Bipolar I disorder is a very serious psychiatric disorder.\u00a0 If left untreated, it can result in disastrous consequences, tearing families apart and destroying lives in many ways.\u00a0 For most people who are diagnosed with it, bipolar I disorder is a lifelong condition that requires ongoing treatment.\u00a0 Currently, there is no cure for this complex, challenging disorder. Symptoms In order to be diagnosed with bipolar I disorder, there must be a history of at least one manic episode.\u00a0 Most people with the disorder also experience episodes of major depression, although a history of depression is not required for the diagnosis.\u00a0The term \u201cbipolar\u201d refers to these two contrasting, or polar-opposite, moods.\u00a0 Individuals with bipolar II disorder have \u201chypomanic\u201d episodes, which are less severe than manic episodes. Mania During a manic episode, individuals often behave as if they\u2019re high on a stimulant drug like speed.\u00a0 They\u2019re full of energy and may be very happy or highly irritable.\u00a0 Manic symptoms may also include: \tGrandiosity or an expansive mood \tDecreased need for sleep; restlessness \tTalkativeness; rapid, pressured speech \tTaking on multiple tasks, projects and goals at once \tHigh degree of distractibility; limited or no focus; impulsivity \tRacing thoughts; changing topics quickly when talking \tEngaging in activities that are very pleasurable and often very risky (e.g. having sex with multiple partners in a brief period of time; going on spending sprees) \tPsychosis (hallucinations and \/ or delusions) To meet the clinical criteria, a manic episode must last at least seven days and may last much longer. Major Depression \u00a0During a major depressive episode, a person feels depressed most of the time and \/ or has little to no interest in doing things he or she normally enjoys.\u00a0 Other symptoms may include tiredness or low energy, feeling agitated or slowed down, having difficulties concentrating or making decisions, problems with sleep or appetite, excessive guilt, feelings of worthlessness or hopelessness, and thoughts of death or suicide. Major depressive episodes last at least two weeks and may last much longer. Mixed Episode Sometimes individuals with bipolar I disorder experience \u201cmixed\u201d mood episodes.\u00a0 This means they are experiencing significant symptoms of both major depression and mania at the same time. Treatment Importance of Treatment One of the reasons why treating bipolar I disorder is so crucial is because manic episodes can be particularly dangerous.\u00a0 Mania causes people to have poor judgment and engage in reckless, erratic behavior.\u00a0 They often inadvertently put themselves and others in danger.\u00a0\u00a0 Another reason treatment is crucial is that individuals with bipolar I disorder have a high risk for suicide, particularly during a period of depression. Treatment serves multiple purposes: 1)\u00a0\u00a0\u00a0\u00a0\u00a0 It helps the individual understand the disorder and learn ways to manage it 2)\u00a0\u00a0\u00a0\u00a0\u00a0 It helps reduce symptoms 3)\u00a0\u00a0\u00a0\u00a0\u00a0 It helps prevent or at least reduce the likeliness of future manic and depressive episodes 4)\u00a0\u00a0\u00a0\u00a0\u00a0 It stabilizes current mood symptoms 5)\u00a0\u00a0\u00a0\u00a0\u00a0 It helps keep the patient and others safe Treatment Options Hospitalization It\u2019s not uncommon for individuals with undiagnosed bipolar I disorder to end up hospitalized during their first manic episode.\u00a0 Since manic episodes are, by their nature, pretty extreme, they tend to be noticed and cause significant concern.\u00a0 The individual is often brought in to a hospital ER or mental health clinic by family members, paramedics, or the police for an evaluation.\u00a0 With mania, several days of inpatient treatment are often required in order to stabilize the patient.\u00a0 Once stabilized, outpatient treatment is crucial. Recurrent hospitalizations for manic episodes are not uncommon for individuals with bipolar I disorder.\u00a0 While this is less likely to occur for patients who continue with treatment (including medication) on an outpatient basis, it can also occur even with treatment in some situations. Sometimes individuals with bipolar I disorder need hospitalization during a major depressive episode.\u00a0 This level of treatment is most likely indicated if the patient is severely depressed and \/ or suicidal.\u00a0 Mixed episodes also typically require inpatient treatment. Advantages of inpatient treatment include:\u00a0 1) it keeps the patient (and others) safe as he or she is being stabilized.\u00a0 2)\u00a0 It allows for 24\/7 observation which a) helps ensure an accurate diagnosis (sometimes initial diagnoses are inaccurate) and b) gives the attending psychiatrist the opportunity to note the effects (and side effects) of medication.\u00a0 3)\u00a0 It gives the patient a break from outside stressors, which can help facilitate stabilization and recovery.\u00a0 4) It provides intensive treatment over a short period of time, including both group and individual therapy. Medication \u00a0Although depression, anxiety, and many other psychiatric disorders can often be effectively treated with psychotherapy alone, bipolar I disorder treatment generally requires medication as well.\u00a0 This is because medication \u2013 in the form of mood stabilizers - plays a key role in preventing future manic episodes, or at least in reducing the risk of more episodes.\u00a0\u00a0 Other medications, such as antipsychotics and antidepressants, are also commonly used in the treatment of bipolar I disorder. Mood stabilizers \u2013 Lithium is one of the most commonly prescribed mood stabilizers for the treatment of bipolar disorder.\u00a0 Other medications that help to stabilize mood symptoms and prevent mania are anticonvulsants.\u00a0 These include Depakote (valproic acid), Trileptal (oxcarbazepine), Tegretol (carbamazepine), and Lamictal (lamotrigine). Antidepressants \u2013 Many individuals with bipolar I disorder are also prescribed antidepressant medications.\u00a0 The danger of antidepressants \u2013 particularly the older tricyclics - is that they can potentially trigger a manic episode if the patient is not also taking a mood stabilizer (or appropriate antipsychotic).\u00a0 SSRIs such as Paxil, Zoloft, and Prozac are often prescribed. Antipsychotics \u2013 With bipolar disorder, atypical antipsychotics are often used in conjunction with other medications.\u00a0 Some antipsychotics have been approved specifically for the treatment of bipolar mania, while others primarily target bipolar depression.\u00a0 Seroquel (quetiapine), for example, is approved for both mania as well as the \u201cmaintenance\u201d treatment of bipolar disorder. Antipsychotics help reduce psychotic symptoms that often occur during a manic episode.\u00a0 Abilify (aripiprazole), Zyprexa (olanzapine), Risperdal (risperidone), and Geodon (ziprasidone) are all antipsychotic medications used to treat bipolar symptoms.\u00a0 Individuals who do not benefit from lithium or other mood stabilizers may be prescribed Clozaril (clozapine). Psychotherapy The importance of psychotherapy in the treatment of bipolar I disorder should never be underestimated.\u00a0 Far too often, patients rely solely on medication and bypass psychotherapy.\u00a0 This is unfortunate, because a skilled therapist can help bipolar individuals in many ways.\u00a0 For example, since stress is often a trigger for manic episodes, therapy can help patients learn to manage stress and keep future episodes at bay or to a minimum.\u00a0 Therapy can also help patients identify mood triggers, as well as manage symptoms when they do start to appear. Psychotherapy is often done on an individual basis.\u00a0 However, couples and family therapy can be extremely beneficial.\u00a0 Involving one\u2019s spouse and \/ or family in therapy is a good way to educate them about the disorder. \u00a0The better they understand the disorder, the more supportive and helpful they can be, particularly when symptoms appear.\u00a0 Involving them in therapy will also help bolster support for the patient. Group therapy can also be invaluable to individuals with bipolar disorder.\u00a0 It\u2019s easy for individuals with a serious psychiatric disorder to feel misunderstood, stigmatized and isolated.\u00a0 Participating in group therapy gives each individual the opportunity to share personal experiences while learning from other members\u2019 experiences.\u00a0 Group therapy also provides a sense of community and additional support for each member, both of which can be invaluable to anyone suffering from a serious mental illness. \u00a0Other Treatment Options \u00a0Not everyone with bipolar I disorder responds to traditional treatment. Or, they may obtain some benefit, but it\u2019s not enough.\u00a0 Two other treatment options that may be considered, if indicated, are ECT (electroconvulsive therapy or \u201cshock therapy\u201d) and TMS (transcranial magnetic stimulation).\u00a0 These two treatments can be particularly beneficial for depressive symptoms that are severe.\u00a0 There are side effects, however, with both types of treatment.\u00a0 These must always be weighed to determine if the risks are worth the potential benefits. Potential side effects of ECT include memory loss (including retrograde amnesia, which means memory loss of things that happened prior to the treatment), brief periods of confusion, and minor physical side effects such as headaches, muscle spasms, nausea and vomiting. ECT can also result in medical complications, such as elevated blood pressure. Potential short-term side effects of TMS include discomfort, dizziness, muscle spasms, and headaches.\u00a0 Less common but more serious side effects include seizures, hearing loss, and mania (in individuals with bipolar disorder). Lifestyle Changes and Other Remedies It would be amiss to discuss treatment for any disorder without briefly discussing lifestyle changes that may also help reduce symptoms.\u00a0 As mentioned earlier, stress is a key trigger for mood episodes (especially mania) for those with bipolar I disorder.\u00a0 That\u2019s why it\u2019s imperative to find ways to reduce stress and learn to manage it properly. Beneficial lifestyle changes include: Avoid alcohol and recreational (or non-prescribed) drugs \u2013 As with many psychiatric disorders, individuals with bipolar I disorder are especially prone to self-medicating with alcohol and drugs.\u00a0 Alcohol and drugs can both trigger and exacerbate mood symptoms.\u00a0 It\u2019s best to avoid both altogether.\u00a0 If you have a substance use problem, or are addicted to alcohol or drugs, an alcohol and drug rehab program can help you get on the path to recovery.\u00a0 Be sure to let your treatment providers know that you have bipolar disorder. Avoid high stress jobs and relationships.\u00a0 If you work at a job you hate or one that is highly stressful, consider changing jobs to something less stressful and more enjoyable.\u00a0 Even if doing so means a cut in pay, it may be less costly in the long run.\u00a0 Toxic relationships can also trigger mood episodes, so it\u2019s best to avoid them as much as possible.\u00a0 If you\u2019re in a troubled marriage and don\u2019t want a divorce, consider marriage counseling to help improve your relationship. Take good care of yourself.\u00a0 It\u2019s important to make self-care a priority if you want to keep mood symptoms at bay.\u00a0 This includes getting plenty of restful sleep (on a regular schedule), eating a healthy diet, exercising regularly (talk to your doctor first!), and keeping your life as balanced as possible.\u00a0 Don\u2019t overload your schedule (learn to say \u201cno\u201d when necessary). \u00a0Allow time for fun and relaxation. Other things that can help reduce stress and improve your overall well being when practiced regularly include: \tYoga \tTai Chi or Qigong \tMeditation \tDeep breathing \tRelaxation techniques such as guided imagery or progressive muscle relaxation With proper treatment, good self-care, and careful stress management, many people with bipolar I disorder live happy, fulfilling lives.\u00a0 If you aren\u2019t getting treatment, now is the time to start.\u00a0 If you suspect you may have bipolar disorder but have never been diagnosed, talk to your doctor or set up an appointment with a psychiatrist for an evaluation as soon as possible. If you are taking medication, always take it exactly as prescribed by your doctor.\u00a0 Don\u2019t stop it abruptly or make any changes without consulting with your doctor.\u00a0 Always make sure all your healthcare providers are aware that you have bipolar disorder.