Sad. Angry. Irritable. We all have our moods…especially teenagers. In 1958, Freud even referred to adolescence as a period of extreme instability or “normal psychosis.” When I was in medical school, we first studied what was normal adolescent development so that we could recognize what was abnormal.

Adolescent development involves achieving independence from parents, adopting peer codes and lifestyles, acceptance of body image and establishing sexual, ego, vocational, and moral identities. And while they’re doing all of these developmental tasks, they are also experiencing changes in their hormones and changes in their brains.

So what’s considered par for the course? Certainly, teens experience sad, angry, and irritable moods, just like everyone else. But it’s abnormal when teens experience extreme mood swings, that interfere with sleep, energy level and clear thinking, or when they are in nonstop conflict with their parents.

Abnormal moodiness may actually be a mental health condition called bipolar disorder. As the name implies, bipolar disorder may involve depressive episodes, or a combination of depressive and manic episodes. Besides feeling sad, angry or irritable, symptoms of a depressive episode include:

  • Physical complaints
  • Disturbed sleep
  • Feeling guilty and worthless
  • Eating too little or too much
  • Having little energy and no interest in fun activities
  • Thinking about death or suicide

Symptoms of a manic episode may include:

  • Feeling irritable
  • Feeling extremely happy or “up” 
  • Having much more energy than usual
  • Talking rapidly and compulsively (pressured speech)
  • Having trouble sleeping, yet not feeling tired
  • Having trouble focusing
  • Talking and thinking about sex more often
  • Engaging in risky behaviors.

Not all bipolar disorders are the same. There are several types of bipolar disorder, which are diagnosed based on the length of time a person has suffered from the disorder and the severity of the symptoms. There may be manic and major depressive episodes (Bipolar I disorder); mild to moderate manic (hypomanic) and major depressive episodes (Bipolar II disorder); or hypomanic episodes and depressive symptoms that are less severe than major depression (cyclothymic disorder).

Bipolar disorder may look different in teens than adults.

  • Often the first sign of bipolar disorder in teens is major depression, whereas in adults it is often mania. Of youths with a major depressive episode, an estimated 20 to 40 percent are likely to develop bipolar disorder within five years of the depression’s onset. 
  • During manic episodes, teens tend to be more irritable while adults feel more elated. 
  • Teens spend more time in a mixed state, meaning that they are experiencing symptoms of both mania and depression at the same time. 
  • Bipolar disorder in teenagers is a more continuous illness than adult bipolar disorder. In most adults, the illness appears in discrete episodes and the symptoms may go into remission. 

There is no known cure for bipolar disorder, but there is treatment. Treatment involves medication prescribed by a psychiatrist as well as psychotherapy or “talk therapy.” They go hand-in-hand. Psychotherapy can help teens and their families cope with bipolar disorder and learn strategies to manage moods and behavior. For teens in emotional distress, confidential counseling is available 24/7, toll-free at the National Suicide Prevention Lifeline: 1-800-273-TALK (8255). In the event of an emergency, don’t wait. Call 911 or go to the nearest hospital emergency room.

My advice: Pay attention to your teenager’s moods. Bipolar disorder in teens is an under-recognized illness. If your teenager is having extreme mood swings, brushing it off as “normal teen moodiness” prevents them from getting the help that they need. Singer Demi Lovato, who has bipolar disorder, is an advocate for speaking up and seeking treatment. “You deserve to live a happy and healthy life, and the longer you hold this in, the more you’re delaying your happiness,” she told US News and World Report. “It’s important that you ask for help because it’s not a sign of weakness, it’s a sign of strength.”