A 13-year-old with several weeks of mild depression now exhibits a sudden burst of energy and inability to sit still. What action should be taken?

A 13-year-old with several weeks of mild depression now exhibits a sudden burst of energy and inability to sit still. What action should be taken?

• A. Administer an ADHD diagnostic scale and consider ADHD medication.
• B. Consult with a child psychiatrist to prescribe antidepressant medication.
• C. Reassure the parent that this behavior is common after mild depressive symptoms.
• D. Refer the child to a child psychiatrist for evaluation of bipolar disorder.

Answer: (D)

Recognizing a possible bipolar spectrum mood change in a teen is essential. A several-week history of mild depression followed by a sudden burst of energy, restlessness, and an inability to sit still suggests a manic or hypomanic episode rather than a simple mood rebound or ADHD-only picture. In youths, mania can present with increased activity, pressured speech, decreased need for sleep, and irritability, and it demands careful evaluation by a child psychiatrist. Starting ADHD meds or antidepressants without ruling out bipolar disorder can worsen mood instability or trigger a manic episode, and reassuring the parent doesn’t address the new symptoms or safety concerns. The appropriate next step is a referral for a thorough psychiatric evaluation focused on bipolar disorder so that accurate diagnosis and appropriate mood-stabilizing treatment can be considered, with safety planning as needed.

Recognizing a possible bipolar spectrum mood change in a teen is essential. A several-week history of mild depression followed by a sudden burst of energy, restlessness, and an inability to sit still suggests a manic or hypomanic episode rather than a simple mood rebound or ADHD-only picture. In youths, mania can present with increased activity, pressured speech, decreased need for sleep, and irritability, and it demands careful evaluation by a child psychiatrist. Starting ADHD meds or antidepressants without ruling out bipolar disorder can worsen mood instability or trigger a manic episode, and reassuring the parent doesn’t address the new symptoms or safety concerns. The appropriate next step is a referral for a thorough psychiatric evaluation focused on bipolar disorder so that accurate diagnosis and appropriate mood-stabilizing treatment can be considered, with safety planning as needed.