Bipolar Disorder

Bipolar disorder is one of the most misunderstood conditions in psychiatry, and one of the most misdiagnosed. Many patients first seek help during a depressive episode, and because depression is what brings them through the door, depression is what gets treated. It can take years before someone recognizes that the lows are only half the picture. The other half, the nights where sleep feels unnecessary and you do not miss it, the projects started at 2am with absolute certainty, often does not look like a problem from the inside. Neither does the spending that felt completely justified in the moment. It can feel like energy, clarity, or finally being yourself.

That gap between what bipolar disorder looks like to the person experiencing it and what it looks like to the people around them is one of the reasons accurate diagnosis matters so much. It is a condition that is often quite confusing, even to clinicians, because mood swings and quick anger can look similar on the surface without meeting the criteria for bipolar disorder. Treating bipolar depression with antidepressants alone, without a mood stabilizer, can make things worse. It can trigger manic episodes or accelerate the cycling between highs and lows. A correct diagnosis changes the entire treatment approach, and the difference in outcomes between treated and untreated bipolar disorder is significant.

Many patients with bipolar disorder spend years being treated for depression alone before the full picture becomes clear. A correct diagnosis changes the entire treatment approach.

If you or someone in your family has been treated for depression without lasting improvement, or if periods of high energy and poor judgment keep alternating with crashes, those are patterns worth evaluating carefully. Bipolar disorder is usually a very treatable condition, and when the diagnosis is right and the treatment plan accounts for both sides of it, the improvement in quality of life can be substantial.

Signs and Symptoms

Bipolar disorder involves episodes of mania or hypomania alternating with episodes of depression. A diagnosis requires the presence of at least one manic or hypomanic episode that is not better explained by another cause, such as substance use or a medical condition. The pattern, severity, and frequency vary from person to person.

Manic episodes are marked by a distinctly elevated or irritable mood lasting at least several days. During a manic episode, a person may sleep very little without feeling tired, talk rapidly and jump between ideas, take on unrealistic projects, spend money impulsively, or make decisions that seem out of character. Grandiosity, an inflated sense of ability or importance, is common. In severe cases, mania can include psychotic features such as delusions or hallucinations.

Hypomania is a less intense form of mania. The symptoms are similar but shorter in duration and less disruptive. A person in a hypomanic episode may feel unusually productive and confident. Others around them may notice that something is off even when the person themselves feels fine.

Depressive episodes in bipolar disorder look much like major depression: persistent sadness, loss of interest, changes in sleep and appetite, fatigue, difficulty concentrating, and in some cases thoughts of death or self-harm. The key difference is context. These depressive episodes alternate with periods of elevated mood rather than occurring in isolation.

In children and adolescents, bipolar disorder can be harder to identify. Mood episodes may cycle more rapidly than in adults. Irritability is often more prominent than euphoria. The overlap with ADHD symptoms, particularly distractibility and impulsive behavior, can make it difficult to distinguish one condition from the other without careful evaluation over time.

How We Approach Bipolar Disorder Treatment

Bipolar disorder is a condition where getting the diagnosis right matters as much as the treatment itself. The evaluation starts with a thorough history of you or your child: not just the current episode, but the pattern over time. We ask about sleep, energy, mood shifts, impulsive behavior, family history, and what previous treatments have or have not worked. Many patients arrive having been treated for depression alone, and part of the evaluation is determining whether the full picture includes episodes that were never identified as mania or hypomania.

Medication is central to bipolar treatment in a way that differs from most other conditions we treat. Mood stabilizers and, in some cases, atypical antipsychotics form the foundation. The goal is to reduce the frequency and severity of both manic and depressive episodes. Finding the right medication and dose requires close monitoring, especially early in treatment. We schedule frequent follow-ups during that period because response to medication can shift, and side effects need to be caught and addressed quickly.

Bipolar disorder frequently co-occurs with anxiety, ADHD, and substance use. In children and adolescents, the overlap with ADHD is particularly common and complicates both diagnosis and treatment. Stimulant medications that help ADHD can destabilize mood in a patient with undiagnosed bipolar disorder. That is why the evaluation needs to account for all of it before any prescribing decisions are made.

What to Expect

Your first appointment is an in-office psychiatric evaluation. Dr. Teitelbaum will review your history, ask about your symptoms, and take the time to understand what is going on before recommending a treatment plan. For children and adolescents, a parent or guardian is part of that conversation.

Follow-up visits are scheduled based on your individual needs. When starting or adjusting medication, more frequent check-ins help us monitor your response. Once treatment is stable, visits are typically less frequent.

After your first in-office visit, telehealth appointments are available for patients located in Florida. An in-office visit is required at least every six months.

When to Seek Help

Mood swings that go beyond normal ups and downs, periods of high energy followed by crashes, depression that has not responded to treatment: these are patterns worth evaluating. A psychiatric evaluation can help determine whether bipolar disorder is involved. You do not need to have a diagnosis to call. You do not need to be in crisis.

Bipolar disorder carries a significantly elevated risk of suicide, which is one of the reasons it is so important that it be diagnosed and treated rather than left unrecognized. That is not said to frighten anyone. It is said because this is a condition that responds well to treatment, and the difference between managed and unmanaged bipolar disorder is one of the largest we see in psychiatry.

If you or someone you know is in immediate danger, call 911 or the 988 Suicide and Crisis Lifeline (call or text 988). For non-emergency questions about scheduling or whether our practice is a good fit, call us at (561) 630-8530.