Bipolar I Disorder

Bipolar I disorder is a mental health condition involving distinct periods of markedly changed mood, energy, and activity. It is defined by the occurrence of at least one manic episode: a period in which mood is elevated, expansive, or irritable, energy and activity are clearly increased, and the change is severe enough to disrupt daily life, work, relationships, or safety.

Most people with bipolar I disorder also experience periods of depression, when mood is low, energy is reduced, and interest or enjoyment falls away. Between episodes, many people feel much as they usually do. The pattern, length, and severity of episodes differ considerably from person to person.

Manic episodes can involve reduced need for sleep, rapid speech, racing thoughts, heightened confidence, and impulsive decisions with lasting consequences. In some cases they involve losing touch with reality, or require hospital care to keep someone safe.

Bipolar I disorder is a long-term condition, and it is treatable. Care usually combines medication prescribed and monitored by a clinician with psychological and practical support, and is aimed at both treating episodes and reducing how often they recur.

This page is educational and is not intended to diagnose a mental health condition or replace evaluation by a qualified health professional.

Bipolar I disorder involves episodes of two contrasting kinds, though people do not experience them in the same way or in the same order.

During a manic episode, commonly recognized experiences can include:

• mood that is unusually elevated, expansive, or irritable;
• a clear increase in energy, activity, or restlessness;
• needing much less sleep than usual without feeling tired;
• talking more, faster, or being difficult to interrupt;
• thoughts moving rapidly from one idea to another;
• markedly increased confidence or unrealistic beliefs about one's abilities;
• distractibility; and
• impulsive decisions, including spending, driving, work, or sexual behaviour that carries risk.

During a depressive episode, experiences can include persistently low mood, loss of interest or enjoyment, fatigue, changes in sleep and appetite, difficulty concentrating, feelings of worthlessness, and thoughts of death or suicide.

Some people experience features of both at once, which can be particularly distressing.

These experiences can also occur in other mental health conditions, in physical illness, and with medication or substance use, including stimulants and withdrawal states. This information should not be used as a checklist to diagnose bipolar I disorder.

If you are having thoughts of harming yourself, please see our crisis resources page for how to find urgent support in your location.

Diagnosis requires an appropriate clinical assessment, which considers the pattern of episodes over time rather than how a person feels on a single day.

There is no single cause of bipolar I disorder. Current understanding describes it as arising from a combination of biological and environmental influences.

Factors discussed in the research and clinical literature include:

• family history, which is among the more consistently reported associations;
• differences in brain structure, chemistry, and the regulation of mood and sleep;
• disrupted sleep and disturbed daily routine, which can precede episodes;
• significant life stress, loss, or major change;
• childbirth and the period following it;
• physical illness and some medications; and
• alcohol, stimulants, and other substances, which can trigger or worsen episodes.

The presence of a risk factor does not mean a person will develop the condition, and many people with a family history never do.

Because thyroid conditions, neurological conditions, medications such as steroids, and substance use can produce similar changes in mood and energy, assessment usually includes consideration of physical health.

Recognising personal early warning signs, and protecting sleep and routine, are commonly discussed as part of longer-term management.

Distinguishing bipolar I disorder from other conditions can take time, because episodes occur at intervals and a person may seek help during a depressive period without mania having been recognised.

Bipolar I disorder is distinguished from bipolar II disorder by the presence of a manic episode. In bipolar II disorder, raised mood occurs in a less severe form, called hypomania, alongside episodes of depression. It is also distinguished from major depressive disorder, where periods of raised mood and energy do not occur; a history of mania changes both the diagnosis and what treatment is appropriate.

Conditions that may resemble or occur alongside it include anxiety conditions, attention and impulse-related conditions, substance use, and conditions involving psychosis. Physical causes considered during assessment include thyroid conditions and medication effects.

Because treatment differs, an accurate picture matters. Assessment typically involves looking at the pattern over time, and often information from people who know the person well, since changes during mania may be more apparent to others than to the person experiencing them.

Bipolar I disorder is treatable, and treatment usually has two aims: managing current episodes, and reducing how often episodes return. Approaches are decided with a qualified health professional, and typically continue over the longer term.

Medication has a central role. Several classes are used, including mood stabilising medicines and antipsychotic medicines, chosen according to the type of episode, the person's history, other health conditions, and how they respond. Antidepressants are used selectively in bipolar disorder and with care, because in some people they can affect mood stability. All such decisions, including whether medicine is appropriate and for how long, rest with a prescribing clinician together with the person concerned, and usually involve regular review and sometimes blood monitoring.

Psychological and practical approaches are used alongside medication. These commonly include education about the condition, recognising early warning signs, protecting sleep and daily routine, planning ahead for periods of illness, and support for family members.

During severe episodes, additional care may be needed to keep someone safe, which can include hospital treatment. Some severe or treatment-resistant presentations are treated with procedures used in specialist settings.

If difficulties are worsening, or distress feels unmanageable, contact a qualified health professional. If there is immediate risk of harm, see our crisis resources page for how to find urgent support.

MOMD does not provide individual treatment advice and does not recommend starting, stopping, or changing any medication.

System

Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR)

Classification

Bipolar I Disorder

Category

Bipolar and Related Disorders

Source

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR)

System

International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)

Classification

Bipolar disorder

Code

F31

Category

Mental, Behavioral and Neurodevelopmental disorders

Source

International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)