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.
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.
Related pages
Bipolar
Disorder
Bipolar I & II — including the misdiagnosed cases that have been treated as unipolar depression for years. Accurate diagnosis changes everything. Dr. Farkas's rigorous diagnostic approach catches what others miss.
What is Bipolar?
Bipolar I & II — including the misdiagnosed cases that have been treated as unipolar depression for years. Accurate diagnosis changes everything. Dr. Farkas's rigorous diagnostic approach catches what others miss.
Dr. Farkas brings a rare combination of MD/PhD neuroscience training, NIH research center experience, and clinical expertise to the evaluation and treatment of bipolar disorder. Her 30–60 minute new patient evaluations are designed to understand your full picture — medical history, prior treatments, contributing factors — before any treatment begins.
Effective treatment requires accurate diagnosis. Dr. Farkas's rigorous diagnostic approach ensures the right condition is identified and treated — not just the most common one that looks similar.
Common presentations
How Dr. Farkas treats
Bipolar Disorder
Evidence-based, neurobiologically-informed care. The treatment plan is built around your specific situation — not a protocol template.
What to expect from
your first appointment
A new patient evaluation with Dr. Farkas is 30–60 minutes — not a rushed intake. It covers your full psychiatric and medical history, prior diagnoses, all medications tried, and what has or hasn't worked. You'll leave with a clear diagnosis, a treatment plan you understand and agree with, and a follow-up already scheduled.
Telehealth is available throughout South Carolina, New York, and Virginia. In-person appointments are available at our Hilton Head Island, SC office.
Ready for a real evaluation
of Bipolar?
30–60 minutes. Expert diagnosis. A treatment plan built around your specific situation.