Severe bipolar disorder is a mental health condition that can cause extreme shifts between high, manic episodes and low, depressive episodes.

Bipolar disorder (BD) is a mental health condition that can lead to substantial shifts in an individual’s mood, energy, and concentration levels.

A person with BD may experience shifts between manic episodes, during which they feel “high” and energized, and depressive episodes of feeling sad, hopeless, and worthless. These shifts can make it difficult for a person to carry out everyday tasks.

Severe BD describes when a person experiences manic episodes almost every day for at least 7 days, or severe symptoms of mania that require urgent medical attention. A person may also experience depressive episodes that last for 2 weeks or more, and psychosis symptoms, such as hallucinations.

In this article, we discuss the most severe form of bipolar disorder alongside symptoms, treatments, causes, and how a doctor may diagnose the condition.

Person speaking with a doctorShare on Pinterest
Anderson Coelho/Getty Images

The most severe form of BD is bipolar I disorder. A doctor may diagnose bipolar I disorder if a person experiences manic episodes lasting 7 days or more.

A person with bipolar I disorder may also experience extreme manic and depressive episodes and psychotic symptoms such as hallucinations and delusions. These severe symptoms may lead to a person requiring urgent medical attention.

A person with severe BD may experience extreme bipolar symptoms. They may also experience psychotic symptoms such as delusions and hallucinations.

Manic episode symptoms

A person with severe bipolar disorder may experience extreme symptoms of a manic episode most of the day, every day, for at least 7 days. These symptoms may cause severe disruption at work or in family life and may require urgent medical care. Symptoms can include:

  • extreme elation, euphoria, and excitement
  • extremely irritability
  • excessive jumpiness, or feeling “wired”
  • a decreased need for sleep
  • speaking quickly
  • racing or confused thoughts
  • feeling self-important
  • grandiose speech or ideas
  • behaving impulsively or out of character
  • excessive appetite for food, sex, and alcohol or other substances
  • taking uncharacteristic risks

Read more about the symptoms of a manic episode.

Depressive episode symptoms

A person with severe BD may experience extreme depressive episodes that last for approximately 2 weeks. Symptoms can include:

  • feeling extremely low, sad, anxious, worthless, or hopeless
  • feeling tired or lacking energy
  • sleeping too much or too little
  • difficulty remembering, concentrating, and making decisions
  • losing interest in almost all activities
  • thoughts about death or suicide
  • eating more or less than usual

Read more about symptoms of a depressive episode.

Severe BD is a long-term condition that typically recurs over time. With treatment, a person can help manage the condition and should typically see an improvement in symptoms.

Some treatment options can include:

  • Medications: A doctor may prescribe mood stabilizers such as lithium or valproate, which can help prevent or reduce the intensity of manic and depressive episodes. A doctor may also prescribe atypical antipsychotic medications and antidepressants.
  • Psychotherapy: A doctor may describe this as talk therapy. It can help a person recognize when they are about to have a manic or depressive episode and develop ways to cope with the symptoms.
  • Electroconvulsive therapy (ECT): If a person has severe bipolar disorder, they may find that medications and psychotherapy are not effective. Therefore, a person may wish to consider ECT, a procedure that stimulates the brain with short electrical currents and can help relieve symptoms
  • Repetitive transcranial magnetic stimulation (rTMS): A type of brain stimulation therapy that can relieve symptoms of a depressive episode using magnetic waves.

A person with severe bipolar disorder may experience disorganized thinking, hallucinations, and delusions, which a doctor may refer to as psychotic symptoms.

A person may be experiencing extreme symptoms such as thoughts of harming themselves, and dangerously impulsive behavior. They may also be misusing drugs or alcohol, and may not have eaten or slept properly for several days.

If a person is experiencing psychotic symptoms, or any of these extreme behaviors, they may need to seek urgent medical care and may require hospitalization.

Severe bipolar disorder typically occurs when a person is in their teens or early twenties. However, it can occur at any time of life.

Researchers believe that there may be many different causes of severe bipolar disorder, including:

  • a family history of severe bipolar disorder
  • a certain genetic makeup
  • a particular brain structure and functioning
  • having a history of drug or alcohol misuse
  • having recently experienced a traumatic event

An accurate diagnosis of severe bipolar disorder can help a person receive the right treatment and manage their symptoms.

To diagnose severe bipolar disorder, a doctor may perform various medical tests, including taking blood and a physical examination.

A person may also require a mental health evaluation, during which they can outline their symptoms, family history, and recent experiences.

A doctor may ask a person to keep a record of their thoughts and emotions and may wish to speak with family members to help understand if the symptoms a person is experiencing are due to severe bipolar disorder.

Severe bipolar disorder is a mental health condition that can result in shifts between extreme manic, energized, and erratic moods and extremely low, sad, and hopeless moods.

A person with severe bipolar may experience a manic episode every day for at least 7 days, and a depressive episode for approximately 2 weeks.

Some symptoms of severe bipolar disorder may require hospitalization such as hallucinations, delusions, and disorganized thoughts.

A person may also experience extreme irritability, a decrease in the need for sleep, fast thoughts, and an inflated sense of self.

There is not a direct cause of severe bipolar disorder. However, family history, genetics, brain structure, and brain function may be risk factors for developing the condition.

Once a person receives a diagnosis, a doctor may prescribe medications, psychotherapy, or brain stimulation therapies, to help ease the symptoms of severe bipolar disorder.