Bipolar disorder

What bipolar disorder is

Bipolar disorder is a mood disorder characterized by episodes of unusually elevated mood (mania or hypomania) alongside episodes of depression. The two main forms:

• Bipolar I — defined by at least one full manic episode (usually with depressive episodes too). Mania involves a sustained elevation of mood, decreased sleep need, racing thoughts, increased activity or risky behavior, and often impaired judgment. Severe mania can require hospitalization.
• Bipolar II — defined by at least one hypomanic episode (a milder, shorter version of mania) plus depressive episodes. Often misdiagnosed as just depression for years because the hypomanias don’t feel like a problem — they often feel productive and energizing.

Why getting the diagnosis right matters

This is the single most important thing in bipolar care. Here’s why:

Antidepressants alone, given to someone with undiagnosed bipolar disorder, can trigger or worsen mania, induce rapid cycling, or destabilize mood for years. If you’ve had several rounds of depression, especially with patterns that don’t quite fit unipolar depression, it’s worth a careful evaluation for bipolar before adding more antidepressants.

Patterns that should prompt a bipolar evaluation:

• Depressions that started young (teens or early 20s)
• Depressions that haven’t responded to multiple antidepressants
• Antidepressants that initially worked, then stopped, or made you feel worse
• Family history of bipolar disorder
• Periods (sometimes only days) of unusual energy, decreased sleep need, racing thoughts, or unusually high activity — even if those felt good
• Postpartum depression (higher risk of bipolarity)

How we treat bipolar disorder

Mood stabilizers

The foundation of bipolar treatment. Common options:

• Lithium — the most studied, especially good at preventing both mania and depression and reducing suicide risk. Requires regular blood monitoring.
• Valproate (Depakote) — effective for mania, less so for depression. Not appropriate during pregnancy.
• Lamotrigine (Lamictal) — especially helpful for the depressive side of bipolar.
• Atypical antipsychotics (quetiapine, lurasidone, olanzapine, aripiprazole, others) — effective for mania, mixed states, and bipolar depression.

Therapy

Therapy meaningfully improves outcomes for bipolar:

• Psychoeducation — understanding the illness, its early warning signs, and how to live with it
• Interpersonal and Social Rhythm Therapy (IPSRT) — stabilizing daily routines, especially sleep, which is one of the strongest mood stabilizers there is
• Family-focused therapy when family members are part of the support system

Lifestyle factors that matter

For bipolar, sleep, alcohol use, and stimulant use are not optional considerations — they’re treatment. We’ll work on these together.