Bipolar Disorder
Bipolar disorder is something we are deeply passionate about understanding and destigmatizing. It is frequently diagnosed years after the symptoms began, most often because people seek help during depression and not during the elevated periods — which rarely feel like a problem at the time.
How is bipolar disorder different from depression?
By the presence of elevated episodes.
Bipolar I involves mania: elevated or irritable mood with markedly reduced need for sleep, rapid speech and thought, impulsivity and inflated confidence, severe enough to disrupt function or negatively impact life. These episodes can last as little as a week or months on end.
Bipolar II involves hypomania — the same features of mania, but in milder and briefer form, disruptive but not usually catastrophic. This can last just a handful days and seem to resolve uneventfully. This is very frequently missed because hypomania often feels good, though it can be euphoric (aka happy) or dysphoric (aka irritable). People describe it as their best weeks: productive, sociable, needing less of sleep than usual and still feeling fine.
Why does it get misdiagnosed as depression?
Because nobody makes an appointment because they feel great! The depressive episodes are what bring people in, and unless a skilled clinician specifically asks about periods of reduced sleep need and elevated energy, the pattern is invisible or often seems like “just my personality.” The distinction matters clinically: antidepressants given alone in bipolar depression may be ineffective and can in some cases trigger a switch into mania or hypomania, or accelerate mood cycling.
What should make me consider it?
- Periods of a few or more days needing much less sleep and not feeling tired
- Depression that began in adolescence or early twenties — the earlier age of onset, the more likely a depression is bipolar, not unipolar
- Several antidepressants that worked briefly and then stopped
- An antidepressant that produced agitation, insomnia, or unusual energy
- A first-degree relative with bipolar disorder
- Postpartum onset of severe mood symptoms
None of these is diagnostic alone. Together, they are worth an evaluation.
Is the postpartum period higher risk?
Yes, substantially. The weeks after delivery carry the highest risk of episode onset or recurrence in bipolar disorder of any period in life. If you have bipolar disorder and are pregnant or planning a pregnancy, this deserves careful planning rather than watchful waiting. For more info, please see perinatal and postpartum psychiatry.
How is it treated?
Mood stabilizers and certain second-generation antipsychotics are the mainstays, with antidepressants used cautiously and generally alongside a stabilizer rather than alone.
Sleep regulation is genuinely part of treatment rather than an afterthought — sleep disruption both triggers and signals episodes, and protecting it is protective.
Several effective medications carry metabolic side effects. We monitor and manage those rather than accepting them as a cost of treatment. See obesity psychiatry. Where medication selection has been difficult, pharmacogenetic testing may inform next steps.
If you are in crisis, please immediately call or text 988 for the Suicide & Crisis Lifeline, or call 911. Safety is our top priority, and our outpatient office is not equipped to handle emergencies.
Treatment in person and throughout Arizona
We see patients in person at our office in Glendale (in the Arrowhead area) and via telehealth anywhere in Arizona — from Tucson, to Flagstaff, to the east valley, and everywhere between. Virtual visits are the same appointment with the same provider at the same rate.
Getting Started
Our comprehensive, new patient evaluations are $375 and require 60 to 90 minutes.
Our psychiatric follow-up visits are $125 and require 30 minutes.
(Thank you for arriving early, as we are unable to see late patients and must reschedule if life gets in the way of you arriving on time.)
We are out-of-network with all insurance carriers but will gladly provide a superbill you can submit to insurance to seek reimbursement.
For more info, please see our fees page.
Pinnacle Psychiatry
17505 N 79th Ave, Suite 309, Glendale, AZ 85308
Phone 623.321.2221 · Text 877.749.7502
Monday–Wednesday 8:00am–5:00pm · Thursday 7:00am–5:00pm