You're Not "Too Much" and You're Not "Broken"

If your moods swing between highs that feel electric (but sometimes destructive) and lows that feel crushing—if you've been told you're "too intense" or "dramatic" when you're actually experiencing a real medical condition—you're not alone, and you're not broken.

Bipolar disorder is real, it's treatable, and it doesn't make you less worthy of care, love, or stability.

Bipolar Disorder - Table of Contents

What Bipolar Disorder Actually Is

Bipolar disorder is a mood disorder characterized by episodes of significantly elevated or irritable mood (mania or hypomania) and episodes of depression. It's not just "mood swings"—it's distinct mood episodes that last days to months and significantly affect functioning.

It's Often Misdiagnosed:

  • As depression (if hypomanic episodes are missed or not recognized)
  • As anxiety or ADHD (which often co-occur)
  • As borderline personality disorder
  • As "just being dramatic" or "having a bad personality"

Getting an accurate diagnosis is crucial because treatment for bipolar disorder is different than treatment for depression alone.

Types of Bipolar Disorder

Bipolar I Disorder:

  • At least one manic episode (may also have hypomanic or depressive episodes)
  • Manic episodes are severe and may include psychotic features
  • Often requires hospitalization during manic episodes

Bipolar II Disorder:

  • At least one hypomanic episode and at least one depressive episode
  • Never had full mania
  • Depressive episodes are often more frequent and severe
  • Often misdiagnosed as depression

Cyclothymic Disorder:

  • Chronic mood instability for at least 2 years
  • Multiple hypomanic and depressive symptoms that don't meet full criteria
  • Never symptom-free for more than 2 months

Other Specified/Unspecified Bipolar:

  • Bipolar symptoms that don't fit neatly into categories above
  • Still real, still treatable

What Mania & Hypomania Look Like

Manic Episode (Bipolar I):

  • Elevated, expansive, or irritable mood
  • Decreased need for sleep (not just insomnia—feeling like you don't need sleep)
  • Racing thoughts, rapid speech
  • Grandiosity or inflated self-esteem
  • Increased goal-directed activity or psychomotor agitation
  • Risky or impulsive behavior (spending sprees, sexual indiscretions, reckless driving)
  • Distractibility
  • May include psychotic features (delusions, hallucinations)
  • Lasts at least 7 days or requires hospitalization

Hypomanic Episode (Bipolar II):

  • Same symptoms as mania but less severe
  • Lasts at least 4 days
  • Noticeable change from usual behavior
  • Doesn't cause severe impairment or require hospitalization
  • No psychotic features
  • Often feels good initially (productive, creative, social)

Important: Mania/hypomania isn't just "feeling good." It's a distinct change from your normal state that others notice and that can lead to consequences.

What Bipolar Depression Looks Like

Bipolar depression often includes:

  • Severe low mood, hopelessness
  • Sleeping too much (hypersomnia)
  • Psychomotor slowing (moving slowly, feeling heavy)
  • Severe fatigue and low energy
  • Difficulty concentrating
  • Suicidal thoughts
  • Sometimes psychotic features

Bipolar depression is different from unipolar depression:

  • Often more severe
  • More likely to include increased sleep and appetite
  • More likely to include psychomotor slowing
  • Responds differently to treatment
  • Antidepressants alone can trigger mania

Mixed Episodes & Rapid Cycling

Mixed Features:

  • Symptoms of both mania/hypomania and depression at the same time
  • Particularly dangerous because of high suicide risk
  • Example: depressed mood with racing thoughts and agitation

Rapid Cycling:

  • Four or more mood episodes in 12 months
  • More common in Bipolar II
  • Often harder to treat
  • More common in women

Medical Causes We Rule Out First

Before diagnosing bipolar disorder, we check for medical conditions that can mimic bipolar symptoms:

  • Thyroid disorders: Both hyper and hypothyroidism can cause mood episodes
  • Neurological conditions: Multiple sclerosis, brain tumors, epilepsy
  • Autoimmune conditions: Lupus, others
  • Hormonal imbalances: Cushing's syndrome, others
  • Vitamin deficiencies: B12 deficiency can cause mood symptoms
  • Medication effects: Steroids, stimulants, others can cause mania
  • Substance use: Stimulants, cocaine, alcohol can mimic or trigger episodes

We order comprehensive lab work before finalizing diagnosis.

Co-Occurring Conditions

Bipolar disorder rarely exists alone. We also assess for:

  • Anxiety disorders: Present in 50-75% of people with bipolar disorder
  • ADHD: Common and requires careful treatment coordination
  • Substance use disorders: Very common (self-medication, risk-taking during mania)
  • Eating disorders: Higher rates in bipolar disorder
  • PTSD: Can co-occur and complicate treatment
  • Medical conditions: Metabolic syndrome, thyroid problems, migraines

Our Approach to Bipolar Treatment

Accurate Diagnosis First: We take comprehensive history including:

  • Past mood episodes (even if they seemed "just happy" at the time)
  • Family history (bipolar has strong genetic component)
  • Response to past medications (especially antidepressants)
  • Substance use patterns
  • Sleep patterns
  • Functional impairment during episodes

Mood Stabilization is Primary: Unlike unipolar depression, bipolar disorder requires mood stabilizers as the foundation of treatment.

We May Use:

Mood Stabilizers:

  • Lithium (gold standard, very effective)
  • Anticonvulsants (valproate, carbamazepine, lamotrigine)
  • Atypical antipsychotics (quetiapine, olanzapine, aripiprazole, lurasidone, others)

For Depression in Bipolar:

  • Mood stabilizer as foundation
  • Sometimes adding antidepressant (carefully, with mood stabilizer)
  • Atypical antipsychotics with antidepressant properties
  • Lamotrigine (particularly good for bipolar depression)

For Mania/Hypomania:

  • Mood stabilizers
  • Atypical antipsychotics
  • Sometimes benzodiazepines for acute agitation
  • Sleep medications (sleep disruption can trigger episodes)

For Maintenance:

  • Continued mood stabilizer to prevent future episodes
  • Regular monitoring
  • Relapse prevention planning

Important Medication Considerations:

  • Antidepressants alone can trigger mania—they must be used carefully
  • Some medications require regular blood monitoring (lithium, valproate)
  • Finding the right medication often takes time and adjustment
  • We consider side effects, your lifestyle, and your preferences

Medication Monitoring

Some bipolar medications require regular monitoring:

  • Lithium: Blood levels, kidney and thyroid function
  • Valproate: Blood levels, liver function
  • Antipsychotics: Weight, metabolic panel, movement disorders
  • Lamotrigine: Rash monitoring (especially when starting)

We coordinate this monitoring and make it as convenient as possible.

Beyond Medication: What Else Helps

Sleep Hygiene: Sleep disruption both triggers and signals mood episodes. Protecting sleep is crucial.

Routine & Structure: Regular sleep/wake times, meals, and activities help stabilize mood.

Mood Monitoring: Tracking mood, sleep, and activities helps identify early warning signs of episodes.

Substance Use: Alcohol and drugs can trigger episodes and interact with medications. We address this non-judgmentally.

Stress Management: While you can't eliminate stress, managing it reduces episode risk.

Therapy: We're not therapists, but we can connect you with therapists who specialize in bipolar disorder (CBT, DBT, IPSRT, family therapy).


Support System: Family/friends who understand your diagnosis and early warning signs.

Relapse Prevention

Identifying Triggers:

  • Stress
  • Sleep disruption
  • Seasonal changes
  • Life transitions
  • Substance use
  • Medication non-adherence

Early Warning Signs:

  • Decreased sleep need
  • Increased energy or goal-directed activity
  • Racing thoughts
  • Irritability
  • Increased spending or risk-taking
  • Social withdrawal (depression)
  • Changes in appetite or sleep

Crisis Planning:

  • What to do if you notice early warning signs
  • Who to contact
  • When to go to emergency services
  • Advanced directives (when stable, deciding what you want if you become manic)

What Treatment Looks Like

Initial Evaluation (60-90 minutes): Comprehensive diagnostic assessment, including past episodes, family history, substance use, and functional impact.

Lab Work: Blood work to rule out medical causes and establish baseline for medication monitoring.

Treatment Planning: Collaborative discussion of medication options, benefits, side effects, and monitoring requirements.

Starting Medication: Usually beginning with mood stabilizer, starting at lower doses and adjusting based on response and blood levels.

Frequent Follow-Up Initially: During medication adjustment phase, appointments every 2-4 weeks to monitor response, side effects, and blood levels.

Maintenance Care: Once stable, appointments typically every 1-3 months for ongoing medication management and relapse prevention.

Crisis Support: Access between appointments if experiencing episode warning signs.

Ages We Serve

We provide bipolar disorder care for:

  • Teens (12+): Bipolar often first appears in adolescence
  • Young adults: Peak age of onset is late teens/early 20s
  • Adults: Ongoing management and new diagnoses
  • Older adults: Long-term management and late-onset bipolar

The Reality of Living with Bipolar

It's Manageable: With proper treatment, most people with bipolar disorder can live stable, fulfilling lives.

It Takes Time: Finding the right medication combination often requires patience and adjustment.

It's Chronic: Bipolar disorder is a lifelong condition, but that doesn't mean constant suffering—it means ongoing management.

Medication is Usually Necessary: Unlike some conditions, bipolar disorder typically requires ongoing medication to prevent episodes.

You're Not Your Diagnosis: Having bipolar disorder doesn't define you. It's one part of your health that you manage.

Telehealth Throughout Colorado

All appointments are virtual, offering:

  • Regular access to care regardless of where you live
  • Easier to maintain consistent appointments
  • Privacy and comfort of your own space
  • Reduced barriers when you're depressed or manic

Insurance & Access

We accept most major insurance including:

  • Aetna
  • Cigna
  • United Healthcare
  • Oscar
  • Optum
  • Blue Cross Blue Shield
  • Private pay options

Note: We do not accept Medicaid or Medicare at this time.

Crisis Support

If you're in crisis:

  • 988 Suicide & Crisis Lifeline: Call or text 988
  • Colorado Crisis Services: 1-844-493-8255
  • 911 if you're in immediate danger
  • Nearest emergency room if experiencing manic episode with risk of harm

You Deserve Stability

Bipolar disorder can feel chaotic and overwhelming, but stability is possible. You don't have to ride the roller coaster forever.

With proper diagnosis, medication management, and support, most people with bipolar disorder achieve significant mood stability and quality of life.

Ready for Expert Bipolar Care?

If you think you might have bipolar disorder, if you've been diagnosed but struggling with treatment, if you're tired of the mood swings and ready for stability—we're here.

Book an appointment online or call us at (719) 212-1951.

Same-week appointments available. Stability is possible.

Frequently Asked Questions

How do you know if it's bipolar or just depression?

We take detailed history of past mood episodes, family history, and response to antidepressants. Bipolar depression often includes different symptoms, and people with bipolar often have periods of elevated or irritable mood.

Can bipolar disorder be treated without medication?

For most people, no. Bipolar disorder has strong biological/genetic components and usually requires medication for mood stabilization. Therapy and lifestyle changes are helpful additions but not usually sufficient alone.

Will I be on medication forever?

Most people with bipolar disorder need ongoing medication to prevent future episodes. Stopping medication significantly increases relapse risk.

What if I liked how I felt during hypomania?

Many people enjoy hypomania initially—increased energy, creativity, productivity. But it often progresses to problematic mania or is followed by severe depression. Treatment helps prevent the destructive parts while maintaining your personality.

Can you have bipolar disorder and ADHD?

Yes, they commonly co-occur. Treatment requires careful medication selection to avoid triggering mania.

What about pregnancy?

Some bipolar medications aren't safe during pregnancy. We carefully weigh risks and benefits and can work with you to find the safest approach for your situation.

Forest Path Psychiatry & Healing is a nurse-led psychiatric practice serving all of Colorado via telehealth. Our board-certified PMHNPs provide comprehensive, trauma-informed care for bipolar disorder including accurate diagnosis, mood stabilization, and relapse prevention.