Bipolar I Disorder

Bipolar I disorder is a serious mental health condition that causes extreme shifts in mood, energy, and behavior, involving intense manic episodes that can disrupt every aspect of daily life.

Table of contents

• What is Bipolar I Disorder?
• How Bipolar I Differs from Other Types
• Signs and Symptoms
• What Causes Bipolar I Disorder?
• How Bipolar I Disorder is Diagnosed
• Treatment Options
• Living with Bipolar I Disorder

What is Bipolar I Disorder?

Bipolar I disorder is a lifelong mental health condition that causes intense shifts in mood, energy levels, thinking patterns, and behavior^[1]. Previously known as manic-depressive illness or manic depression, this condition involves experiencing extreme emotional highs and lows that can significantly interfere with your ability to carry out day-to-day tasks^[1].

The defining feature of bipolar I disorder is the experience of manic episodes. To be diagnosed with bipolar I disorder, you must have had at least one manic episode in your life that lasted for at least a week, with or without ever experiencing a depressive episode^[3]. A manic episode is a period of abnormally elevated or irritable mood, along with extreme changes in emotions, thoughts, energy, talkativeness, and activity level^[3].

Approximately 2.8% of adults in the United States are diagnosed with bipolar I disorder each year, and around 4.4% may experience it at some point in their life^[6]. The condition affects people assigned male at birth and people assigned female at birth equally^[6]. Bipolar disorder is most often diagnosed in young adults, particularly those ages 18-29^[6].

How Bipolar I Differs from Other Types

There are several types of bipolar disorder, and each has different patterns of mood episodes^[6]. Understanding these differences is important for proper diagnosis and treatment.

Bipolar I disorder is the most severe form of bipolar disorder. People with this type have experienced one or more episodes of mania, which is an extremely elevated mood state that can include psychotic symptoms like delusions or hallucinations^[1]. Most people with bipolar I also experience depressive episodes, but depression is not required for diagnosis^[6].

Bipolar II disorder involves at least one major depressive episode and at least one hypomanic episode, which is a less severe form of mania^[1]. People with bipolar II never experience full-blown manic episodes^[6]. Hypomania doesn’t last as long as manic episodes and doesn’t interfere with daily functioning as much^[3].

Cyclothymic disorder (also called cyclothymia) involves many periods of hypomanic symptoms and depressive symptoms that do not meet the full criteria for bipolar I or bipolar II disorder^[1]. These symptoms must occur for at least two years in adults, or one year in children and adolescents^[5].

Signs and Symptoms

People with bipolar I disorder experience distinct periods when their emotions feel much more intense than usual. During mood episodes, you might act in ways that are very different from how you normally behave^[6]. These episodes can last for most of the day, every day, and sometimes continue for several days, weeks, or even months^[6].

Between episodes, many people with bipolar I have long periods of emotional stability when they don’t have any symptoms. This normal mood state is called euthymia^[3].

Manic Episode Symptoms

During a manic episode, people experience a highly energized level of physical and mental activity that is noticeable by others^[3]. Symptoms of mania include^[4]:

• Feeling very happy, excited, or euphoric
• Feeling very irritable or agitated
• Having a lot of energy and feeling restless
• Not needing much sleep
• Racing thoughts or difficulty concentrating
• Speaking fast or talking a lot, sometimes not making sense to others
• High sex drive
• Feeling overly confident or adventurous
• Being impulsive or extravagant, such as spending lots of money
• Saying or doing things that are rude, inappropriate, or not usual for you

People in manic states may engage in activities that cause them physical, social, or financial harm, such as suddenly spending or gambling extreme amounts of money or driving recklessly^[3]. They may also develop psychotic symptoms, such as delusions and hallucinations, which are false beliefs or seeing and hearing things that aren’t real^[3].

Depressive Episode Symptoms

While not required for diagnosis, most people with bipolar I disorder also experience periods of depression^[6]. During a depressive episode, symptoms include^[4]:

• Feeling sad, upset, or hopeless
• Not being interested in things you usually enjoy
• Low energy or feeling very tired
• Difficulty sleeping or sleeping too much
• Eating too much or too little
• Low confidence and feeling worthless
• Not being able to concentrate
• Avoiding spending time with other people
• Having thoughts about harming yourself

Mixed Episodes

Sometimes people experience both depressive and manic symptoms at the same time, which is called a mixed episode^[5]. This can be particularly distressing and difficult to manage.

What Causes Bipolar I Disorder?

Researchers don’t know exactly what causes bipolar I disorder, but it’s likely a combination of several factors^[6].

Brain Biology

Studies suggest that the brains of people with bipolar I disorder form and work differently than those without the condition^[6]. These differences could affect how your brain processes and manages emotions, stress, or energy levels.

Genetics

There’s no single “bipolar gene,” but bipolar disorder is one of the most heritable mental health conditions^[7]. You’re more likely to develop bipolar disorder if you’re related to someone who has it, particularly a close family member like a parent or sibling^[6].

Environmental Factors

Your surroundings and life experiences likely play a role in developing bipolar disorder. Risk factors include^[6]:

• Childhood trauma, such as abuse, neglect, or family conflict
• Negative stressful life events, like the death of a loved one
• Substance misuse, including drugs and alcohol
• Having another mental health condition such as anxiety, depression, or ADHD

Being mistreated in childhood, particularly experiencing emotional abuse or neglect, is another possible contributor to developing bipolar disorder later in life^[7].

How Bipolar I Disorder is Diagnosed

Bipolar disorder can take time to diagnose because it affects everyone differently and the symptoms are similar to other mental health conditions^[4]. There is no single blood test or brain scan that can diagnose bipolar I disorder.

Evaluation Process

If a doctor thinks you may have bipolar disorder, they will refer you to a mental health specialist called a psychiatrist^[4]. Your evaluation may include^[8]:

Physical exam and lab tests. Your healthcare professional may do a physical exam and laboratory tests to rule out any medical problems that could be causing your symptoms.

Mental health assessment. A psychiatrist will talk to you about your thoughts, feelings, and behavior patterns. You may answer a series of questions about your moods and symptoms. With your permission, family members or close friends may be asked to provide information about your symptoms.

Mood charting. You may be asked to keep a daily record of your moods, sleep patterns, or other factors that could help make the right diagnosis and determine the right treatment^[8].

Diagnostic Criteria

To meet the criteria for bipolar I disorder, you must have had at least one manic episode in your life for at least a week^[3]. The manic episode may have been preceded by or followed by hypomanic or major depressive episodes, but these are not required for diagnosis^[9].

The mental health provider will assess whether the behaviors represent distinct changes in your mood and behavior that negatively impact daily life functioning^[5]. They will also rule out other possible causes, such as substance use or other medical conditions.

Treatment Options

Although bipolar I disorder is a lifelong condition, you can manage your mood swings and other symptoms by following a treatment plan^[1]. Treatment is best guided by a psychiatrist who is skilled in treating bipolar and related disorders^[8].

Medications

Pharmacotherapy with mood stabilizers is a first-line treatment that should be continued indefinitely because of the risk of relapse^[9]. The types and doses of medicines needed are based on your symptoms^[4].

Mood stabilizers are usually part of bipolar I treatment and help control episodes of mania. Examples include lithium, valproic acid, carbamazepine, and lamotrigine^[12]. Lithium is widely recognized as moderately useful during all phases of bipolar illness and might possess specific effectiveness in suicide prevention^[13].

Antipsychotics may be given alone or along with a mood stabilizer. Both first and second generation antipsychotics are widely used for the treatment of acute mania^[13]. Examples include olanzapine, risperidone, quetiapine, aripiprazole, ziprasidone, and lurasidone^[12].

Antidepressants help manage depression but can trigger switching to mania, so guidelines suggest their cautious use in combination with an antimanic agent^[13]. Monotherapy with antidepressants is contraindicated in bipolar I disorder during manic episodes^[9].

Some medicines need to be taken all the time, while others are only taken when symptoms get worse^[4]. It’s important not to stop taking your medication unless you are told to by a doctor, even if you feel better^[4].

Psychotherapy

Talk therapy, also known as psychotherapy, is an important part of treatment and is used along with medications^[1]. The first-line psychosocial intervention in bipolar disorder is psychoeducation, followed by cognitive-behavioral therapy (CBT)^[13].

Therapy can help you learn to control behaviors that are putting stress on your life and relationships^[16]. With therapy, you can also learn to identify triggers for your mood episodes and develop strategies to manage them.

Other Treatments

If you’re at risk of self-harm, suicide, or harming someone else, you may need to stay in a hospital or have support from a crisis team at home^[4]. In some cases, electroconvulsive therapy (ECT) or other treatments may be recommended by your healthcare team^[13].

Living with Bipolar I Disorder

If you have bipolar I disorder, it’s important to know what can trigger your mood episodes. Common triggers include feeling stressed, not getting enough sleep, or being too busy^[4]. Some triggers may not be under your control, like the death of a loved one or a change in the weather^[15]. However, you have more control over other triggers.

Establish a Daily Routine

Many people with bipolar disorder find that sticking to a daily schedule helps them control their mood^[16]. Try to wake up, eat meals, take medication, and go to bed around the same time every day. Consistency can help prevent episodes by reducing emotional and physical stress^[17].

Prioritize Sleep

Getting regular sleep is especially important for people with bipolar disorder. Being sleep-deprived can trigger mania, and changes in sleep patterns can signal an upcoming episode^[16]. Tips for better sleep include:

• Go to sleep and get up at the same times every day
• Avoid screen time or caffeine late in the day
• Make your bedroom a calming space
• Relax before bed by listening to soothing music, reading, or taking a bath^[16]

Stay Active

Exercise can improve your mood and help you sleep better^[16]. Aerobic activity releases mood-boosting chemicals called endorphins and has been shown to be helpful during depressive episodes^[15]. Start simple, such as walking with a friend, and gradually work up to at least 30 minutes of activity on most days of the week.

Eat Well and Manage Stress

Follow a healthy diet that includes vegetables, fruits, fish, and whole grains. Try to limit or avoid sugar, caffeine, and alcohol, which may worsen mood disturbances^[15]. Stress is a major trigger for bipolar episodes, so finding stress relief strategies that work for you is essential^[15]. This might include yoga, meditation, journaling, or other relaxation techniques.

Avoid Alcohol and Drugs

Alcohol and drugs can affect how your medications work, worsen bipolar disorder, and trigger mood episodes^[16]. They can also make the condition harder to treat, so it’s best to avoid them completely.

Monitor Your Symptoms

Keep a journal noting when your symptoms appear and what you were doing at the time^[15]. Share the journal with your doctor or therapist. Together you can identify causes of and solutions to bipolar episodes. If your symptoms start to change, tell your doctor or therapist right away^[16].

With the right treatment and self-management strategies, people with bipolar I disorder can lead stable and fulfilling lives^[17]. It’s essential to work closely with your healthcare team and maintain open communication about your symptoms and any challenges you’re facing.