Understanding Bipolar I Disorder

Bipolar I disorder is a mental health disorder affecting mood, energy levels, and thought processes. It was previously known as manic-depressive disorder or manic depression.

People with bipolar I disorder experience extreme changes in mood, including periods of extremely high energy known as mania. They usually also suffer from periods of depression. This cycling of extreme moods can disrupt all aspects of someone’s life, especially their work and personal relationships. Bipolar I is a serious illness that requires medical help and support.

What Is Bipolar I Disorder?

Bipolar disorders are a category of mental illnesses where people experience extreme variations in their mood, which then has a strong impact on their personal or work lives. Bipolar I disorder is the most severe of the bipolar disorders.

People with bipolar I disorder have experienced at least one period of “mania” which lasted for more than a week.^[1] Mania is more than just being excitable or enthusiastic. People with mania can have wildly inflated moods and self-esteem. Some experience psychotic symptoms or hallucinations, and many will require hospitalization to recover.

Bipolar disorders are a mental health seen worldwide.^[2] Bipolar I Disorder affects around 1-2% of the population and is equally common in men and women.^[3][4]

Most people with Bipolar I Disorder experience their first symptoms in their late teens or early 20s, although some will be diagnosed later in life.

Many people with bipolar I disorder will also experience other psychiatric disorders. These include anxiety disorders, substance use disorders, ADHD, and personality disorders.^[5]

Symptoms of Bipolar I Disorder

Bipolar I disorder affects people in different ways. Here are some common symptoms and how they might affect someone.

Manic Episodes

Someone with bipolar I disorder who is experiencing a manic episode will have much more energy than usual. This extra energy makes some people feel excited and motivated, as if they can take on the world. Others might become restless and irritable.

This excess energy can cause problems sleeping for people during manic episodes. They may struggle to fall asleep when they feel energetic and their thoughts are racing. They may feel as though they don’t need to sleep when they’re in this stage of their disorder.

Another key feature of manic episodes is a loss of inhibitions or impulse control. People experiencing mania are often less worried about the consequences of their actions and take more risks than they would normally. These choices are based on immediate rewards rather than long-term well-being. For example, they might skip work to go rock climbing without thinking about whether they might lose their job.

Up to 75% of people with bipolar I disorder have some form of psychosis during the height of their manic episodes.^[6] Someone who is experiencing psychosis struggles to tell the difference between things that are real and those that aren’t. These can be divided into delusions (thoughts and beliefs that aren’t connected to reality) and hallucinations (experiencing things that aren’t there).

Many people with bipolar I disorder struggle to notice mania while they’re experiencing it.

Depressive Episodes

Depressive episodes aren’t necessary to be diagnosed with bipolar I disorder, but they are extremely common. Over 95% of people with bipolar I disorder will have periods of depression.^[5] Even those who don’t experience clinical depression can find themselves having episodes where they feel very low and tired.

Depressive episodes typically last at least 2 weeks. During this time, people will feel sad or easily upset. They might have lower self-confidence, reduced appetite, and lose interest in things that they normally enjoy. Some people will sleep a lot more than usual, while others will struggle to sleep.

Many people find it difficult to concentrate or make decisions during their depressive episodes. They might also feel worthless. For some, these feelings can lead to suicidal thoughts, self-harm, and suicide.

Most people with bipolar I disorder find it easier to recognize when they are in a depressive episode than when they’re in a manic one.

Mixed Episodes

Some people with bipolar I disorder don’t have a completely clear distinction between their episodes of mania and depression. Instead, they experience mixed episodes, where they can have symptoms of depression and mania on the same day or even at the same time.

Mixed episodes can be disorienting for people with bipolar I disorder and for those who care about them. They may switch from feeling worthless to feeling invincible and back again in just a few minutes or hours. They might have lots of energy but feel incredibly sad or be extremely lethargic while feeling elated and invincible.

People with bipolar I disorder are at higher risk of self-harm and suicide during mixed episodes than during periods of only mania or depression.^[7]

Remission

People with bipolar I disorder aren’t always in a manic or depressive state, especially when they’ve found an effective medication. Being in remission means that someone’s current symptoms wouldn’t be enough for them to be diagnosed with the disorder. It doesn’t mean that they no longer have bipolar I disorder. They’re just not experiencing severe symptoms.

People in remission with bipolar I disorder may still experience some of their previous symptoms but at a less intense level.^[8] If they have residual symptoms of depression, they might still feel somewhat sad or lethargic, but they wouldn’t experience despair or suicidal thoughts.

Causes of Bipolar I Disorder

There isn’t a simple cause of bipolar I disorder, but researchers have been able to find several factors that can increase your risk of developing it.

People are more at risk of bipolar I disorder if they have a close family member who suffers from the disease. There isn’t a single gene for bipolar I disorder, but many different genes are probably working together to influence how likely you are to develop the disorder.^[9]

One of the ways that your genes might influence your chances of developing Bipolar I Disorder is by affecting how your brain responds to things in your environment. Some studies show that childhood trauma or stressful life events, for example, can increase your risk of bipolar I disorder if you’re already predisposed to the illness.^[10]

Bipolar I disorder can also be environmentally triggered, such as symptoms coinciding with the seasons. This type of bipolar I disorder typically causes depressive symptoms in winter and manic ones in summer, although this is not always the case.

Bipolar I vs. Other Bipolar Disorders

We’ve already mentioned that bipolar I disorder is the most serious of the bipolar disorders. This is because it’s the only one where people experience full mania.

People with bipolar II disorder experience hypomania, which is a less severe version of mania. They are unlikely to have psychotic symptoms or need hospitalization. Although not as severe as manic episodes, hypomania can still cause real problems in people’s lives.

The only difference between bipolar I disorder and bipolar II disorder is in the severity of their manic or hypomanic periods. There is no difference in severity between the two disorders during depressive episodes.^[1]

Cyclothymic disorder is another bipolar disorder that is very similar to bipolar II disorder. People with cyclothymic disorder have hypomanic episodes, but their periods of depression are less severe than those with bipolar II disorder.

Diagnosis of Bipolar I Disorder

Bipolar I disorder is a complicated illness, so your family doctor won’t be able to diagnose you. If they suspect that you might have a bipolar disorder, they’ll refer you to a specialist mental health doctor (most likely a psychiatrist) for diagnosis.

There are no physical tests that can diagnose bipolar I disorder.^[11] Instead, a doctor has to see whether your symptoms match the criteria. They will also have to check that those symptoms aren’t caused by another disease, such as hypothyroidism, or by any medications or other substances you’ve been taking.^[12]

The key symptom doctors are looking for when they diagnose bipolar I disorder is a manic episode. This must have lasted at least a week, during which time you would have experienced an extremely elevated and/or irritable mood.

For a diagnosis of bipolar I disorder, you need to have had at least 3 of the following symptoms during your manic episode.^[5]

• Inflated self-esteem
• Reduced need for sleep
• Talking more than usual
• Racing thoughts
• Being very easily distracted
• Being more active. This might mean doing more tasks or simply fidgeting and struggling to sit still
• Increased risk-taking or harmful behaviors, for example gambling or risky sexual behavior

These symptoms must have caused problems in your social or work life.

You don’t need to have experienced any depressive episodes to be diagnosed with bipolar I disorder. Your doctor will probably still ask about these to help them understand exactly how your bipolar disorder is affecting you and which medications are most likely to help.

Treatment of Bipolar I Disorder

The first line of treatment for bipolar I disorder is medication. Different types of medication can be offered to people with bipolar I disorder, depending on whether they are in a manic episode, a depressive episode, or remission.

During manic episodes, doctors may prescribe antipsychotic medications, mood stabilizers, or both.^[5] Mood stabilizers such as lithium can take several weeks to become effective. In severe cases, doctors may start with a high dose of faster-acting mood stabilizers such as Valproate.^[13]

Antipsychotics can reduce symptoms of psychosis, and they may also help to level out mood. It’s perfectly normal for people with bipolar I disorder without psychosis to be prescribed antipsychotics to help manage their symptoms.^[5]

During depressive episodes, antidepressants might be necessary. These are often less effective in people with bipolar I disorder than they would be for someone who only experiences depression. Sometimes, taking antidepressants can lead to manic episodes, so doctors may prescribe antipsychotics or mood stabilizers at the same time.^[14]

During remission, the main aim of treatment is to reduce the risk of another episode. Mood stabilizers are the most common medications to be used for maintenance, but some antipsychotics can also be used.

Psychotherapy is an important part of many people’s treatment plans. This can involve helping people with bipolar I disorder identify aspects of their lives that put them at risk of relapse, supporting them in making changes to those parts of their lives, and offering coping strategies to reduce the harm caused by manic or depressive episodes.^[15]

Psychotherapy and medication together reduce the frequency of relapse. They also reduce the likelihood of severe relapse, which requires hospital treatment.^[5]

Living with Bipolar I Disorder

Bipolar I disorder can be a difficult diagnosis to receive. There are many misconceptions about bipolar I disorder, and it might be hard for you to know what to expect. While you will need medical help to manage the disorder, there are also things you can do to look after yourself.

Improve Your Self-Awareness

One of the most important things anyone with bipolar I disorder can do is to focus on self-awareness. Being more in tune with yourself and your moods can help you spot things that can trigger manic or depressive episodes. It also gives you a better chance of recognizing manic episodes early, making them easier to manage.

Mood diaries or mood journals let you note important events from the day and rate your mood. You might want to share these with someone you trust, your doctor, or a mental health professional to look for potential triggers. If you prefer not to write, it’s still helpful to take a little time out of each day to check in with yourself and consider how you’re feeling.

Adapt Your Lifestyle

Where possible, avoid situations that trigger a bipolar episode. For many people with bipolar I disorder, this means having a strong routine that includes plenty of sleep, exercise, and a good diet.^[16] Spending time with people you care about can also have a protective effect, so try to build a strong support network.

Plan for Future Episodes

Another helpful suggestion is to plan for both manic and depressive episodes. However well you manage your condition, you are likely to have more episodes in the future. Forward planning can help minimize the impact these will have on your life.

When planning for manic episodes, consider the ways that your loss of inhibition can cause problems and try to introduce protections. If you gamble during these episodes, for example, you could place yourself on a banned list for online gambling sites.

Depressive episodes need a different type of planning, especially if you experience suicidal thoughts. Create a safety plan with contact details of people and organizations you can contact if you are feeling extremely low.

Work with Medical Professionals

Most importantly, remember that bipolar I disorder is a serious medical condition that requires ongoing treatment. Approach your medication and self-care in the same way you would if you had diabetes or a heart condition. Some of the medications for bipolar I disorder can have unpleasant side effects, but it’s important that you don’t stop taking medication without discussing this with your doctor. If the side effects are unacceptable to you, they should be able to recommend alternatives that might be more tolerable.

This information is not intended as a substitute for qualified medical advice. If you are concerned about bipolar I disorder, you should seek advice from your doctor or other healthcare professional.