People with bipolar disorder often have cycles of elevated and depressed mood that fit the description of “manic depression.” When a person’s illness follows this classic pattern, diagnosing bipolar disorder is relatively easy.

But bipolar disorder can be sneaky. Symptoms can defy the expected manic-depressive sequence. Infrequent episodes of mild mania or hypomania can go undetected. Depression can overshadow other aspects of the illness. And substance abuse can cloud the picture.

Taken together, these factors make bipolar disorder surprisingly difficult to diagnose. A few facts about bipolar disorder you may not know:

As many as 20% of people complaining of depression to their doctor actually have bipolar disorder.
About half of people with bipolar disorder have seen three professionals before being diagnosed correctly.
It takes an average of 10 years for people to enter treatment for bipolar disorder after symptoms begin. This is caused in part by delays in diagnosis.

Take WebMD’s Bipolar Disorder Health Check

Take WebMD’s Bipolar Disorder Health Check
Bipolar Disorder Is Often Mistaken for ‘Just’ Depression
People with bipolar disorder are frequently misdiagnosed as having only depression. In bipolar II disorder, the milder form, manic episodes are mild and can pass by unnoticed. Time spent with depression symptoms, meanwhile, outnumbers time spent with hypomanic symptoms by about 35 to one in people with bipolar II disorder.

Time spent with depression symptoms also usually outweighs time spent with mania symptoms in bipolar I disorder by about three to one, although the more severe mania in bipolar I generally is easier to identify.

Major depressive disorder — often referred to as unipolar depression — is different from bipolar disorder II — also called bipolar depression — in that unipolar depression has no intervals of hypomania while bipolar II does have intervals of hypomania.

Anyone evaluated for depression should also be evaluated for a lifetime history of manic or hypomanic episodes.

Bipolar Disorder and Substance Abuse Can Go Hand in Hand
Substance abuse often complicates the diagnosis and treatment of bipolar disorder. Substance abuse is bipolar disorder’s partner in crime. Some studies show that as many as 60% of people with bipolar disorder also abuse drugs or alcohol. Untreated substance abuse can make it virtually impossible to manage the mood symptoms of bipolar disorder if both disorders are present. It can also be hard to make a confident diagnosis of bipolar disorder when someone is actively abusing substances that cause mood swings.

Substances such as alcohol and cocaine can also cloud the picture in bipolar disorder. For example, people high on cocaine can appear manic when they’re not, or have a depression “crash” when the drug wears off. Some people with bipolar disorder use drugs and alcohol as a part of the impulsivity and recklessness of mania. Others may have an independent substance use disorder, which requires its own treatment. Substance abuse may make bipolar episodes (mania and depression) more frequent or severe, and medicines used to treat bipolar disorder are usually less effective when someone is using alcohol or illicit drugs

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In this article
Bipolar Disorder Is Often Mistaken for ‘Just’ Depression
Bipolar Disorder and Substance Abuse Can Go Hand in Hand
Does Your Teenager Have Bipolar Disorder?
Does Your Teenager Have Bipolar Disorder?
Bipolar disorder commonly begins to show itself in the late teens. Bipolar disorder in the teenage years is serious; it’s often more severe than in adults. Adolescents with bipolar disorder are at high risk for suicide.

Unfortunately, bipolar disorder in teens frequently goes undiagnosed and untreated. Partly, this is because while symptoms may begin in adolescence, they often don’t meet the full diagnostic criteria for bipolar disorder.

Symptoms of bipolar disorder in teens may be unusual — not a straightforward “manic depression.” ADHD, anxiety disorders, and substance abuse are often also present, confusing the picture.

Some symptoms that suggest a teenager might have bipolar disorder are:
Uncharacteristic periods of anger and aggression
Grandiosity and overconfidence
Easy tearfulness, frequent sadness
Needing little sleep to feel rested
Uncharacteristic impulsive behavior
Moodiness
Confusion and inattention
Other potential symptoms that may indicate the presence of a psychiatric disorder requiring evaluation may include feeling trapped, overeating, excessive worry, and anxiety. Other possible diagnoses in addition to bipolar disorder that should be considered in the setting of symptoms such as these include unipolar (major) depression, anxiety disorders, substance use disorders, adjustment disorders, attention deficit hyperactivity disorder, and personality disorders such as borderline personality disorder.

It’s important to remember that these symptoms can occur in many healthy teens and adults. The time for concern is when they form a pattern over time, interfering with daily life. Children with symptoms that suggest bipolar disorder should be seen and evaluated by a psychiatrist or psychologist.

Ongoing treatment — both psychotherapy and medication — is essential to controlling the mood swings of bipolar disorder. How can family members help their loved one stick with treatment?

“Learn as much as you can about the disease,” says Kay Redfield Jamison, PhD, professor of psychiatry at John Hopkins University School of Medicine and author of An Unquiet Mind. “Read and read some more. Join support groups. You’ll get emotional support and information you need.”

Also, learn to watch for early signs of mania, especially insomnia. “Sleep deprivation is the easiest way for someone to become manic,” Jamison tells WebMD. “Families and friends need to keep on top of that. If a patient is having sleep problems, get treatment for it.”

The Depression and Bipolar Support Alliance offers these suggestions to families and friends, to help a loved one with bipolar disorder stay with treatment:

Find the right doctor. Help them find a psychiatrist and other health providers who take time to listen closely. Encourage second opinions, if you feel it’s necessary. Help by making appointments.
Make doctor appointments stress-free. Put together a list of questions to ask the doctor. Offer to go along to appointments. Get to know the doctors, nurses, and other practitioners involved in treatment.

Learn about bipolar disorder drugs. You should know about dosages, possible side effects, and what to do.

Relieve fears. Explain the role of medications — that they greatly relieve symptoms without altering personality.

Gently remind. Little “medication reminders” can help ensure sticking with the prescribed treatment plan. Ask for permission to make these reminders.

Chart progress and problems. Help in keeping records of symptoms, treatment, and setbacks. A journal or calendar works well for this.

Relieve daily stress. Establish a daily routine that your bipolar loved one can easily handle. Help with everyday chores, like running errands. Identify triggers that make symptoms worse.

Use words of support. These will help: “I’m here for you.” “You can get through this.” “Don’t give up.” “Your brain is lying to you right now; it’s part of the illness.”

Encourage positive self-talk. Here’s one example: “My life is valuable and worthwhile, even if it doesn’t feel that way right now.”

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Write down “reality checks.” These words can help your loved one through a tough time. An example: “I should not make major life decisions when my thoughts are racing and I’m feeling on top of the world. I need time to discuss these things with others before going through with them.”

Prepare for crisis. If depressive or manic symptoms become severe, your bipolar friend of family member must promise to call you, another trusted person, a doctor, crisis line, or hospital. Ask that they make that promise to you.

Write a crisis plan. List symptoms of mania, depression, and suicide risk — and what to do. List helpful phone numbers, including health care providers, family members, friends, and a suicide prevention crisis line: (800) 273-TALK. Give copies to trusted friends and family members.

Call the doctor about mood changes. A simple change in treatment could prevent a full-blown episode. It’s best to call the doctor immediately when symptoms of depression or mania begin to appear.
Stay positive about bipolar disorder treatment. Medications and psychotherapy do work. Most people with bipolar disorder can return to stable, productive lives. Keep working to find the treatment that works best — and provide the support your loved one needs to get there.

Caring for someone with bipolar disorder can be very hard, whether you’re a partner, parent, child, or friend of someone who has this condition. It’s stressful for everyone it touches.

It’s tough to strike a balance. You want to be supportive and empathetic, because you know the person with bipolar disorder isn’t to blame for their illness.  But their behavior may affect you, and you have to take care of yourself and your needs, not just theirs.

Although there’s no easy solution, these tips may help.

Learn. Read information from reputable web sites, books, and articles that explain the condition. The more you know, the better.

Listen. Pay attention to what your loved one has to say. Don’t assume that you know what he or she is going through. Don’t dismiss all of their emotions and feelings as signs of their illness. Someone with bipolar disorder may still have valid points.

Encourage them to stick with treatment. Your love one needs to take their bipolar medication and get regular checkups or counseling.

Notice their symptoms. They may not be able to see it as clearly as you do when their bipolar symptoms are active. Or they may deny it. When you see the warning signs of mania or depression, you can try to make sure they get help ASAP.

Do things together. People who are depressed often pull away from others. So encourage your friend or loved one to get out and do things he or she enjoys. Ask him to join you for a walk or a dinner out. If he says no, let it go. Ask again a few days later.

Make a plan. Because bipolar disorder is an unpredictable illness, you should plan for bad times. Be clear. Agree with your loved one about what to do if their symptoms get worse. Have a plan for emergencies. If you both know what to do and what to expect of each other, you’ll feel more confident about the future.

Stick to a schedule. If you live with someone who has bipolar disorder, encourage them to stick to a schedule for sleep and other daily activities. Some research shows that it’s helpful to have a regular routine. The person will still need medicine and counseling, but look for everyday things, like exercise and a healthy diet, that supports their overall health.

WebMD Medical Reference

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Reviewed by Joseph Goldberg, MD on February 23, 2016

Are two conditions that are increasingly being diagnosed in American children and teens, often together. And interestingly, in children and teens, there are some similarities in the symptoms of the two conditions. But how can a doctor know for sure if the child has bipolar disorder or ADHD? Also, how does the treatment for these two conditions differ?

Medical science is learning more about bipolar disorder in children and teens. But the condition is still difficult to diagnose. That’s especially true for teenagers in whom irritability and moodiness commonly co-exist as part of a normal adolescence. A preteen or teenager with mood swings may be going through a difficult but normal developmental stage. Or he or she may be suffering from bipolar disorder with periodic mood changes that shift from depression to mania.

In addition, symptoms of ADHD often mimic symptoms of bipolar disorder. With ADHD, a child or teen may have rapid or impulsive speech, physical restlessness, trouble focusing, irritability, and, sometimes, defiant or oppositional behavior. Children or teens with bipolar disorder often have similar behaviors.

According to one study, today’s children and teens are 40 times more likely to be diagnosed with bipolar disorder than they were 10 years ago. The reason isn’t entirely clear. The higher rate of diagnosis could be the result of more awareness on the part of health professionals. There are those, though, who say it could be a result of a lack of parenting that leads to behaviors that are tagged as mental illness.
Some studies have shown that children and teens diagnosed with bipolar disorder are more likely than adults to also be diagnosed with ADHD.

What is childhood bipolar disorder?
Bipolar disorder is a persistent and difficult mental illness. When it occurs in childhood or adolescence, it can completely disrupt the life of the family. Bipolar disorder that’s undiagnosed, misdiagnosed, or poorly treated is associated with:

Increased rates of suicide attempts and completions
Poorer academic performance
Impaired relationships
Increased rates of substance abuse
Multiple hospitalizations
In adults, bipolar disorder is marked by mood changes that go from depression to mania. Adult mania is characterized by decreased need for sleep, rapid speech, euphoria, grandiosity, irritability, racing thoughts, and frenetic activity. The definition of mania is not so clear for bipolar disorder in childhood. Some experts say that being irritable, cranky, and negative may be the only signs of mania in children with bipolar disorder. And other experts argue that childhood bipolar disorder may not even be the same disease as adult bipolar disorder.

What is clear, though, is that bipolar disorder is an increasingly common diagnosis in children — including children of preschool age.

What are the warning signs of bipolar disorder in children and teens?
With bipolar disorder, there are both manic symptoms and depressive symptoms. If your child or teenager has five or more symptoms that persist for at least a week, it is important to seek professional help. With medications and/or psychotherapy, mental health professionals can help stabilize your child’s moods. Treatment can also diminish or eliminate the depressed or manic thoughts and behaviors.

Manic symptoms include:

Severe changes in mood, either extremely irritable or overly silly and elated
Overly-inflated self-esteem, grandiosity
Increased energy
Decreased need for sleep, ability to go with very little or no sleep for days without tiring
Increased talking, talks too much, too fast; changes topics too quickly; cannot be interrupted
Distractibility, attention moves constantly from one thing to the next
Hypersexuality, increased sexual thoughts, feelings, or behaviors; use of explicit sexual language
Increased goal-directed activity or physical agitation
Disregard of risk, excessive involvement in risky behaviors or activities
Depressive symptoms include:
Persistent sad or irritable mood
Loss of interest in activities once enjoyed
Significant change in appetite or body weight
Difficulty sleeping or oversleeping
Physical agitation or slowing
Loss of energy
Feelings of worthlessness or inappropriate guilt
Difficulty concentrating
Recurrent thoughts of death or suicide
How is ADHD different from bipolar disorder?
Bipolar disorder is primarily a mood disorder. ADHD affects attention and behavior; it causes symptoms of inattention, hyperactivity, and impulsivity. While ADHD is chronic, bipolar disorder is usually episodic, with periods of normal mood interspersed with depression, mania, or hypomania.

How is bipolar disorder treated?
Doctors usually treat bipolar disorder in young people the same way they treat it in adults. They use medications called mood stabilizers, which include anticonvulsants such as valproate (Depakote), lamotrigine (Lamicta), carbamazepine ( Tegretol), oxcarbazepine (Trileptal), and lithium. Atypical antipsychotic medications, including aripiprazole (Abilify), asenapine (Saphris), quetiapine (Seroquel), and risperidone (Risperdal), are also used to stabilize mood. Sometimes, children receive a combination of drugs such as a mood stabilizer and an antidepressant.

How is ADHD treated?
Treatment for ADHD includes medications and/or behavioral therapy. ADHD medications can be psychostimulants such as amphetamine and dextroamphetamine (Adderall), methylphenidate (Concerta, Ritalin), and lisdexamfetamine dimesylate (Vyvanse), or nonstimulant medications such as guanfacine (Intuniv) or atomoxetine (Strattera). Antidepressants, such as bupropion (Wellbutrin), are also used.

How can I make sure my child receives a proper diagnosis and treatment?
If your doctor suspects your child has bipolar disorder or ADHD, here’s what you can do:

Ask how the diagnosis was made.
Make sure the doctor talked with the child’s teachers or had written reports from teachers.
Be sure the doctor evaluates the child over a period of time, not just from one visit.
Review all of the information that went into making the diagnosis of ADHD or bipolar disorder.
Before deciding on treatment, consult an expert in child and adolescent psychiatry for a second opinion.
Make sure the doctor sees the child frequently after the diagnosis is made to check the medication for effectiveness and side effects.

Medical Reference….