My Approach to Bipolar Disorder
Why Bipolar Disorder Is Often Misdiagnosed
Many people with bipolar disorder wait years, often 6 to 10, before receiving the correct diagnosis, and up to half are first told they have something else. I don't believe this happens because clinicians are careless. It happens because of the way the illness presents:
- Depression usually comes first and lasts longer. Many people experience depression years before any elevated mood, and spend far more time depressed than elevated. They seek help while depressed and are diagnosed with depression.
- Hypomania often feels good. Less need for sleep, more energy, more ideas, and higher productivity rarely feel like symptoms, so they are seldom reported. Often a partner or family member notices first.
- Symptoms overlap with other conditions. ADHD, anxiety, trauma, personality patterns, and substance use can resemble mood instability, and can also occur alongside bipolar disorder.
- Short appointments miss the timeline. A brief visit captures how someone feels today. Bipolar disorder reveals itself through patterns over a lifetime.
That is why I take a thorough, longitudinal history: your full mood story, sleep patterns, family history, past medication responses, and, with your permission, what the people closest to you have noticed.
Signs That Deserve a Closer Look
- Depression that began early, especially in the teens or early twenties
- Depression that comes on suddenly or keeps returning
- Depression after childbirth or with psychotic features
- Antidepressants that caused agitation, insomnia, or "too good" moods, or stopped working
- A family history of bipolar disorder, suicide, or substance use
- Periods of unusually high energy, reduced need for sleep, racing thoughts, or impulsive decisions
Predisposition: Why Some People Develop Bipolar Disorder
Bipolar disorder is one of the most heritable conditions in psychiatry. Genetics account for roughly 60 to 85 percent of the risk, and having a parent or sibling with bipolar disorder raises the likelihood several-fold. But genes load the dice; they don't decide the outcome. Episodes are often triggered by:
- Sleep and circadian disruption (night shifts, travel, a newborn, all-nighters), one of the most powerful triggers
- Major stress or life transitions
- Alcohol, cannabis, stimulants, and other substances
- Hormonal changes, especially after childbirth
- Seasonal changes
- Antidepressants taken without a mood stabilizer
Understanding your personal triggers is one of the most protective things we can work on together.
My Treatment Approach
I follow evidence-based clinical guidelines and tailor them to your life, goals, and preferences.
- Comprehensive assessment. A complete history, validated screening tools, mood charting, and baseline lab work to rule out medical causes and guide safe prescribing.
- Stabilizing the current episode. For mania or hypomania, mood stabilizers and/or atypical antipsychotics. For bipolar depression, medications with specific evidence in bipolar depression. I avoid treating bipolar depression with an antidepressant alone.
- Preventing relapse. Maintenance treatment chosen according to your history, side effects, and preferences, including options such as lithium, which has strong evidence for reducing suicide risk.
- Safe monitoring. Regular lab work and monitoring of weight, metabolic health, and side effects, adjusting over time rather than settling for "good enough."
- Treating the whole person. Psychoeducation, therapy focused on stabilizing daily routines and sleep, CBT skills, family involvement when you want it, reducing substance use, and a personalized early-warning relapse plan.
What I Want You to Know
A bipolar diagnosis is not a life sentence. With an accurate diagnosis, the right treatment, and a deeper understanding of yourself, many people do very well, often better than they did during years of treatment for the wrong condition. My goal is not only fewer symptoms, but stable sleep, healthy relationships, meaningful work, and a life that feels like your own.
If you've wondered whether your depression might be something more, I'd be glad to talk with you. Schedule a consultation today.