What is Bipolar I Disorder?

Mood changes in response to sad, stressful and even exciting life events are perfectly normal. But unusual shifts in mood, energy and activity levels could indicate bipolar I disorder, the more severe form of bipolar disorder.

Bipolar I disorder, also known as manic-depressive disorder, is diagnosed when a person has experienced at least one manic episode. A manic episode is a distinct period of abnormally and persistently elevated, expansive or irritable mood accompanied by abnormally and persistently increased activity or energy. These episodes last at least one week and are present most of the day, nearly every day.

Bipolar I Symptoms

For a diagnosis of bipolar I disorder, a person must have experienced at least one manic episode, during which he or she may feel euphoric or irritable and exhibit abnormal behaviors. Symptoms of a manic episode include:

• Decreased need for sleep
• Excessive spending
• Flying quickly from one idea to the next
• Hypersexuality
• Increased energy and hyperactivity
• Inflated self-image
• Making and pursuing grandiose, unrealistic plans
• Rapid, uninterruptable and/or loud speech
• Substance abuse

A manic episode is severe enough to significantly impair a person’s social or occupational functioning or to necessitate hospitalization in order to prevent self-harm or harm to others. True manic episodes are not caused by the physiological effects of a substance (alcohol, recreational drugs, medications) or by another medical condition.

Untreated manic episodes can last from a few days to several months. During a severe manic episode, a person may become psychotic or delusional, losing touch with reality. His or her behaviors may seem bizarre to others.

Episodes of depression, which often follow manic episodes days or weeks later, may include:

• Depressed mood
• Feelings of guilt or worthlessness
• Loss of interest or pleasure in activities
• Low energy and activity
• Suicidal thoughts

Bipolar I Diagnosis

Diagnosing bipolar I disorder requires thorough physical and psychological evaluation. Your behavioral health physician will use the criteria for bipolar I disorder listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, to determine if your symptoms indicate the condition.

Diagnostic tests include:

Physical examination: Your physician will perform a physical exam and ask questions about your health to determine if your symptoms could be linked to an underlying physical health problem.

Psychiatric evaluation: Your behavioral health physician will ask about your symptoms, thoughts, feelings and behavior patterns. You will be asked about your personal and family history of mental illness, bipolar disorder and other mood disorders – as bipolar disorder often has a genetic component. Your behavioral health physician may also ask questions to test your reasoning, memory and ability to express yourself.

Causes of Bipolar Disorder Type I

The cause of bipolar I disorder is unknown, but research has shown that it can have a genetic component and run in families. Multiple factors – including stress, lack of sleep, and alcohol or substance abuse – may interact to trigger abnormal brain circuit function. People with a bipolar disorder appear to have physical changes in their brains, and researchers are investigating their significance.

Risk Factors

Risk factors that could contribute to bipolar I disorder include:

Family history: Many studies have found that people with bipolar I disorder often have at least one close relative with bipolar disorder or depression. 

Antidepressant use: Though not thought to be a causative factor on its own, antidepressant use increases the risk of manic episodes in a person with bipolar I disorder, especially when taken as the only medication. 

Excessive alcohol or drug use: Though these behaviors are not thought to cause bipolar I disorder, substance abuse can trigger bipolar symptoms.

Lack of sleep: Though not thought to be a causative factor on its own, lack of sleep increases the risk of manic episodes in a person with bipolar I disorder.

Stress: While a stressful event does not cause bipolar I disorder, it can trigger manic or depressive episodes in people biologically vulnerable to bipolar disorder.

Prevention

Bipolar I disorder cannot be prevented. Seeking treatment at the earliest sign can help prevent the condition from getting worse or interfering with your life. 

If you’ve been diagnosed with bipolar I disorder, these strategies can help you avoid severe manic or depressive episodes.

Don’t abuse alcohol or recreational drugs: These substances have a mood-altering effect that could trigger symptoms.

Seek help at the first warning signs: Call your behavioral health physician if you feel symptoms of a manic episode or depression coming on. 

Seek support for stress: Lean on family and friends, if possible, during stressful situations. Talking to a behavioral health professional can also help you develop effective coping strategies.

Take your medications as directed: Never abruptly stop taking a medication, as it can make symptoms worse. Always talk to your physician if you feel your medication is causing side effects. 

Prognosis

Proper diagnosis and treatment help people with bipolar I disorder lead healthy and productive lives.

Treatment

Most people with bipolar I disorder benefit from a combination of medication and psychotherapy delivered by a psychiatrist, psychologist or other behavioral health professional.

Bipolar I Medications

You may need to try a few different medications, or medication combinations, before you find the one that’s right for you. Some medications take a few weeks before their full effect is obvious. Some cause side effects for certain patients. If you experience any side effects, it’s important to talk to your physician immediately but not to abruptly stop taking the medication, which could cause a worsening of symptoms.

Common medications prescribed for bipolar I disorder include:

Antidepressants: These medications may be prescribed to help manage depression, but – because they can sometimes trigger manic episodes – they’re often prescribed along with a mood stabilizer or antipsychotic medication.

Antipsychotics: These drugs are prescribed when manic or depressive symptoms persist despite treatment with mood stabilizers.

Mood stabilizers: These medications control manic or hypomanic episodes.

Psychotherapy

Also known as talk therapy or psychological therapy, this involves talking about your condition, symptoms, mental health history and life with a mental or behavioral health professional. This type of therapy can help you establish consistent and healthy routines, identify negative behaviors and beliefs and replace them with positive ones, learn about your disorder and educate your loved ones, and improve family support and communication to better manage manic symptoms.

Other Treatment Options

• Electroconvulsive therapy (ECT): Usually reserved for people who don’t improve with medication, this therapy involves electrical currents passed through the brain to impact the function and effects of neurotransmitters.
• Alternative medicine: These approaches aren’t a replacement for medical treatment or psychotherapy, but can sometimes serve as complementary therapies. Nonmedical treatments like acupuncture, meditation, massage therapy, yoga or tai chi may be helpful – when combined with medication and psychotherapy – for some people.

Complications

Early and ongoing treatment is key for managing bipolar I disorder. Left untreated, the disorder can be very disruptive to a person’s life, leading to:

• Damaged or difficult relationships
• Drug and alcohol abuse (self-medicating)
• Poor health
• Poor work or school performance
• Legal and financial problems
• Suicide attempts or suicide

Some people with bipolar I disorder also have other physical or behavioral health conditions that can make the disorder worse or harder to treat. It’s important to seek treatment for these conditions as you seek treatment for bipolar I disorder:

• Anxiety disorders
• Attention-deficit/hyperactivity disorders
• Alcohol or drug abuse
• Chronic health conditions like heart disease, thyroid problems or obesity
• Eating disorders