Bipolar I disorder

Bipolar I disorder is defined by mania. A manic episode lasts at least a week, most of the day, nearly every day, or is severe enough that hospital care is needed. Most people with bipolar I also have separate periods of depression, often lasting two weeks or more. Between episodes, mood often returns to a person's usual baseline.

These signs are a general guide, not a checklist for diagnosis.

Mania can feel energizing at first, so it's often hard to see from the inside. The people around you usually notice the change.

When mania needs urgent care. Severe mania can lead to unsafe choices, or to psychosis, like believing you're famous or have special powers. That needs care right away, and sometimes a hospital stay until things are stable. If you're in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline), any time, day or night. In an emergency, call 911 or go to the nearest emergency room.

Bipolar I is diagnosed from the pattern of your symptoms across your life, not from how you feel on one day. Some people are first diagnosed with depression, because the high periods weren't recognized. People who've had psychotic symptoms are sometimes misdiagnosed with schizophrenia. A careful evaluation looks at:

• Past high and low periods: how long they lasted and how they affected your life
• Changes in sleep, energy and behavior
• Family history of bipolar disorder or other mood conditions
• Past medications and how you responded, including any high period after starting an antidepressant
• Health conditions, such as thyroid disease, and medications or substances that can mimic or worsen mood symptoms
• Conditions that often come along with bipolar disorder, such as anxiety, ADHD, or alcohol or drug use

With your OK, input from someone who knows you well can help fill in the picture. This is part of a comprehensive psychiatric evaluation. Your first evaluation is up to 90 minutes in length. Some people need more time, some less, and we take the time you need. Follow-up visits are typically 20 to 30 minutes, and extended follow-ups are available.

Medication is central to treating bipolar I. The main types are mood stabilizers, such as lithium or valproate, and atypical antipsychotics. Some medications treat an episode that's happening; others help prevent the next one. Some people need to try more than one before finding what works.

Antidepressants aren't used on their own in bipolar disorder, because they can trigger mania or rapid cycling. If one is added for depression, it's alongside a mood stabilizer or an antipsychotic.

We weigh your past responses, side effects, any lab monitoring a medication needs, other health conditions, pregnancy plans and your own preferences, and we explain each choice so you understand it.

Visits also include practical work: keeping a mood chart, protecting a regular sleep routine, spotting your early warning signs, and planning what to do if they show up. Some therapies help alongside medication, such as interpersonal and social rhythm therapy and family-focused therapy. We don't offer standalone weekly therapy, but we're happy to help you find a therapist and, with your permission, we'll coordinate with them.

Bipolar I usually needs long-term treatment, and episodes can come back even with treatment. Regular follow-ups help catch changes early and adjust carefully. Please don't stop a medication on your own; some can cause withdrawal symptoms or a return of symptoms if stopped suddenly.