Bipolar I Disorder

Bipolar I disorder consists of periods of mania and depressive episodes. Individuals with bipolar I disorder also have periods of hypomania, which is less severe than mania. In addition, periods of normal moods are usually present as well.

According to the National Institute of Mental Health (NIMH), about 3 percent of the adult population has bipolar disorder. Men and women have about the same prevalence of bipolar disorder. Often bipolar I disorder symptoms present for the first time in late adolescence or early adulthood. Periods of mania may last one to two weeks, as may periods of depression. However, some individuals have shorter or longer periods of mania or depression.

What it looks like

It is important to know the major components of Bipolar I disorder, which include mania, sometimes hypomania, and some periods of depression, along with normal mood states. This disorder was formerly referred to as manic depression.

Common symptoms of mania include the following:

Experiencing hallucinations or seeing or hearing things that are not there
Engaging in highly impulsive behavior that would not occur in the same non-manic person, such as having sex without protection and/or with engaging in sex with inappropriate people. Another example: taking all the money out of the bank to gamble it or buy expensive items
Needing no sleep or almost no sleep
Speaking so fast that it is hard or impossible for others to understand
Having an extremely inflated view of oneself (grandiosity)
Experiencing racing thoughts
Engaging in multiple projects, many more projects than the person would normally undertake

Hypomania means that the person may exhibit high energy, or euphoria – but these symptoms do not rise to the level of needing hospitalization. Some people with hypomania are not euphoric but instead they are agitated and irritable. People with hypomania may need only 3-5 hours of sleep yet still be able to function well at work, school, and home. They may be more productive at work than they would normally be.

Hypomania and sometimes mania itself may feel good to the individual because the individual may feel very confident during these periods and may believe that they are highly creative. As a result, sometimes people with bipolar disorder don’t like the idea that these euphoric periods may go away altogether with treatment with a mood stabilizer, which is the primary treatment for bipolar disorder. Treatment does not mean that a person will have no moods, or what psychiatrists call “flat affect.” Instead, it means that instead of their moods going up and down uncontrollably like being on a roller coaster of extreme moods, treatment helps a person’s moods become more stable, which also leads to a better ability to manage the ups and downs of their illness and their life.

Sometimes depression follows a manic or hypomanic mood

Some symptoms of depression are:

Having a sad mood
Sleeping much more or much less every day than in the past
Eating much more or much less than in the past, causing an unintentional weight gain or loss
Having difficulty meeting the daily requirements of life, such as dealing with work and one's family
Extreme fatigue much of the time
Difficulty with concentrating most of the time
Feeling like a worthless or bad person, although one hasn't done anything wrong
Taking no pleasure in activities that formerly made one happy
Laughing less often or never
Thoughts of death or suicide

Some describe depression as feeling like their “tank” is empty. Others report feeling extremely sad, or start to feel insignificant - that other people are looking right through them. Many people with depression stop getting pleasure from the things that used to make them happy, and can’t imagine being happy again. They sometimes wonder “if it’s all worthwhile,” and imagine how life would be if they weren’t around. The depressed mind can play horrible tricks on one’s thinking.

Sometimes a mixed state of both mania and depression may occur, in which the person is extremely agitated and distressed, although this mood state often does not appear to others to be connected with current events in the person’s life.

It is also true that some people with bipolar disorder cycle from one mood state to the next rapidly, while others may remain in the same mood state for weeks or months. It should be noted, however, that mood stabilizing medications help the individual maintain a more even keel as far as mood changes are concerned.

Psychotic symptoms may present in a manic state when a person has bipolar I disorder. The person may believe they have super powers or is a member of royalty. The individual may also imagine that he has committed a crime, when no such crime has occurred. These psychotic symptoms are very real to the person who suffers from them, and sometimes they require hospitalization so that the individual does not harm himself or others.

Having Bipolar I is nobody’s fault

Many people with bipolar I disorder have blamed themselves for years for not being able to “shake” or control their moods and behavior. But bipolar I disorder is no one’s fault. And, most of the time, it is treatable. Blaming oneself for symptoms is like blaming oneself or having brown eyes or blonde hair. It’s not the individual’s fault. However, what a person with Bipolar can do is learn to control the cycling moods with medication and therapy.

The ongoing management of Bipolar I disorder

When a person with bipolar I disorder feels better as a result of medication, therapy, or circumstances, they might assume they are cured, and stop taking their medication. The illusion of being “cured” is enticing. But, with bipolar I disorder, ongoing treatment is necessary, even when the illness is managed. This approach is different from taking an antibiotic for a week for an infection and achieving a complete recovery. In contrast, bipolar I disorder is a chronic illness, comparable to diabetes or hypertension. People with diabetes or hypertension may feel better when they take the appropriate medications. But, if they stop taking their medicine, their symptoms will invariably return.

In the case of bipolar I disorder, if the medication is working and helping the individual, this is a positive indicator of its effectiveness rather than a sign that the underlying mania and depression are gone. For that reason, the process of determining if a person is ready to stop treatment should be made in partnership with a physician to avoid stopping too abruptly or too soon.

They may wonder how their doctor will know how they feel. The answer to this is that the doctor will ask questions and deduce their patient's moods based on what they express. In addition, a doctor will observe the individual. If the individual tells the doctor that they are perfectly calm while they are wriggling about on the couch and talking so fast that it’s hard to understand them the doctor will see that they are not calm.

Outlook

While living with bipolar I disorder can present unique obstacles, and finding the best treatment for one’s symptoms can take several tries, the right treatment can dramatically improve one’s quality of life. The majority of people who are properly diagnosed and treated for bipolar I disorder often gain impressive results. In fact, people who have received medical treatment for their illness often say that starting their medication was one of their most important decisions.

With treatment, people with bipolar I disorder can reclaim their lives. It is also important to note that treatment is particularly important for people with bipolar disorder, because there is a high risk of suicide with this diagnosis. According to the American Psychiatric Association in their diagnostic manual, people with bipolar disorder have about 15 times the risk for suicide compared to people who do not have this diagnosis. Treatment can dramatically reduce this risk.

In good company

Many prominent people reportedly struggle with bipolar disorder, such as General Hospital actor Maurice Benard, the late actress Carrie Fisher, and singer Mariah Carey. Individuals with Bipolar I are definitely not alone in feeling this way.

Substance abuse and Bipolar I

It should also be noted that substance abuse is a common problem among people with bipolar I disorder and researchers have found that at least half of adults with bipolar disorder have substance abuse issues. However, alcohol and street drugs can worsen symptoms and may also prevent individuals with bipolar disorder from taking their medication, either because they forget to take it while under the influence of substances, or they choose to not take their medication.

The current thinking on what causes bipolar disorder

In the past, doctors have explained conditions such as bipolar disorder as a “chemical imbalance.” This may make it seem like this condition is similar to a vitamin or mineral deficiency, and that just taking the right drug will easily cure someone. Unfortunately, bipolar disorder is more complicated. And what’s more, there is disagreement over whether an individual is born with the imbalance or it gets triggered by their environment. Most likely, it’s a combination of both. In support of “chemical imbalance” being the cause, medications that stabilize the brain, such as lithium or other medications often make people with bipolar disorder feel better. These drugs are called “mood stabilizers.”

Bipolar disorder may also be caused by genetics, and we often say that it “runs in families.” If an individual's parent or sibling has depression, it puts them at an increased risk for having this disorder. But, it is a complicated issue: For example, even in the case of identical twins, if one twin has bipolar disorder, the risk for the other twin to develop this disorder is about 50 percent. Since they are identical genetically, it would seem like both twins should develop the disorder–but they do not. This may mean that environmental impacts play a role in whether a person with a genetic risk develops bipolar disorder or not. Researchers are constantly studying possible causes and potential ways to mitigate the effects of this common condition.

People who suffered from severe childhood trauma have a higher risk for bipolar disorder than those who were not traumatized. Some people have both a genetic risk and an environmental risk, increasing the likelihood of developing bipolar disorder.

Other diagnoses

Many people with bipolar disorder also have other diagnoses, especially anxiety disorders. If such disorders are present, they should also be treated as well as bipolar disorder. In addition, as mentioned earlier, sometimes people with bipolar disorder are suicidal, thus it is very important for the person with bipolar disorder to report suicidal thoughts to the physician so that medication can be adjusted as needed. For example, the lithium dosage may need to be changed.

Next: Finding The Right Treatment