, your teen is more likely to develop it at an earlier age and have higher rates of hospitalization.

Several life experiences and environmental factors also may contribute to the development of bipolar disorder. These could include:

  • infections during pregnancy or in adulthood
  • childhood trauma
  • birth complications
  • substance or alcohol use
  • high stress levels

Symptoms of bipolar disorder can look different in teens than in adults. In some cases, it can seem like extreme versions of typical teen behaviors.

Symptoms of a manic episode in teens may look like:

  • acting extremely happy or silly for long periods of time
  • talking rapidly and changing subjects frequently
  • having a short temper or acting extremely irritable
  • having a hard time falling asleep
  • having difficulty focusing and experiencing racing thoughts
  • participating or showing interest in pleasurable but risky activities
  • engaging in risky or reckless activities that show poor judgment

Symptoms of a depressive episode may look like:

  • sleeping a lot more
  • having little energy or interest in activities they previously enjoyed
  • feeling extremely sad for no particular reason
  • acting unusually irritable, angry, or hostile
  • changes in eating habits (eating more or less)
  • frequently expressing aches and pains
  • difficulty concentrating
  • feeling hopeless or worthless
  • difficulty maintaining relationships
  • having thoughts of suicide

It’s important to note that these symptoms can also occur in other conditions. So even if your teen has these symptoms, a diagnosis of bipolar disorder can be given only after a thorough assessment by a mental health professional.

Teens in the early stages of bipolar disorder may be more likely to present with rapid cycling moods and mixed states (mania with depression at the same time).

Childhood sleep and anxiety disorders may precede bipolar disorder

A 2018 study revealed how symptoms could progressively unfold in teens with bipolar disorder.

The findings showed that childhood sleep and anxiety disorders were important predictors of bipolar disorder.

Children with a sleep disorder had a 1.6 time greater chance of developing the condition. Those with anxiety disorders had a 1.8 time increased chance.

The study followed 279 children with at least one parent diagnosed with bipolar disorder. Of those, 24.5% developed bipolar disorder. Symptoms began between ages 12 and 30 years old.

The study revealed that symptoms commonly unfolded in the following order:

  1. nonspecific symptoms such as sleep and anxiety symptoms
  2. minor mood problems
  3. adolescent depression
  4. full-blown bipolar disorder

Depressive episodes took up the majority of symptoms in the early course of the condition, particularly among children whose parents with bipolar disorder responded to lithium.

Young people who went on to develop bipolar disorder received an official diagnosis after a manic or hypomanic episode and/or the first episode of psychosis.

Diagnosing bipolar disorder in teens can be complicated, and it requires a thorough evaluation by an experienced mental health professional.

Assessments typically begin with a symptom checklist and a clinical interview. Your teen will likely be asked questions about their mood, energy levels, sleep, and other factors. A medical history will also be assessed, such as family history and substance use.

The diagnostic criteria used for teens are the same as what’s used for adults.

Treatment for your teen may include a combination of psychosocial interventions and medication.

Finding the best treatment for your teen might take some trial and error. Certain medications and therapy options might work for some teens more than others.

A 2018 trial found that interpersonal and social rhythm therapy (IPSRT) — an educational and skill-based approach used to help stabilize moods in people with bipolar disorder — seemed to help teens establish better sleep-wake cycles.

This in turn appeared to help balance their mood swings. However, this study was small and more research is needed.

Family-focused therapy (FFT) is another psychosocial intervention that helps young people and their families develop better communication and problem-solving skills.

A 2020 trial found that FFT lengthened the periods of wellness between mood episodes and suicidal thoughts in youths ages 9 to 17 years old with a higher chance for bipolar disorder.

Nutrition interventions have also shown promise for managing bipolar disorder symptoms in teens. In a 2015 study, omega-3 fatty acids in combination with family psychotherapy reduced both manic and depressive symptoms in teens.

Other lifestyle changes such as getting enough sleep and avoiding substance use might help your teen manage their symptoms.

For some teens, medications can help manage their symptoms. Commonly prescribed medications include mood stabilizers such as lithium or atypical antipsychotic medications.

Your teen may need to try a few medications, beginning at low doses, to see which one works best.

Having a strong emotional support network can be a valuable tool for parents of teens with bipolar disorder. Sharing experiences with others who are going through the same thing could be helpful.

The Depression and Bipolar Support Alliance (DBSA) is a good source of support, information, and inspiration for parents of teens living with bipolar disorder. The DBSA also has an online support group you can join.

BPHope also offers tips for parents and a list of bipolar resources, including books.

Recognizing and diagnosing bipolar disorder in teens can be challenging. But getting a correct, early diagnosis often results in better outcomes.

As soon as symptoms begin, consider discussing it with a healthcare professional. They will be able to determine whether another condition might be the cause of your teen’s symptoms or refer you to a mental health professional for further evaluation.

A mental health professional can carefully observe your teen and develop a treatment plan if needed.

If you’re unsure where to start on your journey to finding help for your teen, you can check out our find help page.