Young people and bipolar disorder Many people develop the condition in their late teens or early 20s. This is the time when young people's identities are developing and it can have a negative impact on their lives if left untreated.

Child and adolescent psychiatrist Clare Lamb describes the symptoms of mania and depression in young people and talks about the treatments available.

Q: Is bipolar different in young people than in adults?

It depends on the age of the young person and how mature they are.

It’s possible to diagnose bipolar disorder in children and young people who haven't reached puberty, but it's very rare. Diagnosis must be made by someone with specialist experience.

Q: What signs should parents and carers look out for?

The most important thing is spotting something that seems different about the young person.

It may begin with an episode of depression, or an episode of mania. Most people show depressive symptoms first, but in order to diagnose bipolar disorder in young people they must also show signs of mania.

Q: What are the symptoms of depression?

A depressive episode tends to build up slowly over a couple of weeks or months. You're likely to see a number of changes in the young person's thoughts, feelings, behaviour and physical wellbeing.

Their performance at school may deteriorate. They may be unusually moody and withdrawn or uncharacteristically irritable or aggressive with family and friends. Some of the symptoms can include:

• losing interest in things they usually love, such as sport, music, talking to their best mate or watching their favourite programmes
• finding it difficult to concentrate and get on with school work
• feeling tired all the time and lacking in energy and motivation, or alternatively, feeling anxious and uptight
• losing or gaining appetite and weight
• feeling hopeless, worthless or guilty, being very self-critical
• suicidal thoughts or a preoccupation with death

Q: What are the symptoms of mania?

During a manic episode, a person with bipolar will have feelings of extreme happiness or feeling high. Young people I talk to often say they feel buzzy or giddy. They may suddenly become very active and rearrange their bedroom for hours or feel the urge to start a number of creative projects all at the same time. Some of the symptoms can include:

• elevated and/or irritable mood
• lots of energy
• sleeping less than usual
• grandiose plans and ideas
• poor judgement
• take unnecessary risks - going out late, wanting to do exciting things they wouldn't normally do, drinking excess alcohol, taking street drugs
• increased sex drive - they may become disinhibited and behave out of character

"Lucy would rewrite lots of homework into the early hours of the morning. It wasn't a very useful task. She was just very busy rearranging everything and the results were more and more chaotic."

If the illness advances without anyone picking it up, the mania may develop into symptoms of psychosis (seeing or believing things that are not real). Delusions (beliefs that are not real) can build in intensity until the person is strongly convinced, for example, that they have wonderful powers and abilities.

"Paul had just begun learning to play the guitar. But he suddenly began to believe he was a top guitarist about to go on tour and became irritatated at anyone who challenged him on this."

Q: Why is early diagnosis so important?

If you diagnose and start effective treatment early, you’re more likely to get a good outcome.

It gives the young person and their family a chance to find out about the illness and adjust their lifestyle. They can get to know their treatment team and spend time talking about the right treatment for them. They can find out about the support available to help them manage the illness and reduce the risk of reoccurrence.

If the diagnosis is not picked up early, a young person may become very unwell and need admission to hospital in an emergency. It can then be much harder to build up a good relationship with their doctors and therapists, because their first experience of mental health services will have been negative.

Q: How is it treated?

One of the most effective treatments is medication. Different drugs are used for different phases of the illness. If a young person has mania, the treatment will involve taking medication. A young person may be offered a medicine called an antipsychotic. If this doesn't help then a mood-stabilising medicine such as lithium carbonate or sodium valproate will be offered.

During a depressive episode, treatment may involve specific talking treatments and taking medicine (usually the same as for mania). In some cases a medicine for depression called fluoxetine may be offered.

Following treatment for mania or depression a young person should feel better again. It's important that they continue to see their doctor and continue with treatment to stop the moods coming back. It’s a question of getting the combinations and doses of drugs right, and this can take time.

There can be side effects that may alter a young person's weight, growth and concentration levels, for example. But there are clear guidelines governing the use of medicines and the young person's physical health will be closely monitored.

"On medication, Angela feels she can think and manages to sort out problems. Everything was racing around so much before that she couldn't actually concentrate for long enough. She doesn’t want to be on medication - it's like a young diabetic doesn’t want to be injecting themselves everyday with insulin - but she's worked out what the risks and benefits are."

Q: What other treatments are there beyond medication?

As well as medication, a young person will be offered individual counselling or talking treatments such as cognitive behavioural therapy (CBT) and family meetings. This helps them understand bipolar disorder, explore its possible causes and learn to manage their mood swings and notice when they're starting.

It's important that they establish a regular rhythm to their lives and a stable sleep pattern.

"Sally couldn't stay up all night if she went to a party with friends. She was actually putting herself at risk and could easily get in a position where she was triggering her mood disorder. Lack of sleep is a trigger for many people with bipolar."

A young person will also be offered practical support. Stress is often a trigger and, with permission from a young person, the counsellor may talk with the school or college about reducing the number of GCSEs.

Q: What do young people with bipolar worry about?

As the condition tends to run in families, young people often ask me: "Does this mean I’m going to be like my mum?"

But today's treatments and resources are different and we manage to pick up bipolar disorder earlier in the young person's life. A parent might not have been diagnosed until much later, after many episodes or illness. We explain there are differences in personality and help young people to develop their own identity, separate from their illness.

There are also lots of good role models - successful celebrities, sports people and academics - who have bipolar disorder. Many young people also find support groups and online communities helpful to discuss their experiences with their peers.

Q: What do I do if I’m worried about someone?

Talk to someone you trust. Going to a family member, teacher, school counsellor or school nurse is a good place for a young person to start.

If you're worried about a member of your family or someone you know, your GP is the first point of call. They can provide you with information, support and advice. Some young people won't go to a GP, but a school nurse or youth counsellor can also get a young person to the right services.

It's about getting the correct support and making sure young people get the best treatments. If we get things right, there's every possibility for recovery and a good quality of life.

Dr Clare Lamb is a consultant child and adolescent psychiatrist with North Wales Adolescent Services, part of the Conwy and Denbighshire NHS Trust.