Will bipolar I disorder worsen if untreated?

Charles J. Sophy, MD
Adolescent Medicine

If left untreated, the depression and mania of bipolar I disorder can typically come back and even worsens. While you may have no symptoms between mood episodes with bipolar I disorder, depression and mania typically come back over time. 

To avoid worsening problems with bipolar mania, it is important to seek treatment with a psychiatrist, an expert in diagnosing and treating mental health disorders. The psychiatrist will diagnose your bipolar disorder using the criteria from the Diagnostic and Statistical Manual of Mental Disorders, or DSM. 

Depending on the type of problem, your doctor will prescribe a mood-stabilizing medication, an antidepressant, or an antipsychotic medication. 

Bipolar I disorder has manic or mixed episodes that last at least a week. Mania symptoms can become so intense that you may need hospitalization to bring your mood down from the lofty high. Staying on your treatment plan can help you prevent serious problems with mania and bipolar disorder.

If left untreated, the depression and mania of bipolar I disorder can worsen to the point of hospitalization. Most people with bipolar I disorder seek medical treatment for the depression instead of the mania. Mania is an excited mood state where people are filled with extreme energy, ideas, and creativity. Yet if left untreated, mania can escalate so high that it results in psychosis, hallucinations, and paranoia.
John Preston, PsyD

Bipolar I (manic depressive illness with both major depressive episodes and mania) is, by definition, highly recurrent. Unfortunately, if it is untreated almost 100% of the time recurring episodes will be seen. The average time between the first and second episode is 18 months...so some people diagnosed with bipolar I will get treatment for the first episode and after several months not experiencing recurring symptoms, will conclude that the diagnosis was wrong, stop taking medications, only to eventually have a second episode. Often with untreated or inadequately treated bipolar disorder, episodes get progressively more severe and/or harder to treat.

In addition to teaching graduate and medical school, I have given a number of talks for people who have bipolar disorder and their families. This issue comes up a lot, and understandingly so. Also, many people ask about the possibility of treating bipolar disorder without medications. Lifestyle management can go a long way to help prevent episodes; especially the following:

1. Getting between 7-9 hours of sleep EVERY night

2. Avoid sleep deprivation (e.g. staying up late to party or for students, pulling all-nighters to study)

3. Significantly limit the use of alcohol and caffeine

4. Waking up at the same time each day (something that is a high yield strategy, but also something most people do not like to do).

5. If possible, avoid travel across time zones and shift work (these things disrupt the circadian cycle and can destabilize people suffering from bipolar disorder)

As important as these lifestyle changes are, bipolar disorder MUST be treated with mood stabilizing medications. My heart goes out to all people being treated with the various bipolar medications; the side effects are often very difficult to deal with. However, all studies have shown that medication treatment is a must. On-going medication treatment and routine lifestyle management are enormously helpful in reducing recurrent episodes.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.