Bipolar Disorder I Symptoms, Causes & Treatment Options

Bipolar disorder is a chronic mental health condition characterized by episodes of depression and elevated mood (mania) that can cause significant difficulties with daily functioning if not adequately treated.

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Contents

  1. Overview
  2. Symptoms
  3. Potential Causes
  4. Treatment, Prevention and Relief
  5. When to Seek Further Consultation
  6. Questions Your Doctor May Ask
  7. References

What Is Bipolar Disorder I?

Summary

Bipolar disorder is a common, lifelong mental health condition of variable severity that can run in families, characterized by episodes depression and mania that last for weeks or months. Symptoms often start in adolescence or young adulthood.

Mania is a state of elevated or irritable mood, with changes in behavior, such as decreased need for sleep, increased goal-directed and risky activities, and increased talkativeness. Depressive episodes in bipolar disorder are like major depression, characterized by low mood, loss of pleasure, and low energy. Mood episodes are separated by periods of remission with stable mood and minimal difficulties with daily function.

Treatment for bipolar disorder varies from person to person, depending on symptoms and other individual factors. It often consists of medications such as mood stabilizers and antipsychotics that help reduce extreme symptoms. Hospitalization may be recommended in acute episodes. Psychotherapy can also be helpful.

Recommended care

You should visit your primary care physician who will coordinate your care with a mental health professional such as a psychiatrist. Bipolar disorder is a serious condition which is treated with prescription medication (usually Lithium).

Bipolar Disorder I Symptoms

Everyone’s experience with bipolar disorder is a little different but typically includes periods of depressed mood as well as periods of elevated mood (mania) that cause notable impairment in social or occupational functioning. Some people only have a few mood episodes in their entire lifetimes while others may have several per year [1].

Main symptoms of manic episodes

A manic episode is a distinct period of at least one week of persistently elevated, expansive, or irritable mood associated with abnormally increased activity or energy [2]. In many ways, mania is the opposite of depression. During a manic episode, three or more of the following symptoms are present and noticeably different from usual behavior:

  • Inflated self-esteem or grandiosity: There may be feelings of being extremely optimistic or euphoric.
  • Decreased need for sleep: You may wake up feeling well-rested after only a few hours of sleep.
  • Increased talkativeness
  • Racing thoughts: Your thoughts may seem to jump from one thing to another without clear connections.
  • Distractibility
  • Increased goal-directed activity: Your pursuit of work, school, social, or sexual goals may increase.
  • Psychomotor agitation: Purposeless movements
  • Increased risky activities: This includes involvement in activities that may have negative consequences such as shopping sprees, reckless driving, unwise investments, gambling, dangerous sports, or risky sexual activities, without an appreciation of possible harm.

In addition to manic episodes, people with bipolar disorder may also experience hypomanic episodes. A hypomanic episode is a distinct period of at least four days of elevated, expansive, or irritable mood, with three or more of the symptoms above. However, unlike a manic episode, hypomanic episodes do not cause marked social or occupational impairment or necessitate hospitalization [2].

Main symptoms of depressive episodes

Depressive episodes in bipolar disorder are similar to those in major depressive disorder and include at least two weeks of depressed mood or a loss of pleasure as well as at least five of the following symptoms:

  • Change in appetite: This will likely lead to unintentional weight loss or gain.
  • Changes in sleep patterns: Difficulty falling asleep or staying asleep (insomnia) or sleeping more than usual (hypersomnia) will occur most days.
  • Psychomotor agitation or slowing: Others may notice unusual restlessness or slow movements.
  • Fatigue or low energy nearly every day
  • Excessive feelings of guilt or worthlessness
  • Difficulty concentrating or making decisions
  • Thoughts of death: You may feel that life is not worth living or plans for ending one’s life [2].

Sometimes mood episodes are not clearly manic or depressive but have features of both. These periods are called mixed episodes and have a particularly high suicide risk.

Other symptoms

Though not part of the core diagnostic criteria, a number of other symptoms can occur in manic episodes. These include:

  • Dressing colorfully or flamboyantly
  • Acting authoritatively
  • Lack of insight into abnormal behavior
  • Interpersonal difficulties
  • Feeling unfairly treated
  • Delusions: Such as hyper-religious beliefs or paranoia
  • Hallucinations [1]

Complications

Without treatment, bipolar disorder can be extremely disabling and result in a variety of difficulties, such as:

  • Unstable relationships and divorces
  • Legal problems
  • Financial problems
  • Attempted suicide
  • Job loss
  • Alcohol or drug abuse
  • Other medical problems: Such as heart disease, diabetes, and obesity [4]

Bipolar Disorder I Causes

Like most mental health conditions, bipolar disorder results from a complex interplay of biological and environmental factors. It affects one to four percent of people overall, across each race, sex, and ethnicity [3,4]. Symptoms usually start in adolescence or young adulthood and often decrease in severity over the lifespan.

  • Genetic predisposition: Bipolar disorder has been found to run in families. Roughly half of people with bipolar disorder have a family member with the condition [3].
  • Neurobiological differences: Research is ongoing to understand differences in brain structure and function between people with bipolar disorder and people without the condition [3].
  • Environmental factors: Stressful life events, sleep disruptions, and exposure to high levels of hostile emotions have been associated with the development of bipolar disorder among people with a family history of the condition [4].

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Treatment Options and Prevention

Treatment

Treatment may include a combination of medications, psychotherapy, and, at times, hospitalization to foster mood stability and minimize disability.

Medications

A variety of medications can be used to treat bipolar disorder. Your physician will select the best medications for you based on your symptoms, other medical conditions, and concerns about side effects, which vary across medications. It is important to continue taking medications regularly as prescribed to reduce the chances of relapse [4].

  • Mood stabilizers: Medications such as lithium, valproic acid (Depakote), and lamotrigine (Lamictal) can help promote mood stabilization in bipolar disorder. Women who wish to become pregnant should discuss the risks and benefits of these medications carefully with their physician.
  • Anti-psychotics: Medications such as olanzapine (Zyprexa), quetiapine (Seroquel), and risperidone (Risperdal) are also effective in controlling extreme symptoms of bipolar disorder and may be prescribed in combination with other medications.
  • Antidepressants: Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and other antidepressants may be used in depressive episodes along with other medications. Antidepressants alone are usually not a safe treatment for bipolar disorder because they may trigger manic episodes.
  • Benzodiazepines: Medications such as lorazepam (Ativan), clonazepam (Klonopin), and diazepam (Valium) are effective for symptoms such as anxiety, irritability, and insomnia, but can be sedating and lead to physical dependence with long-term use. They may be prescribed to help relieve symptoms in acute mania.

Psychotherapy

Talk therapy with a trained professional is an effective additional treatment for bipolar disorder in order to improve social function, minimize the need for medications and hospitalizations, and reduce relapse [4].

Hospitalization

Brief hospitalizations may be needed in acute phases of bipolar illness to reduce chances for self-harm. Hospitalization aims to restore normal sleep, reduce severe symptoms, and establish a helpful medication regimen.

Prevention

In addition to the treatments listed above, making adjustments to live a healthier lifestyle may also help maintain stable mental health and wellbeing.

  • Avoid alcohol and other drugs: Alcohol, tobacco, and other drugs, despite sometimes seeming to relieve uncomfortable feelings in the short-term, can worsen symptoms overall. Quitting is difficult, but your physician can offer you resources to help.
  • Monitor for warning signs of recurrence: Keep a mood journal and/or get help from friends and family in order to identify when your mood and behaviors are changing. People who are able to recognize early warning signs have fewer hospitalizations and are better able to maintain their daily lives [4].
  • Take your medications as prescribed: Maintain open communication with your doctors and therapists. Let them know if you have questions or concerns about your medications so they can help you achieve your goals.

When to Seek Further Consultation

If your mood is negatively impacting your life

The strong emotional states that characterize bipolar disorder can be distressing to you and people close to you. If you are feeling down or experiencing other symptoms of depression such as losing interest in things you previously enjoyed or losing your appetite, report these symptoms to your physician to get more help, especially if they persist for more than two weeks. Although some people enjoy feelings of mania, manic episodes can cause significant financial, legal, and interpersonal problems. If you feel your mood changing, seek additional support from a mental health professional.

If someone you know has developed symptoms of mania

Mania is a medical emergency that can result in serious physical and social consequences. If the behavior of someone you know has changed, with a decreased need for sleep, elevated mood, risky activity, or other symptoms listed above, call 911, or seek help at the nearest emergency room.

If you are having thoughts of ending your life

If for any reason you are feeling that life is no longer worth living, report these thoughts to your physician, call 911, or seek help at the nearest emergency room.

If you are having problems controlling the use of substances

If the use of alcohol, tobacco, or other substances is getting in the way of your life, talk to a physician about other ways to control your symptoms and regain control of your life.

Questions Your Doctor May Ask to Diagnose

To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.

  • Are you having difficulty concentrating or thinking through daily activities?
  • Are you feeling irritable (easily made upset)?
  • Are your symptoms causing difficulty at work, socializing, or spending time with friends & family?
  • Are you sleepy during the day?
  • Are you experiencing a headache?

If you've answered yes to one or more of these questions

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References

  1. Coryell W. Bipolar Disorders. Merck Manual Professional Version. Reviewed May 2018. Merck Manuals Professional Version Link
  2. Severus E, Bauer M. Diagnosing bipolar disorders in DSM-5. Int J Bipolar Disord. 2013;1:14. Published 2013 Aug 23. doi:10.1186/2194-7511-1-14. NCBI Link
  3. Martinowich K, Schloesser RJ, Manji HK. Bipolar disorder: from genes to behavior pathways. J Clin Invest. 2009;119(4):726-36. NCBI Link
  4. Price AL, Marzani-nissen GR. Bipolar disorders: a review. Am Fam Physician. 2012;85(5):483-93. PubMed Link