Psychiatric Care for Bipolar Disorder

Bipolar disorder involves mood episodes: periods of mania or hypomania, with elevated or irritable mood, high energy, racing thoughts and less need for sleep, and periods of depression. Episodes can disrupt work, school, relationships and health. Bipolar disorder can be mistaken for depression or ADHD, so an accurate diagnosis matters.

How our physicians help

Our physicians take a detailed history, often with input from family, to make a careful diagnosis. Treatment centers on thoughtful medication management with regular monitoring, combined with psychotherapy, attention to sleep and daily routine, and a plan for spotting early warning signs of an episode. When an episode needs a higher level of care, we coordinate with hospital and program teams.

Signs of mania and hypomania in adults

Mania is a high period strong enough to disrupt daily life, and it sometimes needs hospital care. Hypomania is a milder form that can feel good, while others notice you seem different. Signs include:

• Unusual confidence, or certainty that you have special ideas or plans
• Feeling rested after only a few hours of sleep, several nights in a row
• Taking risks you normally would not, such as large purchases or sudden job changes
• Snapping at people in a way that is new for you

Bipolar disorder in teens

Most teenage moodiness is not bipolar disorder. What stands out is a clear change from the teen's usual self that lasts for days:

• Several nights of very little sleep without seeming tired
• Sudden jumps in energy, plans or confidence that seem out of character
• Irritability or anger well beyond what is usual for them
• New risky behavior that worries the adults around them

How a bipolar diagnosis is made

No lab test or brain scan can confirm bipolar disorder. The diagnosis rests on your history, so your physician maps your moods over the years, including the stretches that felt great. Many people seek help only when depressed and never mention those stretches, yet they are often the key clue. The evaluation covers:

• Past highs and lows, how long they lasted and what others noticed
• How you reacted to any antidepressant or stimulant
• Family history of bipolar disorder or other mood conditions
• Sleep patterns and alcohol or drug use
• Thyroid problems and medications such as steroids, which can shift mood
• Trauma and other conditions that can look similar

Treatment options for bipolar disorder

Bipolar disorder is usually long-term, so treatment aims to calm the current episode and help prevent the next one. Many people have long stable periods with steady care, though finding the right plan can take patience.

Weight gain, sleepiness or shakiness are real trade-offs, so please raise them with your physician. Stopping mood medication on your own, even when you feel great, can bring on a new episode. If you might become pregnant, tell your physician early, because some mood medications need extra review. Options include:

• Mood stabilizers help keep mood steady and lower the chance of new episodes.
• Certain antipsychotic medications treat mania and, in some cases, bipolar depression.
• Antidepressants need care. Used alone, they can set off mania in some people, so physicians use them cautiously or not at all.
• Interpersonal and social rhythm therapy helps keep sleep, meals and daily routines steady, since disruption can set off episodes.
• Family-focused therapy teaches a household how the illness works and how to plan for hard times.

Supporting a family member

Early mania can feel wonderful, so the person may not see the change. Talk during a calm period and write a plan together. It can list warning signs, who may call the physician, and what happens with money or driving if an episode starts.

During an episode, stay calm, avoid arguing about plans or beliefs, and help protect sleep.

Bipolar disorder can bring thoughts of suicide, most often during depression but also when high and low symptoms mix. If this happens to you or someone in your family, call or text 988 (the Suicide & Crisis Lifeline) or call 911. We are not an emergency service.

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