Can You See It?
Teenagers can be so unbelievably moody. Well … a far more palatable word for it is reactive.
Overreactive (like yelling that brings the house down), intensely reactive (meltdowns that go on for hours, leave a hole in the drywall, or tear the room apart), egregiously reactive (with threats to jump off the roof, open a vein, down some pills), and . . . insufferably nonplussed. Apathetic. Unmotivated. Just downright bored.
Is this what kids are like now? Is this what your kid is like? (or Is this what you were like?) Is this what everybody else’s kid is like?
How do you know if what you’re seeing at home falls within the norm . . . or points to something bigger?
Like bipolar disorder. Does your teen exhibit signs of bipolar disorder? Signs that should point you in the direction of help. How can you tell the difference between adolescent drama and an agitated mania or mixed episode?
If you’ve never seen it before, how will you know?
Bipolar disorder isn’t diagnosed on the basis of a single symptom. Or a single episode of rage. Or an impulsive (regretful) moment.
But if you wonder about the changes you’ve seen in your teen’s behavior and state of mind — and what parent doesn’t wonder what’s normal anymore? — then sit up straight, because this is probably the most important reading you will ever do. It could save her life.
At first, it isn’t that easy to differentiate between a teen who’s reacting to frustration and a teen experiencing a bipolar manic episode.
Both are intense.
But are unpleasant.
And helping a teen grow up through the volatile reactions of adolescence, the moments of intimidation from challenging responsibilities, the sorrow of a spurned young love … can seem to mimic parenting a teen through bipolar disorder.
However, they bear no resemblance, as surprising at that sounds.
But if you’re the parent, how do you know?
Does Your Teen Exhibit Signs of Bipolar Disorder?
There are specific symptoms of bipolar disorder that go beyond your teen’s angry outburst. Symptoms that together paint a picture of an overall debilitating condition.
To make it easier to put this picture together… to see if there are symptoms compelling enough for your child to be evaluated by a psychiatrist … there are some helpful and well-known mnemonics that can help you know what to look for. (A mnemonic is just a way to remember something that’s really important.)
First, the manic symptoms to watch for… DIG FAST.
There’s just about nothing else that can dig you into a hole faster than being a little, or a lot, manic. That means having intensely happy, angry or wildly swinging moods with several of the following at the same time:
jumping from one thing to another to another, without getting anything done, and just leaving a mess
poor judgement with reckless behavior
that can start with feeling that you are just surrounded by idiots, that nobody really gets you or your vision, and it gets worse from there
Fast thoughts —
thoughts that fly through your head so fast it’s dizzying, sometimes with speech so fast it’s hard to interrupt
Appetite for risk —
fun, food, alcohol, gambling, drugs, sex, spending — it seems like whatever you do, you want more of, and risks you might never take are now opportunities you can’t wait to jump right into
Sleep needs diminish —
you can get by with very little sleep over days or weeks
Thoughts become increasingly disorganized —
and you can become hard to follow
Next, the depression symptoms that emerge in very low and incredibly empty states…SIG:E CAPS
with difficulty falling asleep or staying asleep, waking up too early, or wanting to sleep all day — or a mix of these
loss of interest in things that used to interest you
brooding about all the mistakes you’ve made, how you’ve messed up, feeling ashamed of yourself, feeling worthless
lack of energy, fatigue, listlessness
Cognition / Concentration:
poor concentration, cloudy thinking, inability to make decisions, forgetfulness
a loss of appetite for life, pleasure, food, and the things you used to enjoy
variable agitation when anxiety is high, or just dragging when lethargy is pervasive
passive thoughts of death as a relief, intrusive thoughts of killing yourself, deliberate planning for suicide, impulsive suicide attempts
If you’re wondering what SIG:E CAPS means, it comes from the prescription pad your doctor uses. The term SIG: is printed on the pad and that’s where he writes the directions for taking the prescription.
It stands for a Latin word, signetur, which means “write on the label.” Since lethargy, or loss of energy, is such a strong symptom in the diagnosis of depression, E stands for energy, or the need to write a prescription for Energy in the form of an antidepressant. And CAPS refers to those capsules that will help the patient feel better. We used to think that antidepressants could be energy capsules — or should be energy capsules — and although we’re more sophisticated in our thinking of what antidepressants do and how they act, SIG: E CAPS sticks.
Sort of silly, isn’t it? But like all mnemonics, using relevant letters like this helps us, and the patient, remember the most prominent symptoms of depression and the depression in bipolar disorder.
So, does your teen exhibit signs that could indicate bipolar disorder? These tools, DIG FAST and SIG:E CAPS will give you a starting place to examine your teen’s frame of mind and behavior. And the earlier this potentially devastating illness is diagnosed, the earlier treatment can begin, and the more likely your son or daughter can feel better, function better, and live a more rewarding life.
Of course, psychiatric diagnosis and formulation is much more complex than simple observation, tallying checklists or counting up checkboxes. There’s a host of other symptoms, syndromes, disorders, developmental issues, and character traits that make teasing this apart an art as well as a science. That’s where we come in.
The Danger of Untreated Bipolar Disorder
Here’s something else to consider. When an adult over 30 is diagnosed with depression, they often have a frame of reference as to what life can be like. They have a compass, so to speak, from their memories of happier, healthier times.
On the other hand, when young teens are diagnosed, they quickly lose sight of happier times, of what it’s like to feel good. To be fully functional. That shortened perspective can be so dangerous as it feeds their despondency, and suffocates their hope when asking themselves, “why live?”
The pressure to find rapid and effective treatments for depression in teenagers continues to rise. Pressure to reduce the negative changes in their brains that will impact who they become as they mature. And also, the pressure to find treatments to ease the hopelessness during the years when impulsivity is strong, and most dangerous.
IV Ketamine for Teen Depression
One study at the University of Minnesota is currently accepting candidates to test the effectiveness of ketamine in adolescents who’ve suffered from treatment-resistant depression. The 3-year study began in 2014, and takes a look at the neurobiological mechanisms that make ketamine work — at an age where getting well can change the whole trajectory of your life for the better.
This is extraordinary.
They’re studying teens and how low doses of ketamine affect their depression. Change the course of their lives. Save their lives.
So it’s exciting to think that IV ketamine for unipolar and bipolar depression doesn’t have to be reserved just for adults.
The study will be completed this year, so conclusions are pending. But we’re hoping the conclusions will reveal ketamine is an effective drug that provides fast, safe relief for treatment-resistant depression and bipolar disorder, as well as other mood disorders in teenagers, too.
This is critically important because for many people who suffer with unipolar and bipolar depression, their symptoms began during adolescence … somewhere between the ages of 12 and 20.
What’s more, during the teen years, the outcomes of serious major depressive disorder or bipolar depression can be devastating … even deadly. Suicidal ideation is sometimes the only trigger needed for a teen to make an irreversible decision.
And here’s why.
During the years before the prefrontal cortex has completed its development – usually in the mid-twenties – the risk of impulsive reactions to emotional pain are very high.
So to find a way to stop the suicidal drive that causes so many lives to be cut short is simply but profoundly life-saving.
And IV ketamine’s specialty is to erase suicidal thinking and hopelessness … fast. We’re talking in less than 4 hours.
There’s more to be learned about treating adolescents with IV ketamine.
But consider this. With everything that teens face in terms of the risk of life-long depression or bipolar disorder, as well as their elevated risk of acting on suicidal impulses, the sooner we aggressively study and support widespread adolescent treatment, the better.
Ok, that was a mouthful. I’m just saying that we need dramatically improved treatments for depressed teens and those with bipolar disorder. Their developing brains make rash decisions at times. Their susceptibility to treatment is at its peak when they’re young. And their risk of suicide makes this a terribly urgent need.
Meanwhile, we continue to seek every possible treatment to achieve the greatest possible relief for our adolescent and adult patients at Innovative Psychiatry. We evaluate each patient with a proverbial “fine tooth comb” to design the most effective and customized treatment possible.
Contact us for an appointment so we can learn more about you and provide the help so you, or your teen, can be restored to your very best self.
When you’re at ease, balanced, and resilient, you can perform at your best, love at your best, and achieve at your best. In short, you can enjoy your life and look forward to your future. What a beautiful thing.
To the restoration of your best self,
Lori Calabrese, M.D.