What is Bipolar I?

Mary McMahon
Mary McMahon

Bipolar I is a form of bipolar disorder characterized by at least one manic or mixed episode in a patient's history. Patients also commonly experience depression, explaining why this condition is sometimes called “manic-depressive disorder.” Bipolar I is the most serious form of bipolar disorder and it can include disabling symptoms that make it difficult for the patient to function during a manic, depressive, or mixed episode. Treatment options are available and as neurologists learn more about the brain and how it functions in people with conditions like bipolar I, other options may develop.

Bipolar I was once commonly referred to as manic depression.
Bipolar I was once commonly referred to as manic depression.

Diagnosing patients with bipolar disorder is challenging, and requires a series of medical tests and patient interviews. First, physical causes for mania, like medications and recreational drugs, must be ruled out. The patient must also be carefully interviewed for diagnostic signs of other mental illnesses that are treated and managed differently. If a physician can confirm that a patient has experienced one or more manic or mixed episodes and there are no physical causes, the patient may have bipolar I. If a patient has only experienced hypomanic episodes, the diagnosis is bipolar II.

During a severe depressive episode, patients diagnosed with bipolar I may attempt self-harm.
During a severe depressive episode, patients diagnosed with bipolar I may attempt self-harm.

Some patients have a form known as bipolar I with psychotic features. In these cases, during manic or mixed episodes, the patient experiences symptoms of psychosis like delusions and hallucinations. These can make the manic episodes more intense, as well as more dangerous, for the patient, because the patient may experience feelings of invincibility and can also develop extreme paranoia and other symptoms. During manic episodes, patients are typically highly active and may have disorganized speech and thoughts.

One of the standard treatments available for patients with bipolar I is lithium, a medication that helps patients avoid the extreme highs and lows associated with bipolar disorder. Patients can also take other medications and may benefit from psychotherapy. Therapy can help patients manage and address emotions to avoid creating situations where emotions feed episodes of mania or hypomania, and therapy can also help patients with depressive symptoms.

Some people with bipolar I and other forms of bipolar disorder choose not to control their conditions with medication. Management with therapy and other techniques may be sufficient to meet their needs. Every patient is different, and patients may find it helpful to meet with several mental health professionals to find a practitioner who meets their needs and is willing to work with them to develop an appropriate treatment plan.

Patients suffering from bipolar I with psychotic features may experience extreme paranoia.
Patients suffering from bipolar I with psychotic features may experience extreme paranoia.
Mary McMahon
Mary McMahon

Ever since she began contributing to the site several years ago, Mary has embraced the exciting challenge of being a wiseGEEK researcher and writer. Mary has a liberal arts degree from Goddard College and spends her free time reading, cooking, and exploring the great outdoors.

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Discussion Comments


@honeybees - I have been involved in the mental health field for a number of years and what you have described with your brother is common.

It can sometimes be difficult to come up with a diagnosis right away because so many symptoms of mental disorders are the same and overlap.

Someone who is manifesting symptoms of bipolar I may also have symptoms that are similar to someone who is maniac depressive.

One advantage to that is that many of the same medications will help, regardless of what the specific diagnosis is.

Another thing that is so important is that the patient work with their doctor and follow their instructions. So many times they begin to feel better when taking their medication and then think they don't need it.

If they abruptly stop, it doesn't take long before the symptoms return and they are right back where they started from.

What is most beneficial is when there is someone who can be sure they take their medication and take it at the appropriate times.

If they are living alone, this can be hard to do, but the best results are achieved when they are consistent with their medication.


Diagnosing and treating mental illness can be a very difficult thing to do. My brother was experiencing some bipolar I symptoms, but it took a long time before they came up with a real diagnosis.

They were aware there was a chemical imbalance, but didn't know for sure if he was suffering from schizophrenia or a bipolar disorder.

When he was having one of his episodes, he would not recognize his wife and thought a stranger was in the house. He also had a hard time sleeping and would wander around the house at night and his wife was afraid he would go outside at night and get lost.

Once he started on medication is symptoms improved, but has been told this is something he will have to remain on for the rest of his life.


My sister is dating a man whose ex-wife has bipolar I. She is fine as long as she takes her medication, but when she goes off of it, she becomes dangerous.

She recently showed up at his house when my sister was over there. She started hitting and punching both of them, and then she threatened to come back and kill them. She is small, and either one of them could have taken her out, but she felt invincible.

The next day, she apologized to both of them. She told them that she had quit taking her medication, but her behavior that night proved to her that she needed it.


@OeKc05 – Lithium does sound bad, but most people who have bipolar I are already disoriented and confused. The medication might make them a tad more flustered in the beginning, but the results it delivers outweigh the temporary adverse effects.

My uncle has bipolar I with hallucinations. He sees and hears people in the room with him during his episodes. He tried therapy alone, but it wasn't enough. He gets so frightened when these people show up in his house that he cannot remember what his therapist told him to do to make them disappear.

He did seem a little more out of it when he started taking lithium, but at least he wasn't hallucinating. His head eventually cleared up, and now, he's almost normal.


@wavy58 – I am bipolar, and I asked my doctor about lithium once I found out I had the disease. He told me that since my kidney function was already impaired, I could not take the drug. He said it can harm your thyroid and kidneys, especially if they aren't in good shape to begin with.

He also told me some of the other things lithium can do to you. He said it can cause you to become confused and disoriented. It can make your hands tremble, some of your hair fall out, and your memory and muscles weak.

I told him that I wouldn't want to take this drug even if my kidneys were healthy. He did say that the side effects usually go away once your body gets used to the drug, which could take a few weeks.


Does anyone know what some of the side effects of lithium are? My sister just got diagnosed as being bipolar, and she is currently trying to decide whether to take medication or do therapy.

I have heard some people say that it can cause you to feel really sick. That couldn't be good for a person battling a mental condition. If she does become sick from the lithium, will the feeling go away, or will it continue as long as she takes the medicine?


@Subway11 - Whether it is bipolar or any other mental illness I don’t think that prescription medication alone is enough. People suffering from these chemical imbalances in their brain also have to have therapy in order to deal with their depressive symptoms.

The combination of drug and behavioral therapies really make the difference in the quality of life of the patient. Sometimes support groups in which people with bipolar can talk to others can be really healing because most people don’t know what this disorder is like unless they experience it firsthand.

Drugs will help but over time people become accustomed to the dosages and the medication in no longer as effective.


@MrSmirnov- I think that a person that might be suffering from this condition would most likely see a psychiatrist. They would be the ones that are the most helpful because they can also prescribe medication to deal with the mood swings.

I had an uncle that was diagnosed with bipolar disorder I. He went through bouts of severe depression and then he would be so happy that it was really incredible.

During his manic stages he would talk incessantly and would also go on shopping sprees. He had to be hospitalized a few times because his condition would worsen because he would not take his medication.

He was prescribed lithium, but I wonder how effective his dosage was because his moods did not stabilize much throughout his life. I can’t even image having to deal with these symptoms because it must be so hard to strike the right balance between medication and the feelings that you are having. I bet is must be a frustrating condition to experience.


@MrSmirnov - If you think your friend's daughter has bipolar disorder, or any other mental health issue for that matter it is a good idea to take her to your family doctor and get a referral to a qualified mental health professional. It can be tough to diagnosis something as complex as bipolar disorder so you shouldn't start labeling her with anything until you've seen a professional.

Whatever you do, try and remember that bipolar I disorder is a difficult thing to pin down. It may take your friend's daughter a lot of therapy and medication to get it under control if she does in fact have this problem.


If you suspect that someone you love is displaying bipolar symptoms, what can you do to help?

My best friend's daughter has been suffering from periods of extreme excitement and deep depression and we are both worried that her issues may go beyond what is normal for a teenager.

We've been doing some reading on the disorders bipolar I and bipolar II and feel that bipolar may be what she is suffering from. We're not doctors by any means and we're really not sure what to do for her. How does one go about getting a diagnosis for bipolar I? Do you need to be referred to a psychologist?

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