Bipolar Disorder

Bipolar disorder involves episodes of elevated or irritable mood, called mania or hypomania, that alternate with depressive episodes. It is usually the depressive side that brings someone in, because the elevated side rarely feels like a problem while it is happening.

It is frequently mistaken for depression at first. People tend to seek help when they feel terrible rather than when they feel unusually good, and ordinary depression screening does not ask about elevated mood at all. Getting the diagnosis right before treatment begins matters, because an antidepressant given on its own to someone with bipolar disorder can trigger a manic episode or make mood cycling worse.

Why the evaluation looks further back

The evaluation asks specifically about periods of reduced need for sleep, unusually high energy, racing thoughts, and uncharacteristic risk-taking, not only about low mood. Family history is part of this too. Hypomania, the milder form, often feels good at the time - productive, confident, sociable, needing little sleep and feeling fine on it - which is exactly why it rarely gets reported as a symptom. If someone close to you can describe what you are like during those stretches, their account is genuinely useful, since elevated episodes are often hard to see clearly from the inside.

Keeping mood stable over time

Medication is usually central, most often a mood stabiliser or an antipsychotic rather than an antidepressant on its own, and some of these require blood monitoring, which is arranged and tracked rather than left for you to remember. Alongside medication, sleep is treated as a real clinical target: sleep loss can both signal an approaching episode and help bring one on, which makes it one of the more useful things to track. Appointments happen in person in Raleigh or by secure video, whichever suits you, and follow-up continues on a regular basis, because stability is something maintained over time rather than reached once and left alone.

If you are having thoughts of suicide

Thoughts of suicide can occur during the depressive episodes of bipolar disorder, and they are safe to raise with your provider at any appointment, not only in a crisis.

If you are in immediate danger, do not wait. Call or text 988 to reach the Suicide & Crisis Lifeline, call 911, or go to your nearest emergency room. This practice does not provide emergency services.