Bipolar Disorder

Bipolar disorder is among the most misdiagnosed conditions in psychiatry, and the misdiagnosis usually goes in one specific direction: people with bipolar II spend an average of several years being treated for “depression” that isn’t responding the way depression should, because the hypomanic episodes never came up in clinic — either because they felt good and so didn’t count as a problem, or because the patient didn’t know the difference between “productive” and “hypomanic.”

Getting the diagnosis right is the single most important thing we can do for someone with bipolar disorder. The treatment is different from treatment for unipolar depression. Antidepressants alone — which is what most mistakenly-diagnosed people end up on — can make bipolar worse.

The three main forms

• Bipolar I. At least one full manic episode in the lifetime. Mania is a distinct change: decreased need for sleep without feeling tired, racing thoughts, rapid speech, inflated self-confidence, impulsive decisions (spending, sex, risky behavior), and often psychotic features in severe episodes. Hospitalization is sometimes necessary. Depressive episodes usually also occur.
• Bipolar II. At least one hypomanic episode (a milder, shorter version of mania — usually 4+ days, not functionally catastrophic) and at least one major depressive episode. The depression tends to dominate the course and is what brings people in. The hypomanias often feel good. This is the form most often missed.
• Cyclothymia. Chronic mood fluctuation between mild depressive and mild hypomanic states, lasting at least two years, without ever reaching full criteria for either extreme.

There is also a category for mood patterns that don’t fit neatly into these boxes — real, treatable, and common.

What we ask about in an evaluation

A careful bipolar workup is not a 20-minute visit. We’re looking for:

• Distinct episodes, not a baseline mood state. Bipolar is about change over time.
• Hypomanic or manic episodes, which patients often don’t volunteer because they don’t seem like problems. Questions like “have there been times you needed a lot less sleep and still felt great?” get better answers than “have you had mania?”
• Family history. Bipolar is heritable. A parent or sibling with bipolar I makes the diagnosis more likely.
• Treatment history. Antidepressants that caused agitation, irritability, or mania. Periods of unusually fast speech or decision-making that felt great at the time and bad in retrospect.
• Rule-outs. Substance use, thyroid problems, sleep disorders, and ADHD can all produce symptoms that look bipolar-ish.

How treatment works

Bipolar is a lifelong condition in the same sense that diabetes or hypertension are — manageable, not curable. The goal of treatment is mood stability and prevention of future episodes, not just getting through the current one.

Medication is the core of bipolar treatment, and there are several classes of medications with good evidence for different parts of the picture. Which one is right depends on your particular pattern (more manic or more depressive), what you’ve tried before, any medical conditions in the mix, and what side effects you’ll tolerate. Most people try more than one before finding the right fit. Your clinician walks you through the options and how they differ.

Therapy alongside medication is valuable. The approaches with the most evidence for bipolar focus on stabilizing daily rhythms (sleep, meals, routines — all of which are major drivers of mood stability), recognizing early warning signs of both mood states, and building a crisis plan for future episodes. When family or a partner can be part of treatment, outcomes improve.

Sleep and lifestyle are not optional in bipolar. Consistent sleep, consistent routine, avoiding alcohol and recreational substances, and limiting caffeine are load-bearing parts of care. A night of poor sleep can genuinely precipitate a manic episode, and protecting sleep becomes a treatment goal in itself.

What to watch for

Part of treatment is learning your own early warning signs — the subtle 3-day shifts that precede bigger episodes. These are specific to each person. Some people’s early warnings: sleeping 5 hours and feeling fine, talking faster than usual, starting new projects impulsively, a creative burst, irritation at minor things. Noticing them early enough to adjust gives you a chance to head off full episodes.

We build that list with you.

When to come in

• If you’ve been treated for depression and it hasn’t responded the way it should, or if antidepressants have made things worse
• If you have periods of distinct, time-bound elevated mood along with your low periods
• If bipolar runs in your family and you’re concerned about your own pattern
• If you already have a diagnosis and your current regimen isn’t holding — come in for a review

Come in now if:

• You’re in a manic or hypomanic episode and can’t sleep, or are making decisions you’re worried about
• You’re having thoughts of suicide or self-harm

For immediate crisis support, the footer of this page has 988 and Colorado Crisis Services.

For non-emergency care, book an appointment or call 720-443-1691.