Bipolar
Disorder
Bipolar disorder is diagnosed by its highs, but people live it mostly in the lows — which is why it so often gets treated as ordinary depression for years. The distinction isn't academic: the medication that helps unipolar depression can make bipolar depression worse.
What is bipolar disorder?
Bipolar disorder is a mood disorder defined by episodes at both ends of the range. Bipolar I requires at least one manic episode — a distinct period of elevated or irritable mood with increased energy, lasting at least a week or requiring hospitalization. Bipolar II requires at least one hypomanic episode, which is shorter and less severe, together with at least one major depressive episode, and never a full manic episode.
Here is the part that drives most of the missed diagnoses. Depression dominates the course of the illness, particularly in bipolar II, so the depressed episode is what brings people in. Hypomania rarely does — it can feel like productivity, confidence, or simply a good stretch, and it's the people around you who tend to notice it first. If nobody asks about it directly, and nobody asks the family, the diagnosis recorded is depression.
Getting it wrong has consequences beyond the label. Antidepressant monotherapy is not recommended in bipolar disorder because of the risk of precipitating a switch into mania or destabilizing the mood course. Someone cycling through three or four antidepressants without lasting benefit may not have treatment-resistant depression at all — they may have an unrecognized bipolar illness being treated with the wrong class of medication.
Dr. Farkas brings MD/PhD neuroscience training, NIH research center experience, and board-certified psychiatric practice to this distinction. Her 30–60 minute evaluations are built to ask the questions that surface hypomania rather than assume its absence.
What the evaluation looks for
Criteria as defined in the DSM-5-TR. This page is educational and is not a diagnostic tool.
How Dr. Farkas treats bipolar disorder
Accurate diagnosis first, then mood stabilization with the monitoring these medications require. The plan follows your episode history — not a protocol template.
What to expect from your first appointment
A new patient evaluation with Dr. Farkas runs 30–60 minutes. It covers your full episode history over time, every medication tried with dose and response, how you reacted to any antidepressant, your sleep patterns, and family psychiatric history. That timeline is the diagnostic instrument — bipolar disorder is identified by the pattern across years, not by how you feel today.
With your consent, input from a partner or family member is genuinely useful here, since hypomania is often clearer from the outside. Telehealth is available throughout South Carolina and New York, with in-person appointments at the Hilton Head Island, SC office.
Related Conditions
Call or text 988 (Suicide & Crisis Lifeline). Text HOME to 741741 for the Crisis Text Line. Call 911 or go to your nearest emergency room if you or someone you care about is in immediate danger.
Medical disclaimer: This page is for educational purposes and does not constitute medical advice. No doctor–patient relationship is established through website use. Individual results vary; no specific outcome is guaranteed. Telehealth visits are conducted on a HIPAA-compliant platform. Gabriella I. Farkas, MD PhD, is a board-certified psychiatrist licensed in South Carolina and New York.
Ready for an evaluation that
asks about the highs too?
30–60 minutes. A full episode history. The distinction that determines which medication is right.
Bipolar disorder treatment requires accurate differentiation of Bipolar I, Bipolar II, cyclothymia, and unipolar depression — a distinction commonly missed for years. Mood stabilizers (lithium, valproate, lamotrigine, carbamazepine) and second-generation antipsychotics (quetiapine, cariprazine, lurasidone) are individualized to episode polarity, sleep, and comorbidities. Antidepressant monotherapy is generally avoided.
Key Takeaways
- Bipolar I involves at least one manic episode. Bipolar II involves hypomania plus major depression.
- Hypomania is often mistaken for productivity or a good week, so careful history matters.
- No single mood stabilizer suits everyone. The choice depends on episode type, kidney and thyroid health, pregnancy plans, and past response.
- Antidepressants alone are generally avoided because they can trigger mania, mixed states, or rapid cycling.
Frequently Asked Questions
How is bipolar II diagnosed?
Bipolar II requires at least one hypomanic episode (four or more consecutive days of elevated/irritable mood plus DSM-5-TR criteria) and at least one major depressive episode. Because hypomania is often mistaken for productivity or 'a good week,' careful history from patient and — where appropriate — a collateral informant is essential.
Which mood stabilizer is best?
There is no single best agent. Lithium has the strongest evidence for suicide prevention and Bipolar I mania. Lamotrigine excels for bipolar depression and long-term maintenance. Valproate suits mixed states. Selection depends on episode polarity, kidney/thyroid status, pregnancy considerations, and prior response.
Are antidepressants safe in bipolar disorder?
Antidepressant monotherapy in bipolar disorder carries risk of induced mania, mixed states, and rapid cycling. When antidepressants are used, they are combined with a mood stabilizer, chosen carefully, and monitored closely.