Bipolar 1 disorder, once known as manic depression, is a mental illness that involves vast, out-of-control mood swings from depressed to elevated moods. There are four types of bipolar disorder:
- bipolar 1
- bipolar 2
- bipolar not otherwise specified
Bipolar 1 is the type most easily diagnosed as it contains the most pronounced elevated mood, called mania. A person with bipolar 1 (also noted as bipolar i) has episodes of both mania and depression. The presence of these episodes are the hallmark symptoms of bipolar I.
About 6 million people, or 2.5% of the U.S. population, suffers from bipolar disorder. About 1% of the people in the U.S. are thought to have bipolar 1 disorder.
Bipolar I Symptoms of Mania
A Bipolar I diagnosis requires at least one manic episode in the person's lifetime with a duration of one week or more. In order to be considered a manic episode, it must drastically impair a person's social or occupational functioning, or lead to hospitalization. It must not be attributable to another condition.
A manic episode is characterized by a profound mood disturbance of elation, irritability or expansiveness. According to the current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), at least three of the following bipolar 1 symptoms of mania must also be present:1
- Diminished need for sleep
- Excessive talking or pressured speech
- Racing thoughts or flight of ideas
- Clear evidence of distractibility
- Increased level of goal-focused activity at home, at work, or sexually
- Excessive pleasurable activities, often with painful consequences
People are most frequently diagnosed with bipolar type 1 when they have a manic episode that results in hospitalization. Bipolar psychosis can also be part of mania.
Bipolar 1 Symptoms of Depression
Bipolar 1 disorder also requires the presence of major depressive episodes. According to the DSM-IV-TR, a major depressive episode must consist of either a marked depressed mood or loss of pleasure / interest for at least two weeks. Bipolar I symptoms of a major depressive episode must cause significant impairment or distress and must not be explained by another illness.
A depressed episode also must contain four or more of the following bipolar 1 symptoms of depression (three if the person shows both a depressed mood and lack of pleasure):
- Significant weight loss or gain or significant loss or increase in appetite
- Hypersomnia or insomnia – too much sleep or too little
- Psychomotor retardation or agitation – lethargic or agitated movements and demeanor; can be seen by others
- Loss of energy or fatigue
- Decrease in self-worth or feelings of guilt
- Decreased concentration ability or marked indecisiveness
- Preoccupation with death or suicide; patient has a plan or has attempted suicide
Bipolar I Symptoms of a Mixed-Episode
A bipolar 1 disorder episode may be diagnosable as both a manic and a depressed episode. This is known as a mixed episode and is quite common in bipolar disorder type 1. For a mixed episode diagnosis, the depression need only be present for one week.