{{short description|Bipolar disorder that is characterized by at least one manic or mixed episode}} {{Use dmy dates|date=September 2020}} {{Infobox medical condition (new) | name = Bipolar I disorder | synonym = Manic-depressive disorder, bipolar affective disorder | image = | caption = | image_upright = | specialty = Psychiatry | symptoms = Mood instability, behavioral changes, psychosis in some cases | complications = Suicide, self-harm | onset = 15-25 years of age | duration = | types = | causes = Complex | risks = Family history | diagnosis = By psychiatric evaluation | differential = Other bipolar disorders, borderline personality disorder, antisocial personality disorder | prevention = | treatment = Pharmacotherapy such as mood stabilizers, antipsychotics; supplemental psychotherapy | medication = Lithium, anticonvulsants, antipsychotics | prognosis = | frequency = ~1% of the global population is affected | deaths = 15-20% die by suicide<ref name=suicide/> }}
'''Bipolar I disorder''' (also referred to as BD-I or type one bipolar disorder) is a type of bipolar spectrum disorder characterized by the occurrence of at least one manic episode.<ref>{{cite web|url=http://psychcentral.com/lib/the-two-types-of-bipolar-disorder/000612|title=The Two Types of Bipolar Disorder|work=Psych Central.com|access-date=25 November 2015|archive-date=6 August 2013|archive-url=https://web.archive.org/web/20130806115733/http://psychcentral.com/lib/the-two-types-of-bipolar-disorder/000612}}</ref><ref name=":2" /> Symptoms of bipolar I disorder typically begin at age 15-25 years of age, with depression being the most common initial symptom.<ref>{{Cite journal |last1=Nierenberg |first1=Andrew A. |last2=Agustini |first2=Bruno |last3=Köhler-Forsberg |first3=Ole |last4=Cusin |first4=Cristina |last5=Katz |first5=Douglas |last6=Sylvia |first6=Louisa G. |last7=Peters |first7=Amy |last8=Berk |first8=Michael |date=2023-10-10 |title=Diagnosis and Treatment of Bipolar Disorder |url=https://jamanetwork.com/journals/jama/article-abstract/2810502 |journal=JAMA |language=en |volume=330 |issue=14 |pages=1370–1380 |doi=10.1001/jama.2023.18588 |pmid=37815563 |issn=0098-7484 |archive-url=https://web.archive.org/web/20251114235232/https://jamanetwork.com/journals/jama/article-abstract/2810502 |archive-date=14 November 2025 |url-access=subscription |access-date=15 January 2026 |url-status=live }}</ref> People may also have one or more depressive episodes.<ref name="Bipolar Disorder: Who's at Risk?">{{cite web|title=Bipolar Disorder: Who's at Risk?|url=http://www.webmd.com/bipolar-disorder/guide/bipolar-disorder-whos-at-risk|access-date=22 November 2011|archive-date=19 April 2009|archive-url=https://web.archive.org/web/20090419031326/http://www.webmd.com/bipolar-disorder/guide/bipolar-disorder-whos-at-risk|url-status=live}}</ref> Typically, manic episodes can last at least 7 days for most of each day to the extent that the individual may need medical attention, while the depressive episodes last at least 2 weeks.<ref>{{Cite web |title=Bipolar Disorder - National Institute of Mental Health (NIMH) |url=https://www.nimh.nih.gov/health/topics/bipolar-disorder |access-date=2024-03-16 |website=www.nimh.nih.gov |language=en |archive-date=5 August 2018 |archive-url=https://web.archive.org/web/20180805121848/https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml |url-status=live }}</ref> The prevalence of bipolar disorders is about 1% worldwide.<ref name=":1">{{Cite journal |last1=Oliva |first1=Vincenzo |last2=Fico |first2=Giovanna |last3=De Prisco |first3=Michele |last4=Gonda |first4=Xenia |last5=Rosa |first5=Adriane R. |last6=Vieta |first6=Eduard |date=Jan 2025 |title=Bipolar disorders: an update on critical aspects |journal=The Lancet Regional Health. Europe |volume=48 |article-number=101135 |doi=10.1016/j.lanepe.2024.101135 |issn=2666-7762 |pmc=11732062 |pmid=39811787}}</ref>
== Signs and symptoms == Bipolar I disorder is characterized by severe, recurrent mood changes and behavioral changes.<ref>{{Cite journal |last1=Mari |first1=Jair |last2=Dieckmann |first2=Luiz Henrique Junqueira |last3=Prates-Baldez |first3=Daniel |last4=Haddad |first4=Michel |last5=Rodrigues da Silva |first5=Naielly |last6=Kapczinski |first6=Flavio |date=2024-11-05 |title=The efficacy of valproate in acute mania, bipolar depression and maintenance therapy for bipolar disorder: an overview of systematic reviews with meta-analyses |journal=BMJ Open |volume=14 |issue=11 |article-number=e087999 |doi=10.1136/bmjopen-2024-087999 |doi-access=free|issn=2044-6055 |pmc=11552594 |pmid=39500601}}</ref> A manic episode is a key feature of bipolar I disorder and is required for diagnosis of bipolar I disorder.<ref name=":8">{{Cite book |title=Diagnostic and statistical manual of mental disorders: DSM-5 |date=2013 |publisher=American psychiatric association |isbn=978-0-89042-554-1 |edition=5th |location=Washington |pages=123–154}}</ref> Hypomanic episodes, major depressive episodes, and psychotic features may also be present but are not necessary for diagnosis.<ref name=":8" /> thumb|Graph illustrating mood fluctuations in bipolar disorders
=== Manic episodes === A manic episode is a distinct period of time, lasting at least one week and for most of each day, where an individual experiences persistent irritable mood and/or persistent euphoria or elation that is disproportionately out of norm.<ref name=":6" /> These symptoms are severe, and cause either significant impairment in an individual's life or require hospitalization.<ref name=":6" /> Furthermore, these symptoms and changes are not caused by medications, illicit substances, or another medical condition.<ref name=":6">{{Cite book |last=Black |first=Donald W. |title=Introductory Textbook of Psychiatry |date=May 4, 2020 |publisher=American Psychiatric Association Publishing |year=2020 |isbn=978-1-61537-413-7 |edition=7th |location=USA |publication-date=July 28, 2020 |chapter=Chapter 6 Mood Disorders}}</ref>
=== Hypomanic episodes === Similar to mania, hypomanic episodes involve distinct periods of time where an individual experiences persistent, increased energy, euphoria, elation, or irritable mood that is disproportionately out of norm.<ref name=":8" /> They differ in severity of impairment and symptom duration.<ref name=":8" /> A hypomanic episode lasts a minimum of 4 days in a row and for most of the day and does not require hospitalization or involve psychotic symptoms.<ref name=":8" />
=== Depressive episodes === A depressive episode involves depressed mood and/or anhedonia (lack of interest or pleasure) in addition to other symptoms of depression that lasts for at least 2 weeks.<ref name=":8" /> Other symptoms of depression include unintentional weight changes, changes in appetite, sleep disruption (lack of sleep or excessive sleep), restlessness or slowness, lack of energy, difficulty concentrating, and suicidal ideation.<ref name=":8" />
=== Psychosis === Most people with bipolar disorder experience psychosis during their lifetime, with one half to two-thirds of people experiencing it.<ref name=":7">{{Cite journal |last1=Chakrabarti |first1=Subho |last2=Singh |first2=Navdeep |date=2022-09-19 |title=Psychotic symptoms in bipolar disorder and their impact on the illness: A systematic review |journal=World Journal of Psychiatry |volume=12 |issue=9 |pages=1204–1232 |doi=10.5498/wjp.v12.i9.1204 |doi-access=free |issn=2220-3206 |pmc=9521535 |pmid=36186500}}</ref> Symptoms of psychosis include delusions, hallucinations, or both. Delusions are more common than hallucinations in bipolar disorder. Psychotic symptoms occur more frequently during manic or mixed episodes. Having psychotic episodes indicates a more severe illness. People with psychosis have poor insight and more agitation, anxiety, and hostility. Psychotic symptoms are more common in bipolar type I compared to bipolar type II.<ref name=":7" />
== Risk Factors == Currently, there are no single, clear causes of bipolar disorder.<ref name=":5">{{Cite journal |last1=Rowland |first1=Tobias A. |last2=Marwaha |first2=Steven |date=September 2018 |title=Epidemiology and risk factors for bipolar disorder |journal=Therapeutic Advances in Psychopharmacology |volume=8 |issue=9 |pages=251–269 |doi=10.1177/2045125318769235 |issn=2045-1253 |pmc=6116765 |pmid=30181867}}</ref> However, there are evidence that suggest there may be a genetic component that contribute to the development of bipolar disorder.<ref name=":5" /> Studies from identical twins suggest that there is a 5-10% lifetime risk (about seven times greater compared to the general population) of developing bipolar disorder if there is a first-degree relative diagnosed with bipolar disorder.<ref name=":5" /> Bipolar disorder appears to be more common in high-income countries compared to low-income countries, and higher rates of bipolar I disorder are seen in individuals that are separated, divorced, or widowed compared to those who are married or never married.<ref name=":8" /> ==Diagnosis== The essential feature of bipolar I disorder is a clinical course characterized by the occurrence of one or more manic episodes or mixed episodes.<ref>{{Cite journal|last1=Phillips|first1=Mary L|last2=Kupfer|first2=David J|date=2013-05-11|title=Bipolar disorder diagnosis: challenges and future directions|journal=Lancet|volume=381|issue=9878|pages=1663–1671|doi=10.1016/S0140-6736(13)60989-7|issn=0140-6736|pmc=5858935|pmid=23663952}}</ref> One episode of mania is sufficient to make the diagnosis of bipolar disorder. Often, individuals have had one or more major depressive episodes and may or may not have a history of major depressive disorder.<ref name="DepressionD">{{cite web |title=Online Bipolar Tests: How Much Can You Trust Them? |url=http://depressiond.org/bipolar-test/ |url-status=live |archive-url=https://web.archive.org/web/20120113081941/http://depressiond.org/bipolar-test/ |archive-date=13 January 2012 |access-date=7 January 2012 |publisher=DepressionD}}</ref> Because depression is typically one of the first symptoms of bipolar disorders, the initial diagnosis of bipolar disorder may be delayed.<ref name=":1" />
Episodes of substance-induced mood disorder due to the direct effects of a medication, or other somatic treatments for depression, substance use disorder, or toxin exposure, or of mood disorder due to a general medical condition need to be excluded before a diagnosis of bipolar I disorder can be made. Bipolar I disorder requires confirmation of only 1 full manic episode for diagnosis, but may be associated with hypomanic and depressive episodes as well.<ref name=":2">{{Cite book|title=Diagnostic and statistical manual of mental disorders: DSM-5.|others=American Psychiatric Association., American Psychiatric Association. DSM-5 Task Force.|isbn=978-0-89042-559-6|edition=Fifth|location=Arlington, VA|oclc=847226928|year = 2013}}</ref> In contrast, diagnosis for bipolar II disorder does not include a full manic episode; instead, it requires the occurrence of both a hypomanic episode and a major depressive episode.<ref name=":2" /> Serious aggression has been reported to occur in one out of every ten major, first-episode, BD-I patients with psychotic features, the prevalence in this group being particularly high in association with a recent suicide attempt, alcohol use disorder, learning disability, or manic polarity in the first episode.<ref>{{Cite journal|last1=Khalsa|first1=Hari-Mandir K.|last2=Baldessarini|first2=Ross J.|last3=Tohen|first3=Mauricio|last4=Salvatore|first4=Paola|date=2018-08-11|title=Aggression among 216 patients with a first-psychotic episode of bipolar I disorder|journal=International Journal of Bipolar Disorders|volume=6|issue=1|page=18|doi=10.1186/s40345-018-0126-8|issn=2194-7511|pmc=6161985|pmid=30097737 |doi-access=free }}</ref>
Bipolar I disorder often coexists with other disorders including PTSD, substance use disorders, and a variety of mood disorders.<ref name=":02">{{Cite journal|last1=Cerimele|first1=Joseph M.|last2=Bauer|first2=Amy M.|last3=Fortney|first3=John C.|last4=Bauer|first4=Mark S.|date=May 2017|title=Patients With Co-Occurring Bipolar Disorder and Posttraumatic Stress Disorder: A Rapid Review of the Literature|journal=The Journal of Clinical Psychiatry|volume=78|issue=5|pages=e506–e514|doi=10.4088/JCP.16r10897|issn=1555-2101|pmid=28570791}}</ref><ref>{{Cite journal|last1=Hunt|first1=Glenn E.|last2=Malhi|first2=Gin S.|last3=Cleary|first3=Michelle|last4=Lai|first4=Harry Man Xiong|last5=Sitharthan|first5=Thiagarajan|date=December 2016|title=Prevalence of comorbid bipolar and substance use disorders in clinical settings, 1990–2015: Systematic review and meta-analysis|journal=Journal of Affective Disorders|volume=206|pages=331–349|doi=10.1016/j.jad.2016.07.011|issn=1573-2517|pmid=27476137}}</ref> Studies suggest that psychiatric comorbidities correlate with further impairment of day-to-day life.<ref>{{Cite journal |last1=Léda-Rêgo |first1=Gabriela |last2=Studart-Bottó |first2=Paula |last3=Sarmento |first3=Stella |last4=Cerqueira-Silva |first4=Thiago |last5=Bezerra-Filho |first5=Severino |last6=Miranda-Scippa |first6=Ângela |date=2023-02-01 |title=Psychiatric comorbidity in individuals with bipolar disorder: relation with clinical outcomes and functioning |journal=European Archives of Psychiatry and Clinical Neuroscience |volume=273 |issue=5 |pages=1175–1181 |doi=10.1007/s00406-023-01562-5 |pmid=36725737 |s2cid=256501014 |issn=0940-1334}}</ref> Up to 40% of people with bipolar disorder also present with PTSD, with higher rates occurring in women and individuals with bipolar I disorder.<ref name=":02" /> A diagnosis of bipolar 1 disorder is only given if bipolar episodes are not better accounted for by schizoaffective disorder or superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or a psychotic disorder not otherwise specified.<ref>{{cite web|url=http://www.pchtreatment.com/bipolar-treatment-center/|title=Bipolar Disorder Residential Treatment Center Los Angeles|work=PCH Treatment|access-date=25 November 2015|archive-date=31 March 2012|archive-url=https://web.archive.org/web/20120331064424/http://www.pchtreatment.com/bipolar-treatment-center/}}</ref>
===Medical assessment=== Regular medical assessments are performed to rule-out secondary causes of mania and depression.<ref name=":3" /> These tests include complete blood count, glucose, serum chemistry/electrolyte panel, thyroid function test, liver function test, renal function test, urinalysis, vitamin B12 and folate levels, HIV screening, syphilis screening, and pregnancy test, and when clinically indicated, an electrocardiogram (ECG), an electroencephalogram (EEG), a computed tomography (CT scan), and/or a magnetic resonance imagining (MRI) may be ordered.<ref name=":3">{{Cite journal|last=Bobo|first=William V.|date=October 2017|title=The Diagnosis and Management of Bipolar I and II Disorders: Clinical Practice Update|journal=Mayo Clinic Proceedings|volume=92|issue=10|pages=1532–1551|doi=10.1016/j.mayocp.2017.06.022|pmid=28888714|issn=0025-6196|doi-access=free}}</ref> Drug screening includes recreational drugs, particularly synthetic cannabinoids, and exposure to toxins.
===Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV-TR)=== {| class="wikitable" |- ! Dx code # ! Disorder ! Description |- | 296.0x | Bipolar I disorder | Single manic episode |- | 296.40 | Bipolar I disorder | Most recent episode hypomanic |- | 296.4x | Bipolar I disorder | Most recent episode manic |- | 296.5x | Bipolar I disorder | Most recent episode depressed |- | 296.6x | Bipolar I disorder | Most recent episode mixed |- | 296.7 | Bipolar I disorder | Most recent episode unspecified |}
===Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5)=== In May 2013, American Psychiatric Association released the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). There are several proposed revisions to occur in the diagnostic criteria of Bipolar I Disorder and its subtypes. For Bipolar I Disorder 296.40 (most recent episode hypomanic) and 296.4x (most recent episode manic), the proposed revision includes the following specifiers: with psychotic features, with mixed features, with catatonic features, with rapid cycling, with anxiety (mild to severe), with suicide risk severity, with seasonal pattern, and with postpartum onset.<ref name=":03">{{Cite book|title=Diagnostic and Statistical Manual of Mental Disorders|last=American Psychiatric Association|date=2013-05-22|publisher=American Psychiatric Association|isbn=978-0-89042-555-8|doi=10.1176/appi.books.9780890425596|url-access=registration|url=https://archive.org/details/diagnosticstatis0005unse}}</ref> Bipolar I Disorder 296.5x (most recent episode depressed) will include all of the above specifiers plus the following: with melancholic features and with atypical features.<ref name=":03" /> The categories for specifiers will be removed in DSM-5 and criterion A will add or there are at least 3 symptoms of major depression of which one of the symptoms is depressed mood or anhedonia.<ref name=":03" /> For Bipolar I Disorder 296.7 (most recent episode unspecified), the listed specifiers will be removed.''<ref name=":03" />''
The criteria for manic and hypomanic episodes in criteria A & B will be edited. Criterion A will include "and present most of the day, nearly every day", and criterion B will include "and represent a noticeable change from usual behavior". These criteria as defined in the DSM-IV-TR have created confusion for clinicians and need to be more clearly defined.<ref name="ReferenceA">{{cite book|title=Issues pertinent to a developmental approach to bipolar disorder in DSM-5|publisher=American Psychiatric Association|year=2010}}</ref><ref>{{cite book|title=Diagnostic and Statistical Manual of Mental Disorders (4th ed. text revision)|year=2000|publisher=American Psychiatric Association|location=Washington, DC|pages=345–392}}</ref>
There have also been proposed revisions to criterion B of the diagnostic criteria for a Hypomanic Episode, which is used to diagnose For Bipolar I Disorder 296.40, Most Recent Episode Hypomanic. Criterion B lists "inflated self-esteem, flight of ideas, distractibility, and decreased need for sleep" as symptoms of a Hypomanic Episode. This has been confusing in the field of child psychiatry because these symptoms closely overlap with symptoms of attention deficit hyperactivity disorder (ADHD).<ref name="ReferenceA"/>
===ICD-10 === * F31 Bipolar Affective Disorder * F31.6 Bipolar Affective Disorder, Current Episode Mixed * F30 Manic Episode * F30.0 Hypomania * F30.1 Mania Without Psychotic Symptoms * F30.2 Mania With Psychotic Symptoms * F32 Depressive Episode * F32.0 Mild Depressive Episode * F32.1 Moderate Depressive Episode * F32.2 Severe Depressive Episode Without Psychotic Symptoms * F32.3 Severe Depressive Episode With Psychotic Symptoms
=== Differential diagnosis === When evaluating an individual for bipolar I disorder, other psychiatric conditions that mimic or present with similar symptoms to bipolar I disorder must be considered. It is possible that some of these may be co-occurring with bipolar I disorder.<ref name=":8" />
* Other bipolar disorders, such as bipolar II or bipolar disorder due to another medical condition<ref name=":8" /> * Major depressive disorder with hypomanic or manic symptoms<ref name=":8" /> * Anxiety disorders including Generalized Anxiety Disorder (GAD), panic disorder, post-traumatic stress disorder (PTSD)<ref name=":8" /> * Attention-deficit/hyperactivity disorder (ADHD)<ref name=":8" /> * Substance or medication-induced bipolar disorder<ref name=":8" /> * Personality disorders such as borderline personality disorder<ref name=":8" />
== Management ==
===Medication=== Pharmacotherapy is the primary method of managing bipolar disorder, with multiple medications and combinations available.<ref name=":9">{{Cite journal |last=Singh |first=Balwinder |last2=Swartz |first2=Holly A |last3=Cuellar-Barboza |first3=Alfredo B |last4=Schaffer |first4=Ayal |last5=Kato |first5=Tadafumi |last6=Dols |first6=Annemieke |last7=Sperry |first7=Sarah H |last8=Vassilev |first8=Andrea B |last9=Burdick |first9=Katherine E |last10=Frye |first10=Mark A |date=August 2025 |title=Bipolar disorder |url=https://linkinghub.elsevier.com/retrieve/pii/S0140673625011407 |journal=The Lancet |volume=406 |issue=10506 |pages=963–978 |doi=10.1016/S0140-6736(25)01140-7 |issn=0140-6736 |pmc=12340982 |pmid=40712624}}</ref> Medications used may vary depending on the side effect profile and patient preference as well as the phase of bipolar disorder being managed (acute mania, bipolar depression, mixed states, or maintenance relapse prevention).<ref name=":9" /> # Lithium (has a narrow therapeutic range and typically requires monitoring).<ref>{{Cite journal |last1=Burgess |first1=S. |last2=Geddes |first2=J. |last3=Hawton |first3=K. |last4=Townsend |first4=E. |last5=Jamison |first5=K. |last6=Goodwin |first6=G. |date=2001 |title=Lithium for maintenance treatment of mood disorders |journal=The Cochrane Database of Systematic Reviews |issue=3 |article-number=CD003013 |doi=10.1002/14651858.CD003013 |issn=1469-493X |pmid=11687035|pmc=7005360 }}</ref> It has suicide-protective effects, with an 87% reduction in suicide risk compared to placebos in mood disorders.<ref>{{Cite journal |last=Barroilhet |first=S. A. |last2=Ghaemi |first2=S. N. |date=2020-07-07 |title=When and how to use lithium |url=https://www.researchgate.net/profile/Sergio-Barroilhet/publication/342111738_When_and_how_to_use_Lithium/links/5ef374cba6fdcceb7b1f9576/When-and-how-to-use-Lithium.pdf |journal=Acta Psychiatrica Scandinavica |language=en |volume=142 |issue=3 |pages=161–172 |doi=10.1111/acps.13202 |issn=0001-690X |archive-url=https://web.archive.org/web/20250426220954/https://onlinelibrary.wiley.com/doi/abs/10.1111/acps.13202 |archive-date=26 April 2025 |access-date=2 February 2026 |url-status=live }}</ref> # Anticonvulsants, such as valproate,<ref>{{Cite journal|url=http://www.cochrane.org/CD004052/DEPRESSN_valproate-for-acutre-mood-episodes-in-bipolar-disorder|title=Valproate for acutre mood episodes in bipolar disorder {{!}} Cochrane|journal=Cochrane Database of Systematic Reviews|issue=1|article-number=CD004052|doi=10.1002/14651858.CD004052|pmid=12535506|year=2003|last1=MacRitchie|first1=Karine|last2=Geddes|first2=John|last3=Scott|first3=Jan|last4=Haslam|first4=D. R.|last5=Silva De Lima|first5=Mauricio|last6=Goodwin|first6=Guy|url-access=subscription|archive-date=6 July 2018|access-date=9 March 2016|archive-url=https://web.archive.org/web/20180706191051/http://www.cochrane.org/CD004052/DEPRESSN_valproate-for-acutre-mood-episodes-in-bipolar-disorder|url-status=live}}</ref> carbamazepine, or lamotrigine # Atypical antipsychotics, such as quetiapine,<ref>{{cite journal|last1=Datto|first1=Catherine|title=Bipolar II compared with bipolar I disorder: baseline characteristics and treatment response to quetiapine in a pooled analysis of five placebo-controlled clinical trials of acute bipolar depression |journal=Annals of General Psychiatry|date=11 March 2016|volume=15|article-number=9 |doi=10.1186/s12991-016-0096-0 |pmid=26973704 |pmc=4788818 |doi-access=free }}</ref><ref>{{cite journal |last1=Young |first1=Allan |title=A Randomised, Placebo-Controlled 52-Week Trial of Continued Quetiapine Treatment in Recently Depressed Patients With Bipolar I And Bipolar II Disorder|journal=World Journal of Biological Psychiatry |date=February 2014 |volume=15|issue=2|pages=96–112 |doi=10.3109/15622975.2012.665177 |pmid=22404704|s2cid=2224996 }}</ref> risperidone, olanzapine, lurasidone, or aripiprazole # Combination therapies such as lithium or valproate with antipsychotics<ref name=":9" /> A review of validated treatment guidelines for bipolar disorder by international bodies was published in 2020.<ref>{{Cite journal |last1=Verdolini |first1=Norma |last2=Hidalgo-Mazzei |first2=Diego |last3=Del Matto |first3=Laura |last4=Muscas |first4=Michele |last5=Pacchiarotti |first5=Isabella |last6=Murru |first6=Andrea |last7=Samalin |first7=Ludovic |last8=Aedo |first8=Alberto |last9=Tohen |first9=Mauricio |last10=Grunze |first10=Heinz |last11=Young |first11=Allan H. |date=Dec 22, 2020 |title=Long-term treatment of bipolar disorder type I: A systematic and critical review of clinical guidelines with derived practice algorithms |journal=Bipolar Disorders |volume=23 |issue=4 |pages=324–340 |doi=10.1111/bdi.13040 |issn=1399-5618 |pmid=33354842 |s2cid=229693238}}</ref>
Usage of antidepressants alone in the treatment of bipolar disorders is not recommended.<ref>{{Cite journal |last1=Nierenberg |first1=Andrew A. |last2=Agustini |first2=Bruno |last3=Köhler-Forsberg |first3=Ole |last4=Cusin |first4=Cristina |last5=Katz |first5=Douglas |last6=Sylvia |first6=Louisa G. |last7=Peters |first7=Amy |last8=Berk |first8=Michael |date=2023-10-10 |title=Diagnosis and Treatment of Bipolar Disorder: A Review |journal=JAMA |volume=330 |issue=14 |pages=1370–1380 |doi=10.1001/jama.2023.18588 |issn=1538-3598 |pmid=37815563}}</ref> However, antidepressants may be used to supplement mood stabilizers or second-generation antipsychotics (adjuvant therapy).<ref>{{Cite journal |last=Hirschfeld |first=R. M. |date=2014-12-01 |title=Differential diagnosis of bipolar disorder and major depressive disorder |url=https://www.sciencedirect.com/science/article/pii/S0165032714700047 |journal=Journal of Affective Disorders |series=Advances in the Diagnosis and Treatment of Bipolar Depression |volume=169 |pages=S12–S16 |doi=10.1016/S0165-0327(14)70004-7 |pmid=25533909 |issn=0165-0327|doi-access=free }}</ref><ref name=":4">{{Cite journal |last1=Oliva |first1=Vincenzo |last2=De Prisco |first2=Michele |last3=La Spina |first3=Enrico |last4=Paolucci |first4=Sofia |last5=Fico |first5=Giovanna |last6=Anmella |first6=Gerard |last7=Hidalgo-Mazzei |first7=Diego |last8=Murru |first8=Andrea |last9=Pompili |first9=Maurizio |last10=Fornaro |first10=Michele |last11=Solmi |first11=Marco |last12=Yildiz |first12=Ayşegül |last13=Leucht |first13=Stefan |last14=Vieta |first14=Eduard |last15=Radua |first15=Joaquim |date=September 2025 |title=Switch to mania after acute antidepressant treatment for bipolar depression: a systematic review and network meta-analysis of randomised controlled trials |url=https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00345-1/fulltext |journal=eClinicalMedicine |language=English |volume=87 |article-number=103413 |doi=10.1016/j.eclinm.2025.103413 |pmid=40823496 |issn=2589-5370 |archive-url=https://web.archive.org/web/20250808213936/https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00345-1/fulltext |archive-date=8 August 2025 |pmc=12355415 |access-date=16 January 2026 |url-status=live }}</ref> There has been concerns that usage of antidepressants may cause individuals to switch to mania (sometimes referred to as antidepressant-induced mania).<ref name=":4" /> Current studies have not shown clear differences in significant risk of switching to mania between different antidepressants when compared to placebos.<ref name=":4" />
For the treatment of treatment-resistant bipolar depression, the NMDA receptor antagonist ketamine and its S-enantiomer esketamine (Spravato) have emerged as rapid-acting anesthetic/sedative options with less risk of overdose than other anesthetics.<ref name="Queissner2026">{{cite journal |last1=Queissner |first1=Robert |last2=Fellendorf |first2=Frederike |last3=Reininghaus |first3=Eva Z. |date=2026 |title=Ketamine as an NMDA-Modulating Therapy in Bipolar Disorder: Rationale and Evidence |journal=Frontiers in Psychiatry |doi=10.3389/fpsyt.2026.1777402 |doi-access=free|url=https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2026.1777402/abstract |access-date=February 11, 2026}}</ref> They act quickly to block NMDA receptors and treat depression, with effects lasting up to a week. However, it is unknown exactly why it works.
In severe cases, Electroconvulsive therapy (ECT), a type of brain stimulation therapy where seizures are electrically induced in anesthetized patients for therapeutic effect may be used for bipolar depression<ref>{{Cite journal |last=Mutz |first=Julian |date=Feb 2023 |title=Brain stimulation treatment for bipolar disorder |journal=Bipolar Disorders |volume=25 |issue=1 |pages=9–24 |doi=10.1111/bdi.13283 |issn=1399-5618 |pmc=10210071 |pmid=36515461}}</ref>
Patients with bipolar disorder may benefit from supplemental psychotherapy (such as cognitive behavioral therapy) in reducing recurrences and stabilizing depressive phases.<ref>{{Cite journal |last1=Miklowitz |first1=David J. |last2=Efthimiou |first2=Orestis |last3=Furukawa |first3=Toshi A. |last4=Scott |first4=Jan |last5=McLaren |first5=Ross |last6=Geddes |first6=John R. |last7=Cipriani |first7=Andrea |date=2021-02-01 |title=Adjunctive Psychotherapy for Bipolar Disorder: A Systematic Review and Component Network Meta-analysis |journal=JAMA Psychiatry |volume=78 |issue=2 |pages=141–150 |doi=10.1001/jamapsychiatry.2020.2993 |issn=2168-6238 |pmc=7557716 |pmid=33052390}}</ref> Interventions that target sleep regulation and mood monitoring, as well as efforts to reduce stigma, are beneficial in improving their quality of life.<ref name=":9" />
Patients with bipolar disorder may struggle with non-adherence to pharmacological treatment; long-acting injectable antipsychotics maybe beneficial with adherence to some patients.<ref>{{Cite journal|last1=Tohen|first1=Mauricio|last2=Goldberg|first2=Joseph F.|last3=Hassoun|first3=Youssef|last4=Sureddi|first4=Suresh|date=2020-06-16|title=Identifying Profiles of Patients With Bipolar I Disorder Who Would Benefit From Maintenance Therapy With a Long-Acting Injectable Antipsychotic|journal=The Journal of Clinical Psychiatry|volume=81|issue=4|doi=10.4088/JCP.OT19046AH1|issn=1555-2101|pmid=32558403|s2cid=219923839|doi-access=free}}</ref>
==Prognosis== Bipolar I usually has a poor prognosis, which is associated with substance abuse, psychotic features, depressive symptoms, and inter-episode depression.<ref>{{cite web | url=https://www.ncbi.nlm.nih.gov/books/NBK558998/#article-18332.s11 | pmid=32644424 | year=2023 | last1=Jain | first1=A. | last2=Mitra | first2=P. | title=Bipolar Disorder | publisher=StatPearls | access-date=14 March 2023 | archive-date=23 March 2023 | archive-url=https://web.archive.org/web/20230323031802/https://www.ncbi.nlm.nih.gov/books/NBK558998/#article-18332.s11 | url-status=live }}</ref> A manic episode can be so severe that it requires hospitalization. An estimated 63% of all BP-I related mania results in hospitalization.<ref>{{cite journal | pmid=14596627 | year=2003 | last1=De Zelicourt | first1=M. | last2=Dardennes | first2=R. | last3=Verdoux | first3=H. | last4=Gandhi | first4=G. | last5=Khoshnood | first5=B. | last6=Chomette | first6=E. | last7=Papatheodorou | first7=M. L. | last8=Edgell | first8=E. T. | last9=Even | first9=C. | last10=Fagnani | first10=F. | title=Frequency of hospitalisations and inpatient care costs of manic episodes: In patients with bipolar I disorder in France | journal=Pharmacoeconomics | volume=21 | issue=15 | pages=1081–1090 | doi=10.2165/00019053-200321150-00002 | s2cid=41439636 }}</ref> The natural course of BP-I, if left untreated, leads to episodes becoming more frequent or severe over time.<ref>{{cite web | url=https://www.treatmentadvocacycenter.org/evidence-and-research/learn-more-about/463-bipolar-disorder-fact-sheet | title=Bipolar Disorder – Fact Sheet | access-date=14 March 2023 | archive-date=19 May 2023 | archive-url=https://web.archive.org/web/20230519153647/https://www.treatmentadvocacycenter.org/evidence-and-research/learn-more-about/463-bipolar-disorder-fact-sheet }}</ref> The absolute risk of suicide is highest for BP-I than all other mood and mental disorders.<ref>{{cite journal | last1=Kim | first1=Hyewon | last2=Jung | first2=Jin Hyung | last3=Han | first3=Kyungdo | last4=Jeon | first4=Hong Jin | title=Risk of suicide and all-cause death in patients with mental disorders: a nationwide cohort study | journal=Molecular Psychiatry | date=2025 | volume=30 | issue=7 | pages=2831–2839 | doi=10.1038/s41380-025-02887-4 | pmid=39843548 | pmc=12185347 }}</ref> Approximately 15-20% of people with bipolar disorder die by suicide, with 30-60% making at least one attempt.<ref name=suicide>{{Cite journal |last1=Gergel |first1=Tania |last2=Adiukwu |first2=Frances |last3=McInnis |first3=Melvin |date=2024-10-01 |title=Suicide and bipolar disorder: opportunities to change the agenda |url=https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(24)00172-X/abstract |journal=The Lancet Psychiatry |language=English |volume=11 |issue=10 |pages=781–784 |doi=10.1016/S2215-0366(24)00172-X |issn=2215-0366 |pmid=38885666|url-access=subscription }}</ref> The attempts use more lethal means than those among the general population.<ref>{{cite journal | last1=Dome | first1=P. | last2=Rihmer | first2=Z. | last3=Gonda | first3=X. | title=Suicide Risk in Bipolar Disorder: A Brief Review | journal=Medicina | date=2019 | volume=55 | issue=8 | page=403 | doi=10.3390/medicina55080403 | doi-access=free | pmid=31344941 | pmc=6723289 }}</ref> Individuals with BP-I typically have a shorter life expectancy compared to the general population, with estimates suggesting a reduction of 11 to 20 years.<ref>{{cite journal | last1= Kessing | first1= L. V. | last2= Vradi | first2= E. | last3= Andersen | first3= P. K. | title= Life expectancy in bipolar disorder | journal= Bipolar Disorders | date= 2015 | volume= 17 | issue= 5 | pages= 543–548 | doi= 10.1111/bdi.12296 | pmid= 25846854 }}</ref> With proper treatment, individuals with BP-I can, however, lead a healthy lifestyle.<ref>{{cite web | url=https://www.samhsa.gov/serious-mental-illness/bi-polar | title=Living Well with Bipolar Disorder | date=7 May 2019 | access-date=15 March 2023 | archive-date=15 March 2023 | archive-url=https://web.archive.org/web/20230315020449/https://www.samhsa.gov/serious-mental-illness/bi-polar | url-status=live }}</ref>
===Education=== Psychosocial interventions can be used for managing acute depressive episodes and for maintenance treatment to aid in relapse prevention.<ref name=":0" /> This includes psychoeducation, cognitive behavioural therapy (CBT), family-focused therapy (FFT), interpersonal and social rhythm therapy (IPSRT), and peer support.<ref name=":0">{{Cite journal|last1=Yatham|first1=Lakshmi N.|last2=Kennedy|first2=Sidney H.|last3=Parikh|first3=Sagar V.|last4=Schaffer|first4=Ayal|last5=Bond|first5=David J.|last6=Frey|first6=Benicio N.|last7=Sharma|first7=Verinder|last8=Goldstein|first8=Benjamin I.|last9=Rej|first9=Soham|last10=Beaulieu|first10=Serge|last11=Alda|first11=Martin|date=2018|title=Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder|journal=Bipolar Disorders|volume=20|issue=2|pages=97–170|doi=10.1111/bdi.12609|issn=1399-5618|pmc=5947163|pmid=29536616}}</ref>
Information on the condition, importance of regular sleep patterns, routines and eating habits and the importance of compliance with medication as prescribed. Behavior modification through counseling can have positive influence to help reduce the effects of risky behavior during the manic phase. Additionally, the lifetime prevalence for bipolar I disorder is estimated to be 1%, while bipolar spectrum disorder has been estimated to affect as much as 6% of people.<ref>{{Cite journal|last1=Merikangas|first1=Kathleen R.|author-link=Kathleen Merikangas|last2=Akiskal|first2=Hagop S.|last3=Angst|first3=Jules|last4=Greenberg|first4=Paul E.|last5=Hirschfeld|first5=Robert M.A.|last6=Petukhova|first6=Maria|last7=Kessler|first7=Ronald C.|date=1 May 2007|title=Lifetime and 12-Month Prevalence of Bipolar Spectrum Disorder in the National Comorbidity Survey Replication|journal=Archives of General Psychiatry|volume=64|issue=5|pages=543–552|doi=10.1001/archpsyc.64.5.543|issn=0003-990X|pmc=1931566|pmid=17485606}}</ref>
== See also == {{Portal|Psychiatry|Psychology|Medicine}} <!-- Please keep entries in alphabetical order & add a short description WP:SEEALSO --> {{div col|colwidth=20em|small=yes}} * Outline of bipolar disorder * Bipolar disorder * Bipolar II disorder * Bipolar NOS * Cyclothymia * Bipolar disorders research * History of bipolar disorder * Creativity and bipolar disorder * List of people with bipolar disorder * International Society for Bipolar Disorders * Detailed listing of DSM-IV-TR bipolar disorder diagnostics codes * Borderline personality disorder * Kleine–Levin syndrome * Major depressive disorder * Seasonal affective disorder * Racing thoughts * Emotional dysregulation{{div col end}} <!-- please keep entries in alphabetical order -->
==References== {{reflist}}
{{Medical resources | DiseasesDB = | ICD11 = {{ICD11|6A60}} | ICD10 = {{ICD10|F31.9}} | ICD9 = {{ICD9|296.7}} | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = | eMedicineTopic = | MeshID = }}
{{Bipolar disorder}}{{Mental disorders}} Category:Bipolar spectrum Category:Depression (mood) Category:Mood disorders