Bipolar Disorder Psychiatrists: In Person & Online

What is Bipolar Disorder?

Bipolar disorder is a serious mood disorder in which a person experiences extended periods of high or irritable mood and high energy at times, and low mood and energy at other times. These mood swings can lead to significant inconsistency in ability to function and keep up with day-to-day obligations. An individual with bipolar disorder can also have periods of feeling in the middle (“euthymic”). This disorder used to be called manic-depression. In a 12-month period in the United States, it is estimated that about 1.8% of the adult population is struggling with some form of this illness. The most typical age of onset is the early to mid-20s.

If you believe you or a loved one have bipolar disorder, please know this is a treatable condition. With the right treatment implemented as soon as possible, individuals with bipolar disorder can regain control over their moods and functioning. Mood episodes can be minimized or prevented in most cases. Our bipolar disorder specialists at Rittenhouse Psychiatric Associates can evaluate for, diagnose, and treat bipolar disorder either in person or online. Reach out today to start getting help for bipolar disorder.

What are the Symptoms of Bipolar Disorder?

Symptoms of bipolar disorder include distinct mood episodes that are unequivocally different from an individual’s baseline mood. The different mood episodes are called manic episodes, hypomanic episodes, and depressive episodes. These mood states must not occur solely due to substance use or another medical condition.

Mania and hypomania are characterized by a period of high energy, euphoric or irritable mood, motivation, rapid or increased speech, racing thoughts, impulsive behavior, decreased need for sleep, distraction, and elevated self-esteem. A severe episode lasting 7 or more days, or an episode of any duration that includes psychotic symptoms (paranoia, delusions, hallucinations) or requires hospitalization is called mania. A relatively mild episode that lasts 4 or more days is referred to as hypomania.

Hypomania is difficult for providers and patients to recognize because it does not impair functioning and is not distressing. In fact, individuals experiencing hypomanic symptoms often only recognize that they feel great, productive, and confident.

The most common mood state experienced in bipolar disorder is depression. Depression (or a depressive episode) in bipolar disorder is the same as depression in unipolar depression (or major depressive disorder). Many individuals with bipolar I or II disorder seek treatment specifically for depression and do not think to discuss the symptoms of hypomania or mania without specific inquiry from their provider.

It is important to understand that a manic or hypomanic episode need only occur ONCE in a lifetime for the patient to be considered to have bipolar disorder instead of major depressive disorder. Many individuals discount the importance of disclosing such symptoms if they occurred once many years ago. Withholding this information will impede appropriate treatment and may lead to harmful treatment that can worsen the symptoms. Providers at Rittenhouse Psychiatric Associates will thoroughly obtain your history of mood symptoms in person or online. They will differentiate among the possible mood disorders and recommend appropriate treatment based on their assessment.

Symptoms of Mania or Hypomania

Symptoms of mania and hypomania include:

• A distinct period of time during which an individual experiences uncharacteristically elevated, expansive, or irritable mood and increased activity or energy that lasts most of the day, nearly every day

Plus several of the following symptoms:

• Significantly increased confidence, self-importance, or grandiose feelings
• Decreased NEED for sleep (not just difficulty sleeping)
• Talking excessively or feeling pressure to keep talking
• Subjective feeling that thoughts are racing, which can manifest as continuous speech about loosely related topics, one after another
• Distractibility, being drawn to unimportant details
• Increase in activity. Sometimes the activity is productive, such as taking on lots of projects, making a lot of social plans, getting a lot of tasks done around the house, increased sexual activity, and partaking in a lot of creative endeavors. Sometimes the activity is not productive, such as excessive pacing, rearranging of things without a specific reason, hand-wringing, fidgeting, inability to sit still
• Reckless behavior that can result in serious consequences (uncontrolled shopping sprees or gambling, indiscriminate sexual behaviors or affairs, suddenly or impulsively quitting a job or moving).

Sometimes, some symptoms of depression are mixed into the same period as a manic or hypomanic episode. This adds additional complexity to the diagnosis of bipolar disorder.

Here is an example of a patient describing a period of hypomanic symptoms. “My mood was better than usual, and it felt like everything was finally coming together in my life. I was way more outgoing and made a ton of plans with my friends. A lot of people told me to slow down because I was talking and moving fast. I only needed 4 or 5 hours of sleep and felt totally refreshed. Usually I need at least 8 hours of sleep. I got way more work done than I usually do.”

Here is an example of a provider describing a patient with mania: The patient was sleeping 1-2 hours per night for days on end and reported “chain smoking” day and night. She was hardly eating or drinking. The patient was speaking very quickly and jumped from topic to topic, each with little connection to the last. She was pacing around her house frequently and would constantly shift positions if she sat down. The patient ended up outside in the middle of the night, shouting at the neighbors’ windows about problems she had found out about going on in the government. When someone tried to talk to her to see if she was OK, they could not get a word in. She was eventually picked up by the police and taken to the local crisis response center for psychiatric evaluation.

Symptoms of Depression

Depression symptoms do not differ in bipolar I disorder, bipolar II disorder, or major depressive disorder. The symptoms of a depressive episode last for 2 or more weeks, and the symptoms are present most of the day nearly every day. The symptoms include:

• Depressed, sad, blue, empty mood and/or loss of interest in almost all activities most of the day nearly every day

Plus several of the following symptoms:

• Unintentional weight gain or loss, or appetite increase or decrease
• Difficulty sleeping or sleeping excessively
• Being more restless or slow to the point that others notice
• Fatigue or loss of energy
• Lower self-esteem or excessive or inappropriate guilt
• Difficulty concentrating, difficulty thinking, or difficulty making decisions
• Recurrent thoughts about one’s own death, suicidal thoughts with or without a plan, or a suicide attempt

Sometimes, some symptoms of mania are mixed into the same period as a depressive episode. This adds additional complexity to the diagnosis of bipolar disorder.

Here is a patient describing a depressive episode: “I felt really sad and was crying almost every day for a couple of weeks. I didn’t like doing my favorite things anymore. I stopped responding to texts and phone calls. I was sleeping 12 or 14 hours a day, but never felt rested. I was really down on myself and thought the world would be better off without me. I didn’t care if I woke up the next day or not. My apartment was a mess because I just couldn’t motivate myself to clean up. I even showered less than usual.  I also had a hard time focusing at work.”

Types of Bipolar Disorder

Bipolar I Disorder

Psychiatrists or other qualified providers diagnose bipolar I disorder if a person experiences one or more manic episodes. Manic episodes, at times, require hospitalization to manage and keep the individual safe. Mania is a psychiatric emergency.

Although most individuals with bipolar I disorder also experience depressive episodes, depression is not a necessary part of the diagnosis. A person with bipolar I disorder can also have hypomanic episodes and times of feeling neutral (“euthymic”).

The majority of individuals who have bipolar I disorder have a history of 3+ mental health disorders. The most common are: anxiety disorders, alcohol use disorder, other substance use disorder, and attention-deficit/hyperactivity disorder.

Bipolar II Disorder

Bipolar II disorder is diagnosed if an individual has experienced one or more hypomanic episodes, AND one or more depressive episodes. There can be neutral (“euthymic”) periods as well. If at any point the individual experiences a manic episode, the diagnosis is changed to bipolar I disorder.

Cyclothymic Disorder (Cyclothymia)

Cyclothymic disorder is a mood disorder within the bipolar spectrum of illnesses. Like bipolar I and II disorders, there are mood fluctuations that do not fall within the realm of normative. However, the elevations are not severe enough to meet the full criteria for hypomania. Similarly, the lows are not severe enough to meet the full criteria for a depressive episode. The symptoms of subthreshold ups and downs occur more often than not, and are still disruptive to functioning or are distressing. For a diagnosis of cyclothymic disorder to be made, the mood episodes must occur for 2+ years in adults (1+ years in children). There must be no symptom-free periods that last longer than 2 months.

It is important to be aware that individuals who have cyclothymic disorder have a 15-50% chance of developing bipolar I or II disorder later on, and the sooner a mood disorder is treated, the better the overall prognosis.

How Does Rittenhouse Psychiatric Associates Treat Bipolar Disorder?

Treatment for bipolar disorder is not the same for every individual who has it. It is essential for treatment to be personalized, as one treatment that works wonderfully in one individual may not work at all in another. There are specific considerations to weigh regarding all of the different medications, co-occurring substance use, pre-existing medical problems, and other mental health disorders in the same individual.

Your First Visit for Bipolar Disorder

When a patient comes to a provider at Rittenhouse Psychiatric Associates, the first steps are building a relationship with the patient while comprehensively evaluating the patient’s concerns and history. Evaluations include listening to the patient’s story, a thorough review of medical problems, current medications, past medications taken along with associated results or problems, safety assessment, cultural background, family history of medical and mental health problems, social history, educational history, substance use history, and circumstances of the patient’s upbringing. The evaluation may include ordering bloodwork and/or referrals to other specialists in some cases to rule in or rule out other possible diagnoses.

After gathering and considering the above information, the provider will develop a treatment plan that is customized for that individual patient. For bipolar disorder, this does typically include medication recommendations. The plan may also include therapy options, management of sleep and wake patterns, management of problematic substance use, mood tracking, stress management, exercise, and more. As bipolar disorder is complex, the provider and patient might meet a couple of times to discuss all of the details and options.

Therapy for Bipolar Disorder

There are many options for therapy when it comes to bipolar disorder, and different approaches may be beneficial for different individuals. Cognitive behavioral therapy (CBT) is a modality often used for treating mental health problems, including bipolar and mood disorders. CBT can help an individual manage thoughts, feelings, and behaviors that contribute to or exacerbate mood episode symptoms. Other benefits of CBT for bipolar disorder include: learning skills to better manage symptoms, improved ability to cope with the challenges of the disorder, learning to recognize when episodes are starting as early as possible, improving functioning, managing co-occurring conditions (anxiety, substance use, ADHD), building habits that keep an individual stable and healthy, and more. CBT is not appropriate for managing mania.

Another therapy modality option is dialectical behavior therapy (DBT). DBT is based on four core principles: emotional regulation, distress tolerance, mindfulness, and interpersonal effectiveness. Patients learn skills to enhance these abilities in themselves, which can in turn help reduce symptoms of bipolar disorder and reduce distress caused by the symptoms of bipolar disorder. It is also potentially helpful for reducing suicidal behavior, which is of significant concern with this mood disorder.

Psychotherapy with a Rittenhouse Psychiatric Associates provider is available in most states.

Medication Management

Medications are an essential part of managing bipolar I and II disorder symptoms. It is also common for a patient with bipolar disorder to need 2 or more medications for symptoms to fully remit. There are nuanced reasons why one medication may be chosen over another. A psychiatry specialist, such as a psychiatrist or psychiatric nurse practitioner, should guide patients in this process, monitor for problematic side effects, and modify treatment when necessary. Some of these medications require careful monitoring. At Rittenhouse Psychiatric Associates, we believe in using the least amount of medication necessary to achieve adequate improvement and stability of the conditions we treat.

Options available to manage mania, hypomania, and depression include mood stabilizers and antipsychotics. (Of note, a more accurate name for antipsychotic medications is “serotonin-dopamine antagonists,” as they are not solely used for treating psychotic symptoms). While the mechanisms by which these medications work are extremely complex, they can be thought of as evening out abnormal brain activity by changing how brain cells communicate and/or by modifying levels of chemical messengers in the brain.

At times, other categories of medications are called upon to help manage symptoms. These can include anti-anxiety medications, insomnia medications, and antidepressants (with caution, as antidepressants can worsen bipolar disorder symptoms in some situations).

Despite the popular belief that medications for bipolar disorder will make people “flat,” or “feel like a zombie,” or make people “tranquilized,” the right medication(s) at the right dosage(s) for an individual can help them to feel like themselves again, and bring one’s mood within a normative range. People who take medications for bipolar disorder can be successful, active, creative, and maintain a normative range of emotions.

Bipolar Medication Management with RPA Available in these States:

• Delaware
• Florida
• New Jersey
• New York
• Pennsylvania

How to Choose a Bipolar Disorder Treatment Provider

There are several ways to find a psychiatrist or psychiatric nurse practitioner specializing in bipolar disorder treatment. The process can seem overwhelming, but finding a provider is similar to seeking any medical specialist.

• Talk to your doctor about psychiatrists near you who treat bipolar disorder.
• Call local hospitals and teaching institutions for recommendations.
• Call your insurance carrier and ask about bipolar disorder treatment near you.
• Search online for psychiatrists who specialize in bipolar disorder.
• If you have family or friends who have seen local psychiatrists who specialize in bipolar disorder treatment, it may be reasonable to ask if they would recommend (or not recommend) a certain doctor or psychiatrist.
• Utilize national mental health resources for additional guidance.

Rittenhouse Psychiatric Associates In-Person Bipolar Disorder Treatment Locations

• Wilmington, DE
• Collingswood, NJ
• Manhattan, NY
• Center Valley, PA
• Paoli, PA
• Philadelphia, PA
• Pittsburgh, PA

Discover Rittenhouse Psychiatric Associates on YouTube

Learn more about bipolar disorders on the Rittenhouse Psychiatric Associates YouTube channel:

• A Deeper Look at Bipolar I Disorder
• A Deeper Look at Bipolar II Disorder