Bipolar I Disorder

The defining characteristic of bipolar I disorder is mood episodes of mania.

Symptoms of a manic episode can include symptoms like the following: 

• Being extremely productive
• Feeling invincible
• Feeling intense excitement, happiness, or euphoria
• Appearing abnormally wired or jumpy
• Having excessive energy
• Having a decreased need for sleep that may result in restlessness or insomnia
• Speaking quickly; being chattier than usual 
• Having jumbled or racing thoughts
• Being easily distracted
• Having an inflated sense of self-esteem
• Doing impulsive, risky, or uncharacteristic things
• Feeling irritable and agitated

In some cases, people with bipolar I disorder may also experience signs and symptoms like psychotic episodes, paranoia, or extreme delusions—which are what set mania apart from hypomania, besides the period during which symptoms are present. 

Bipolar I disorder depression

People with bipolar I disorder may have depressive episodes as well, which can be characterized by the following depressive symptoms:

• Sadness
• Worry and anxiety
• Thoughts of worthlessness or hopelessness
• A sense of apathy or emotional numbness 
• A lack of interest in activities previously enjoyed
• Forgetfulness 
• Indecisiveness 
• Difficulty concentrating
• Changes in sleep patterns, like sleeping too much or not enough
• Changes in eating patterns, like eating too much or not enough
• Thoughts of death or suicide
• Avoidance of friends and family

Other symptoms: Mixed episodes, hypomania, and rapid cycling

It’s also possible for people with bipolar I disorder to have episodes with mixed features—meaning that they include symptoms of both mania and bipolar depression. For example, people experiencing bipolar I disorder may feel sad but have a lot of energy, or have a decreased need for sleep and racing thoughts but with a persistent sense of hopelessness.

Note also that some people with bipolar I disorder may experience hypomania instead of mania, which is a milder version of this type of episode. During hypomanic episodes, someone with bipolar I disorder may be especially chatty, high energy, and euphoric, but not to the same degree as in a full manic episode. They may not realize that anything is wrong, but friends and family often notice these changes in activity levels and mood swings and find them to be unusual for that individual.

Any of these mood episodes—manic, hypomanic, or depressive episodes—can last weeks or longer. During a bipolar episode, symptoms may occur every day for most of the day. How often moods shift in bipolar I disorder varies from person to person. “Rapid cycling” is when people experience four or more episodes of mania or depression within a year. In rarer cases, a person may even experience multiple bipolar episodes in a single day, a type of rapid cycling called “ultra-rapid cycling.”

Scientists have not isolated a single cause of bipolar I disorder. Instead, it’s believed that there may be several factors involved, including the following. 

Genetics

Although the exact inheritance pattern is not yet completely understood, the risk of developing bipolar disorder appears to be greater for first-degree relatives of someone with the condition than for the general public. The inheritance risk factors for bipolar disorder also seem to be higher in some families than in others.

Stress

Stressful events can incite episodes of mania or depression in someone with this type of bipolar disorder, and research suggests that stress is a significant risk factor for developing bipolar I disorder as well. People with bipolar I disorder may have higher levels of stress hormones at baseline, which increase even more under stressful conditions. 

People with this illness also often show signs of impaired brain function. Some researchers believe that the increased stress hormones and their effects on a brain that is already impaired may contribute to the development of bipolar disorder. However, more long-term studies on how stress systems function in someone with bipolar disorder are needed.

Brain structure and function

Brain scans cannot diagnose bipolar I disorder. Still, research suggests subtle differences in the brains of people with this condition, including lower cortical thickness, smaller subcortical volumes, and changes in the integrity of white matter. 

Bipolar I disorder is a life-long condition, but people with this illness can often effectively manage their symptoms with the right treatment. The overall goal of treatment is usually stabilizing an individual from an acute episode, if necessary, and then achieving a return to pre-illness baseline functioning. Below are a few common components of treatment for bipolar I disorder.

Medication

Some medications may help people manage the symptoms of bipolar I disorder. Medication alongside therapy is often the most effective support method for treating this condition. 

Mood stabilizers are commonly used to treat bipolar I disorder to prevent episodes or reduce their severity. Valproic acid is often the go-to medication for periods of acute mania because it can be weaned quickly. Lithium may be the treatment of choice for euphoric mania rather than episodes with depression or mixed features. Lithium is often given with medications that help clients manage anxiety or sleep disturbances.

Lithium may work best for people with a family history of the disorder. Long-term use of lithium can cause kidney or thyroid problems, so careful monitoring is imperative.

Other medication options are available for individuals with bipolar disorder. Consult your psychiatrist before starting, changing, or stopping a medication. 

Other bipolar I disorder treatment options

Other treatment options for bipolar I disorder may include: 

• Electroconvulsive therapy (ECT). ECT is a procedure where a doctor uses electricity to stimulate the individual’s brain. It may help relieve symptoms in severe cases where the illness has not responded to other treatments, or it may be used if the individual is experiencing a mental health emergency. 
• Repetitive transcranial magnetic stimulation (TMS). This procedure uses magnetic waves to stimulate the brain. It’s similar to ECT but is not as powerful and has a lower risk of side effects.
• Light therapy. Light therapy, a common treatment for seasonal affective disorder, may be a helpful treatment for bipolar I disorder in those who experience worsening depression symptoms in the winter, like with seasonal affective disorder. Seasonal affective disorder and bipolar disorder are separate illnesses, but they may sometimes share this and other features.

Self-care

Self-care techniques are often another crucial component of treatment for bipolar I disorder because they may help individuals manage stress. Some examples of self-care include getting regular exercise, eating nutrient-dense meals often, staying hydrated, prioritizing sleep, and staying connected to friends and family.

Once someone with bipolar I disorder is stable, psychotherapy may help them learn to navigate life with their condition. There are multiple approaches to therapy for people with bipolar disorder, including CBT, FFT, and IPSRT. You might also try online therapy through a platform like BetterHelp to learn more about these and other treatment approaches.

Bipolar I disorder resources: 

• The Depression and Bipolar Support Alliance offers education and other resources, including a directory to find an in-person support group in your area.
• The National Institute of Mental Health offers a wealth of information and digital shareables to raise awareness about bipolar disorder. 

If you have bipolar disorder and are in crisis, or if you are the family member of someone with bipolar disorder who is in crisis, you can contact the National Alliance on Mental Illness Helpline by calling 1-800-950-6264 or by text, email, or online chat, Monday through Friday, 10 am to 10 pm EST. 

For those with thoughts of suicide, contact 988 Suicide & Crisis Lifeline at 988. Please also see our Get Help Now page for more immediate resources.

For help with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357).

One recent meta-analysis of clinical trials examined whether people with bipolar disorder responded better to “treatment as usual” (defined in the study as pharmacotherapy with routine monitoring visits) or pharmacotherapy combined with psychotherapy. The review suggests that CBT, family therapy, and other therapeutic interventions focused on skill training were each associated with a lower probability of recurrence than treatment as usual. These findings indicate that psychotherapy combined with pharmacotherapy may be one of the most effective options for stabilizing mood and preventing recurrences of depression. 

Bipolar I disorder research

Other research echoes these findings, concluding that although pharmacotherapy remains the primary treatment for bipolar I disorder, medication alone rarely leads to long-lasting recovery. Psychotherapy is increasingly being recognized as a central component of treatment, helping people with bipolar I disorder learn the skills to manage their symptoms and improve daily functioning. This research concludes by suggesting that when used in conjunction with medication, therapy specific to bipolar disorder may delay recurrence and improve outcomes.

90% of clients achieve quality of life

After three weeks of online recovery-focused bipolar individual therapy (ORBIT), 90% of all clients with bipolar disorder reported significant increases in quality of life. ¹

¹Journal of Affective Disorders

Here are some more key statistics on bipolar I disorder:

• Some research suggests that bipolar disorder affects between 1–5% of the total population.
• About 70% of people with bipolar disorder begin having symptoms before age 25. In addition, bipolar disorders have multiple common comorbidities, or other health conditions that may occur at the same time. For instance, 70–90% of individuals with this condition also meet the criteria for generalized anxiety disorder, panic disorder, or social anxiety disorder and 30–50% for alcohol or substance use disorders. Up to half also have a personality disorder, and 10–20% have eating disorders like binge eating disorder.
• It’s also possible for bipolar disorder to be comorbid with attention-deficit/hyperactivity disorder (ADHD). One study suggests that, in children, the comorbidity rate of attention-deficit/hyperactivity disorder (ADHD) and pediatric bipolar disorder is 20%, and symptoms of bipolar disorder and attention-deficit/hyperactivity disorder (ADHD) often overlap.
• A growing body of research suggests the effectiveness of online therapy in general, with a 2023 study indicating that it may be effective in reducing symptoms of depression and anxiety in individuals living with bipolar disorder.

If you or a loved one is experiencing warning signs of bipolar disorder or another mental illness, it’s recommended that you seek professional support as soon as possible.

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