In my clinical practice, I regularly see patients who have spent years being treated for depression — sometimes with multiple antidepressants — only to later receive an accurate diagnosis of bipolar disorder. This is not uncommon. Bipolar disorder is one of the most commonly misdiagnosed conditions in psychiatry, largely because people tend to seek help during depressive episodes rather than hypomanic or manic ones.
Understanding bipolar disorder — what it actually looks and feels like — is the first step toward getting the right care.
What Is Bipolar Disorder?
Bipolar disorder is a mood disorder characterized by episodes of mania or hypomania alternating with episodes of depression. The shifts are not just mood swings — they are distinct episodes that last days to weeks and involve significant changes in energy, sleep, behavior, and thinking.
There are several types. Bipolar I involves full manic episodes (which can include psychosis and typically require hospitalization). Bipolar II involves hypomanic episodes — less severe than full mania — alternating with major depressive episodes. Cyclothymia involves milder cycling over at least two years.
Signs of a Manic or Hypomanic Episode
Mania and hypomania can feel good — at first. Common signs include:
- Decreased need for sleep without feeling tired
- Racing thoughts and rapid speech
- Grandiosity or inflated self-esteem
- Increased goal-directed activity or agitation
- Impulsive decisions: spending sprees, risky investments, sexual indiscretions
- Distractibility
- In mania: psychosis, severe impairment, hospitalization may be necessary
Signs of a Bipolar Depressive Episode
Bipolar depression looks similar to major depression but has some distinguishing features:
- Profound fatigue and hypersomnia (sleeping too much)
- Slowed thinking and movement (psychomotor retardation)
- Persistent low mood, hopelessness
- Appetite changes and weight changes
- Difficulty concentrating
- In some cases, mixed features — depressive symptoms with some manic energy simultaneously
Why Bipolar Disorder Is Frequently Misdiagnosed
Most people with bipolar disorder first seek treatment during a depressive episode. Without a full history — including questions specifically about hypomanic or manic periods — depression is the natural diagnosis. Antidepressants are prescribed, which can sometimes trigger hypomanic or mixed episodes in people with unrecognized bipolar disorder.
This is why a thorough psychiatric evaluation matters. I always ask about periods of unusually high energy, reduced sleep, risky behavior, or feeling "on top of the world" — even if the patient comes in describing depression.
Treatment for Bipolar Disorder
Bipolar disorder is a lifelong condition, but it is highly manageable with the right treatment. The goal is mood stabilization — reducing the frequency, severity, and duration of episodes.
Mood Stabilizers
Lithium remains one of the most effective mood stabilizers and has strong evidence for reducing both manic and depressive episodes, as well as reducing suicide risk. Valproate (Depakote) and lamotrigine (Lamictal) are also commonly used. Lamotrigine is particularly effective for bipolar depression.
Atypical Antipsychotics
Several second-generation antipsychotics are FDA-approved for bipolar disorder, including quetiapine, aripiprazole, and lurasidone. These are often used for acute mood episodes and as long-term maintenance therapy.
The Role of Therapy
Medication is the foundation of bipolar treatment — but therapy is a powerful complement. Psychoeducation about the illness, mood charting, identifying early warning signs of episodes, and developing coping strategies all significantly improve long-term outcomes.
Getting Care in Texas
If you suspect you may have bipolar disorder — or if you have been diagnosed and are looking for a provider — Heartland Psychiatry and Wellness offers comprehensive evaluation and medication management via telehealth across Texas. You do not need to travel to a clinic to receive expert psychiatric care.