Understanding Bipolar Disorder: Beyond Mood Swings

Bipolar disorder is a complex mood disorder characterized by episodes of mania or hypomania alternating with episodes of depression. It's not simply "mood swings"—it's a serious neurobiological condition affecting mood regulation, energy, cognition, sleep, and behavior. Research indicates that bipolar disorder involves dysregulation across multiple neurotransmitter systems (dopamine, serotonin, norepinephrine, glutamate) as well as circadian rhythm disruption, sleep architecture changes, and alterations in neural circuits involved in reward processing and emotional regulation.

When I evaluate patients with bipolar disorder, I'm assessing multiple systems: mood episode patterns (manic, hypomanic, depressive, mixed), sleep architecture (decreased need for sleep in mania, disrupted sleep in depression), circadian rhythms (often disrupted in bipolar disorder), energy levels, cognitive function, and factors that may trigger episodes. Bipolar disorder exists on a spectrum, with different presentations requiring different treatment approaches.

Bipolar I disorder involves at least one manic episode (elevated or irritable mood, increased energy, decreased need for sleep, racing thoughts, impulsivity) lasting at least a week or requiring hospitalization. Bipolar II disorder involves hypomanic episodes (similar to mania but less severe) alternating with depressive episodes. Cyclothymic disorder involves numerous periods of hypomanic and depressive symptoms that don't meet full criteria for episodes.

Bipolar disorder affects approximately 2.8% of U.S. adults, according to the National Institute of Mental Health. It's a chronic condition requiring ongoing treatment, but with appropriate care, many patients achieve stability and improved quality of life.

An Integrative Approach to Bipolar Treatment

Effective bipolar treatment requires mood stabilization, typically with mood stabilizers or atypical antipsychotics, combined with psychotherapy, lifestyle management, and attention to sleep and circadian rhythms. Research indicates that bipolar disorder involves dysregulation across multiple systems: neurotransmitter function (dopamine, serotonin, glutamate), circadian rhythms (often disrupted), sleep architecture (decreased need for sleep in mania, disrupted sleep in depression), and stress response systems. An integrative approach recognizes that bipolar disorder affects multiple systems and requires comprehensive management. Learn more about integrative psychiatry.

When I work with patients with bipolar disorder, I'm addressing these systems comprehensively. My approach includes:

Comprehensive Evaluation: Thorough assessment of mood episodes, symptom patterns, medication history, sleep patterns, and factors that may trigger episodes
Mood Stabilization: Evidence-based medication management using mood stabilizers (lithium, valproate, lamotrigine) or atypical antipsychotics, tailored to the specific type of bipolar disorder and individual response
Sleep and Circadian Management: Sleep disruption is both a symptom and a trigger for episodes. Research indicates that circadian rhythm disruption can trigger mood episodes in bipolar disorder. Careful attention to sleep architecture, circadian rhythms, and maintaining regular sleep-wake cycles is essential for stability
Psychotherapy: Evidence-based psychotherapeutic approaches including cognitive-behavioral therapy for bipolar disorder, interpersonal and social rhythm therapy, and psychoeducation about the condition
Lifestyle Medicine: Attention to stress management, regular routines, nutrition, physical activity, and avoidance of substances that can trigger episodes
Episode Prevention: Identifying early warning signs of mood episodes and developing strategies to prevent or minimize their impact

Treatment is long-term and collaborative, focused on maintaining stability, preventing episodes, and supporting overall well-being. Regular monitoring and medication adjustments are often necessary to maintain stability.

Bipolar Depression and Mixed Episodes

Bipolar depression can be particularly challenging, as it often doesn't respond well to antidepressants alone and may require different approaches than unipolar depression. Mixed episodes, in which symptoms of mania and depression occur simultaneously, require careful management to address both sets of symptoms.

Treatment considerations include:

Avoiding antidepressants that may trigger mania or rapid cycling
Using mood stabilizers or atypical antipsychotics that address both depressive and manic symptoms
Addressing sleep disruption, which is often central to mood instability
Managing stress and maintaining regular routines to support mood stability
Psychotherapy focused on managing bipolar symptoms and preventing episodes

The goal is achieving and maintaining mood stability, preventing episodes, and supporting a life that feels meaningful and manageable.

What to Expect in Treatment

Your initial evaluation is comprehensive—typically 90 minutes—allowing time to understand your mood episodes, symptom patterns, medication history, and treatment goals. We develop a collaborative treatment plan focused on mood stabilization and episode prevention.

Treatment typically involves mood-stabilizing medication, regular monitoring, psychotherapy, and lifestyle management. Follow-up appointments focus on monitoring mood stability, adjusting medications as needed, and addressing any emerging symptoms or concerns.

Bipolar disorder is a chronic condition requiring ongoing treatment, but with appropriate care, many patients achieve significant stability and improved quality of life. The goal is not just preventing episodes—it's supporting overall well-being, functioning, and a life that feels stable and meaningful.

Serving Los Angeles Area

I provide adult bipolar disorder treatment to patients throughout Los Angeles County, including Hollywood, Beverly Hills, Santa Monica, West Hollywood, Burbank, Glendale, Pasadena, and surrounding areas. The practice is located in Hollywood and offers both in-person and telepsychiatry visits for adults throughout California.

If you're experiencing symptoms of bipolar disorder or have been diagnosed with bipolar disorder, know that effective treatment is available. With appropriate care, many patients achieve mood stability and improved quality of life.

References & Resources

For additional information about bipolar disorder, I recommend these authoritative sources:

For more information about bipolar disorder, see our article on understanding the bipolar spectrum.

Contact us to schedule a consultation or learn more about our approach to bipolar disorder treatment.