Bipolar 1 Disorder: Causes, Symptoms, and Treatment

What Is Bipolar 1 Disorder?

Bipolar 1 disorder (also known as manic depression or manic-depressive disorder) is a condition of the brain characterized by alternating episodes of extreme depression and euphoria. Bipolar I disorder sufferers have experienced at least one manic episode. When a manic episode occurs, the person is affected by an abnormally high energy level and elevated mood with abnormal behavior that disrupts normal life.

Depression is common to people who suffer from bipolar disorder. Depression and mania are often linked. It is from this standpoint that “manic depression” was coined. Bipolar 1 disorder sufferers can live a normal life between episodes of mania and depression.

Who Is at Risk for Bipolar I Disorder?

Anyone can suffer from bipolar I disorder. Over 6 million Americans suffer from bipolar disorder or about 2.5% of the population.

Symptoms of bipolar disorder usually first appear in teens or early 20s. About 80% of people who develop bipolar I before they turn 50 have the disorder. Bipolar patients are at a higher risk if they have immediate family members with the disorder.

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What Are the Symptoms of Bipolar 1 Disorder?

Bipolar 1 Disorder Symptoms

When someone is having a manic episode, the raised mood may manifest as either euphoria (feeling “high”) or as irritability.

During manic episodes, abnormal behavior includes:

  • Jumping from one idea to another suddenly
  • Speaking fast (uninterrupted) and loud
  • An increase in energy decreased sleep needs, and hyperactivity
  • Self-esteem inflated
  • Excessive spending
  • Hypersexuality
  • Substance abuse

Manic episodes often lead to excessive spending, intimacy with people they wouldn’t otherwise, or pursuing unrealistic goals. The person loses touch with reality during severe manic episodes. Delusions may make them behave bizarrely.

The duration of an episode of mania depends on how long it goes untreated. Symptoms usually persist for several weeks to several months. It may take weeks or months for depression to set in, or it may occur shortly after.

It is common for people with bipolar I disorder to go months without experiencing any symptoms. The majority of people suffering from mania and depression experience rapid-cycling symptoms, where they may experience multiple bouts of mania or depression during a single year. There can also be mixed mood episodes, when manic as well as depressive emotions occur simultaneously, or when these feelings alternate from one pole to another.

Bipolar disorder is characterized by depressive episodes similar to “regular” clinical depression, with depressed mood, loss of pleasure, a reduced level of energy and activity, and thoughts of suicide. In most cases, bipolar disorder symptoms last a few weeks to months, rarely longer than a year.

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What Are the Treatments for Bipolar 1 Disorder?

Bipolar I disorder is treated with mood stabilizers and antipsychotic drugs, and sometimes with sedative-hypnotics such as benzodiazepines clonazepam (Klonopin) and lorazepam (Ativan).

Mood Stabilizers

A simple metal called lithium (Eskalith, Lithobid) can help treat manias accompanied by classical euphoria rather than manias that include both depression and euphoria simultaneously. The treatment of bipolar disorder with lithium has been around for more than 60 years.

Taking lithium for an extended period can be beneficial, rather than using it to treat sudden episodes of manic behavior. To prevent side effects, lithium blood levels should be monitored, as well as kidney and thyroid function tests.

The antiseizure medication valproate (Depakote) also regulates mood. An acute episode of mania is treated faster with it than with lithium. As a preventive measure, it is also commonly used as “off label.” It is important to know that valproate may provide significant improvement in mood as soon as four to five days after it is started as a mood stabilizer by a “loading dose” method.

Other antiseizure medications like carbamazepine (Tegretol) and lamotrigine (Lamictal) may be useful for treating or preventing depressions or manias. Occasionally, less well-established antiseizure medicines are used experimentally to treat bipolar disorder, such as oxcarbazepine (Trileptal).

Antipsychotics

Haldol, Loxapine, and Thorazine are traditional antipsychotics (which are used for severe manic episodes) as well as newer antipsychotic drugs, which are atypical antipsychotics. Specifically, cariprazine (Vraylar) can treat manic and mixed episodes of psychosis.

Aripiprazole (Abilify), asenapine (Saphris), clozapine (Clozaril), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), and ziprasidone (Geodon) are often used, and many other drugs are available. In cases of bipolar I depression, lurasidone (Latuda) can either be used alone or in combination with lithium or valproate (Depakote). Sometimes antipsychotic medicines are used to prevent psychosis.

Benzodiazepines

The class of drugs known as minor tranquilizers includes alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan). Occasionally used to treat acute symptoms accompanying mania, such as agitation and insomnia, have little effect on core mood symptoms such as euphoria or depression. Additionally, they can form habits, so they must be closely monitored.

Antidepressants

Researchers have shown that common antidepressants like fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft) should not be used to treat depression in bipolar I disorder the way they would for unipolar depression. It is possible for them to also trigger or worsen manic episodes in people with bipolar disorder.

Studies suggest that some antidepressants (such as Prozac and Zoloft) may be more effective and safer for bipolar II depression than for bipolar I depression. Due to these factors, bipolar disorder medications with antidepressant properties are first-line treatments for depression, provided they do not cause or worsen mania.

The four FDA-approved treatments for bipolar depression are lurasidone (Latuda), olanzapine-fluoxetine (Symbyax) combination, quetiapine (Seroquel), or quetiapine fumarate (Seroquel XR), and cariprazine (Vraylar).

Mood-stabilizing treatments such as lithium, Depakote, and lamotrigine (Lamictal) may sometimes be prescribed to treat acute bipolar depression (though none of these medicines has FDA approval specifically for this condition). Occasionally, an antidepressant or another medicine may be prescribed after several weeks if these treatments do not work. You may also benefit from cognitive-behavioral therapy.

To prevent recurrences of bipolar I disorder (mania or depression), a continuous course of medications is usually recommended.

Electroconvulsive Therapy (ECT)

Although electroconvulsive therapy (ECT) has a scary reputation, safe and effective treatment can effectively treat both manic and depressive symptoms. When medications may not be effective or likely to bring symptom relief fast enough in treating bipolar I disorder, ECT can often be used.

Can Bipolar I Disorder Be Prevented?

It is unknown what causes bipolar disorder. There is no way to prevent bipolar I disorder entirely.

Once the bipolar disorder has been diagnosed, there are ways to lower the risk of episodes of mania or depression. Regular therapeutic sessions with a psychologist or social worker can assist people in identifying factors that contribute to mood destabilization (such as sleep deprivation, drug or alcohol abuse, and poor stress management), which may result in fewer hospitalizations and overall feeling better. Manic and depressive episodes can be prevented by taking medicine regularly.

How Is Bipolar I Different From Other Types of Bipolar Disorder?

The severely abnormally elevated moods and behaviors that characterize bipolar I disorder are experienced by people with the disorder. Symptoms of manic depression can cause serious disruptions in life (e.g., spending the family fortune or becoming pregnant unintentionally).

Mania never occurs in bipolar disorder type II. Sometimes they appear to be extremely cheerful and even entertaining — the “life of the party.” You might think that’s not so bad, but bipolar II disorder generally involves severe and disabling depression, which can often make treatment much more difficult than it would be if hypomania never happened.

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