Bipolar Disorder Care Pathway

Bipolar disorder is a mood disorder characterized by episodes of mania or hypomania (elevated, expansive, or irritable mood with increased energy) alternating with episodes of depression. The DSM-5-TR distinguishes bipolar I disorder (at least one manic episode — a distinct period of abnormally elevated or irritable mood lasting at least 7 days, or any duration if hospitalization is required) from bipolar II disorder (at least one hypomanic episode and one major depressive episode, without a full manic episode).

Bipolar disorder affects about 2.8% of U.S. adults. It is often misdiagnosed as unipolar depression because people tend to seek help during depressive episodes, and the manic or hypomanic episodes may not be recognized as symptoms. This misdiagnosis matters: standard antidepressants given without a mood stabilizer can trigger manic episodes or rapid cycling. An accurate diagnosis is essential for safe, effective treatment.

Treatment for bipolar disorder typically involves mood-stabilizing medication (lithium, valproate, lamotrigine) as the foundation, often combined with psychotherapy. CBT adapted for bipolar disorder, interpersonal and social rhythm therapy (IPSRT), and family-focused therapy all have evidence. Lifestyle factors — regular sleep, routine, exercise, and avoiding alcohol and drugs — are especially important in bipolar disorder because disruptions to circadian rhythm and substance use are known triggers for episodes.