Centre for Youth Bipolar Disorder
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Information about bipolar disorder

You may have a lot of questions and some concerns about what is happening and what the future will hold.

Information about bipolar disorder and its treatment can give you the facts about this illness. Learning about bipolar disorder will take some time, and these materials are a first step in this process.

Each patient and family has different needs. These materials will discuss general topics about bipolar disorder. You may have other questions after you read this website. Please feel free to ask us about any other questions you have.

Bipolar disorder is a serious condition and yet there is much cause for hope. Many people with bipolar disorder lead fulfilling and satisfying lives. In recent years there have been advances in research. The Centre for Youth Bipolar Disorder will give you top-quality, up-to-date assessment and treatments, dedicated advocacy, and education.

What is bipolar disorder?

  • Bipolar disorder is a recurrent and severe mood disorder which has shifts in moods between "highs" and "lows”.
  • The highs are called manic or hypomanic episodes and the lows are called depressive episodes.
  • These episodes are different from the person's usual mood and behavior.
  • They last from many days up to months (sometimes years in the case of depression) and cause changes in functioning.
  • This affects many parts of a person’s life such as family, friends, work, and school.
  • There are different subtypes of bipolar disorder, which differ based on the length and severity of manic symptoms, and based on whether you have had an episode of depression.

Who is affected by bipolar disorder?

  • Bipolar disorder affects 2-5% of adolescents and is the 4th most disabling condition worldwide for adolescents.
  • The average age of onset for bipolar disorder is between 18-24 years. The earlier the onset, the more likely the condition is to be severe.
  • If you have relatives with bipolar disorder you may be at a greater risk.
  • Bipolar disorder rarely occurs on its own. People with bipolar disorder will sometimes have other psychiatric conditions (e.g., attention-deficit/hyperactivity disorder [ADHD], anxiety, eating disorders, and substance use disorders).

What is the treatment for bipolar disorder?

Treatment for bipolar disorder usually means the use of medication. Medications are very important for treating and preventing manic episodes, and are often also used to treat and prevent depressive episodes. Psychosocial treatment (e.g., individual and/or family therapy) focuses on educating patients and families about bipolar disorder and helping them enhance skills for communicating, problem solving, and dealing with emotions. The goal of early diagnosis and treatment is to limit the burden of symptoms and make your quality of life better.


Psychotherapies that have been studied for adolescent bipolar disorder:

INDIVIDUAL

Cognitive Behavior Therapy (CBT)

  • CBT is based on the theory that the way people think or interpret a given situation will affect their mood and behavior.
  • It focuses on the present and looks to find unhelpful thinking patterns and behaviors as a way to improve your mood and how you function.
  • The goal of CBT is to help people to develop helpful strategies and skills for managing external (e.g., school, relationships) and internal (e.g., worries, negative thoughts)stressors.

Dialectical Behavior Therapy (DBT)

  • DBT helps people create a life worth living by lowering problem behaviors and increasing skillful behavior.
  • DBT teaches individuals about bipolar disorder, to balance their moods, to build communication skills, to increase mindfulness, and to increase use of coping skills.
  • DBT includes individual therapy, phone coaching, and family skills training.

Interpersonal and Social Rhythm Therapy (IPSRT)

  • IPSRT uses techniques to make sure you take your medication properly, manage interpersonal stress, and reduce disruptions in social and circadian rhythms (sleep patterns).

FAMILY

Family-Focused Therapy (FFT)

  • FFT involves the patient’s family and includes 3 main components: psychoeducation, communication enhancement training, and problem-solving skills training.
  • Sessions are with the adolescent, at least one parent, and any siblings that wish to attend.
  • Goals include building understanding of causes, symptoms, risk/protective factors, and the course of bipolar disorder; and developing a relapse prevention plan.
  • FFT is also used as a preventative treatment for bipolar disorder in those who have a parent with bipolar disorder.

Multi-Family Psychoeducational Psychotherapy (MF-PEP)

  • This therapy combines psychoeducation with techniques from cognitive behavior therapy and family therapy.
  • Sessions are held with parent and child groups occurring at the same time.
  • Sessions include education about mood symptoms, course of illness, treatment options, social support, and strategies.

Individual-Family Psychoeducational Psychotherapy

  • This is a form of MF-PEP where single families attend sessions and sessions alternate between parents and adolescents attending separately.

Child- and Family-Focused Cognitive-Behavioral Therapy (CFF-CBT)

  • CFF-CBT uses CBT techniques in addition to interpersonal strategies and education regarding illness. It looks at risk and protective factors and teaches coping, communication, and problem-solving skills.

How is bipolar disorder diagnosed?

Symptoms of hypomania/mania may include:

  • Elevated mood, or extreme happiness that is inappropriate and different from usual
  • Irritability
  • Too much energy
  • Restless and/or increase in activities
  • Inflated self-esteem, grandiosity
  • Racing speech and thoughts
  • Talking more than usual or pressure to keep talking
  • Easily distracted
  • Less need for sleep
  • Risky, thrill-seeking behavior reflecting poor judgment (daredevil acts, hypersexuality)

Symptoms of depression may include:

  • Sadness and/or crying spells, depressed mood
  • Irritability
  • Loss of pleasure, interest, and/or motivation
  • Physically restless and/or slowed down
  • Sleeping too much or inability to sleep
  • Difficulty concentrating, focusing, deciding
  • Fatigue or loss of energy
  • Change in weight and/or appetite
  • Feeling guilty or worthless
  • Thoughts of death or suicide and/or suicide attempts

Manic Episode

Hypomanic Episode

Major Depressive Episode

Symptoms

Continual elevated mood and increased energy + 3 other symptoms (see above)

Continual irritable mood and increased energy + 4 other symptoms (see above)

Continual elevated mood and increased energy + 3 other symptoms (see above)

Continual irritable mood and increased energy + 4 other symptoms (see above)

At least 5 symptoms of depression (see above) are present together.

At least one of the symptoms is either sadness/depressed mood or loss of interest/pleasure.

Length of symptoms

Symptoms last at least 1 week and present for most of the day, nearly every day (symptoms can be shorter than 1 week if the person needs to be in hospital).

Symptoms lead to change in functioning and people may experience psychosis or need to be in hospital.

Symptoms last at least 4 days in a row and present for most of the day, nearly every day.

Symptoms lead to change in functioning and noticeable changes from usual behavior.

Symptoms are present together for at least 2 weeks for the majority of the time (most of the day, nearly every day).

Symptoms lead to change in functioning and major impairment and/or distress.

What are the subtypes of bipolar disorder?

Bipolar I Disorder: At least 1 manic episode. Episodes of hypomania and depression often also occur.

Bipolar II Disorder: At least 1 hypomanic episode + 1 major depressive episode

Other Specified Bipolar Disorder and Related Disorder: Significant hypomanic symptoms that impact social, occupational, or other important areas of functioning but do not meet the full criteria for bipolar I or II; e.g., full hypomania without major depression, brief 1-2 day hypomania

What causes bipolar disorder?

The exact cause of bipolar disorder is not known. Bipolar disorder, like many other complicated medical conditions, is often a result of many causes.

Genetic and Familial Factors

  • Bipolar disorder is one of the most genetic conditions in psychiatry. It is not caused by a single gene. Rather, multiple genes, each with small effects are involved in determining an individual’s risk.
  • Bipolar disorder often runs in families. Having a relative with bipolar disorder raises the risk of developing bipolar disorder. The extent of risk depends on the type of relation (i.e., 1st vs. 2nd degree relative) and on the number of relatives with bipolar disorder.
  • Having a family history of bipolar disorder is a much stronger predictor of bipolar disorder than any gene or combination of genes.

Biological Factors

The following are some examples of biological findings among people with bipolar disorder:

  • Brain: differences in the structure (size of different areas in the brain), function (the way the brain works), and chemistry of the brain.
  • Body: higher rates of physical health conditions, such as heart disease, diabetes, and other risk factors (e.g., obesity, high cholesterol, and high blood pressure).
  • Blood: higher levels of harmful markers (e.g., inflammation), and lower levels of helpful markers (e.g., “neurotrophic” factors), most commonly during mood episodes.

Environmental/Social Factors

  • Major life events, stressors, and/or trauma (psychological and/or physical) can combine with a person's genetic and biological factors (as described above) to raise the risk of developing bipolar disorder.
  • It is important to note that stressors can vary from person to person and can be both negative (e.g., conflict) and positive (e.g., new job, new relationship). Stress affects everyone differently.

Is there anything I can do to protect myself?

Protective factors are things that can lower the impact of bipolar disorder on people’s lives.

  • Having a regular sleep schedule/good sleep hygiene
  • Healthy nutrition
  • Regular physical activity
  • Developing and using adaptive coping skills (e.g., problem solving, deep breathing, and distraction)
  • Getting support from family, friends, and mental health professionals

Risk factors are things that raise the chances of developing mood symptoms. It is important to lower these factors to protect yourself against mood symptoms.

  • Lack of routine/structure and balance
  • High amounts of stress and conflict
  • Not using or taking medications or following treatment
  • Use of drugs and alcohol
  • Stigma
Youth

At the Centre for Youth Bipolar Disorder, we teach you skills for increasing protective factors and lowering risk factors to promote a low-stress environment and improve functioning at school, home, and with relationships.

Exercise as medicine:
How physical activity can help people with bipolar disorder

  • Physical activity is an important part of a healthy lifestyle.
  • Aerobic exercise can be a very important part of treatment for adolescents with bipolar disorder.
  • Aerobic exercise can give you both physical and psychological health benefits.
  • Research has shown that exercise can:
    • Improve depression and anxiety symptoms, as well as improve your ability to think, concentrate, make decisions, and problem solve.
    • Lower the risk of heart disease that is linked with bipolar disorder.
    • Improve quality of life.
  • Long-term fitness habits and routines are often made during adolescence. This means that improving fitness during the teenage years has short-term and lifelong benefits.

If you are interested in learning more about “Exercise as Medicine” and increasing your aerobic fitness, talk to your psychiatrist or therapist at the Centre for Youth Bipolar Disorder! Our social workers can help patients with an exercise plan, identify barriers, engage in problem solving, and work towards increasing motivation.

Youth exercising

Information for teens who are at high-risk for bipolar disorder

Teen jumping in the airThe Centre for Youth Bipolar Disorder provides clinical services and research opportunities for youth who have a parent or sibling with bipolar disorder. These services include psychiatric assessment, monitoring, individual therapy, and family-focused therapy.

  • Youth who have a first-degree relative with bipolar disorder have about a 10% chance of developing bipolar disorder themselves. This is about 5-10 times more than the general population. The risk is even higher if both parents have bipolar disorder.
  • Adolescents who have a parent with bipolar disorder are also more likely to develop other mental health issues such as anxiety, problematic substance use, depression, or attentiondeficit/ hyperactivity disorder (ADHD). These conditions combined with a family history of bipolar disorder raises the likelihood of the adolescent developing bipolar disorder.
  • Although most adolescents who have family members with bipolar disorder do not go on to develop bipolar disorder themselves, about 50% of these adolescents have at least one other psychiatric condition.
  • If you have a familial-genetic risk for bipolar disorder, early treatment that focuses on skills and strategies to help manage stressors can be particularly important.

What is stigma?

  • Hurtful and judgmental comments about mental illness and/or its treatment.
  • Negatively biased beliefs or attitudes about mental illness and/or its treatment.
  • Minimizing, ignoring, and/or normalizing significant symptoms.
  • Blaming people with mental illness and/or their families for their illness.
  • Holding different standards for mental illness compared to other illnesses.
  • Exaggerating the risks and/or minimizing the benefits of treatments.
  • Reducing stigma is an important goal for everyone, including society, patients, families, health care providers, media, schools, and others.

Why does stigma matter?

  • Lowers the likelihood that people come forward for treatment.
  • Adds unneeded shame and stress.
  • Makes it more difficult to take part in treatment.
  • At the Centre for Youth Bipolar Disorder, we strive to break down stigma through our research and education initiatives.

More information & resources

American Academy of Child & Adolescent Psychiatry
Comprehensive page that links out to many resources, including facts for families, major symptoms, and practice parameters.

National Institute of Mental Health (U.S.)
A very extensive look at youth bipolar disorder, including co-morbidities, signs to watch for, and how to help. Parents will find this resource especially helpful.

Children's Mental Health Ontario
This page provides information about mood problems in many different languages, including Chinese, French, Italian, and Punjabi.

American Psychiatric Association
Choose among different topics in mental health and groups of people to learn about.

Canadian Mental Health Association
Information on depression and bipolar disorder, including symptoms, treatment and how to help a loved one.

Public Health Agency of Canada
Scroll down about a quarter of the page to find very comprehensive statistics for mental health of Canadian youth (includes graphs). You will also find detailed information in the mood disorders section.

TeenMentalHealth.org
This website offers easily accessible information, tools, and resources on bipolar disorder and other related disorders.

Bipolar Network News
Articles on the latest research and treatment in bipolar disorder.

Support & consumer advocacy resources

Mood Disorders Association of Ontario
Find support groups in major cities/areas (e.g. Toronto, Ottawa, Kitchener-Waterloo). This site also contains information about support programs for families, online peer support, and telephone support.

Depression and Bipolar Support Alliance
While this site contains an abundance of information on depression and bipolar disorder, especially helpful are their resources are under the "Help Others" tab, where families can learn how to help in a crisis and support a child with a mood disorder.

Mood Disorders Society of Canada
Resources on this page focus on consumer support for a wide variety of mood disorders, including bipolar disorder, and how families can help their loved ones who have a mental illness.

National Alliance on Mental Illness
Here you will find detailed information regarding the symptoms and treatments for youth bipolar disorder. Supports for individuals and family members/friends can be found under the “Support” tab.

Jack.org
A Canadian national network of young leaders, working towards ending mental health stigma through youth-inspired and youth-led programs and initiatives.

Online communities

bp Hope
Online magazine, featuring blogs and articles for individuals and family members affected by bipolar disorder.


Heart Bipolar

“HEART BIPOLAR”

To us, at the Centre for Youth Bipolar Disorder, the heart not only represents dedication and care, but it is a symbol that bipolar disorder is linked to cardiovascular risk and affects mind, brain, and body


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