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A case report of manic-depressive illness in a fifteen-year-old girl is presented, with a discussion of the diagnostic and therapeutic issues which are raised. The
patient was previously well adjusted and then suffered one depressive and two manic attacks in one year. Her mania responded well to treatment with lithium carbonate, but it recurred briefly when the lithium level fell to subtherapeutic levels. She has been asymptomatic for the two years since then. Manic-depressive illness may be underdiagnosed in adolescents in the United States.