Bipolar disorders
Careful diagnosis across the whole course of illness — and treatment designed to keep you well, not just to end the current episode.
Bipolar disorder is among the most consequential diagnoses in psychiatry to get right — and among the most frequently missed. I have spent four years treating bipolar disorders at UCSF’s Bipolar Clinic and inpatient service, and it is the center of this practice.
Who this is for
- People with an established diagnosis of bipolar I or bipolar II disorder who want expert, continuous care.
- People with recurrent depression that keeps returning, or that responded to antidepressants briefly and then stopped.
- People who have been called “treatment-resistant” without a clear explanation of why.
- People whose mood, sleep and energy change in ways that never quite fit the diagnosis they were given — including those who recognize no obvious “highs.”
- Families and clinicians seeking a second opinion on a complex or contested diagnosis.
How I evaluate
The evaluation reconstructs the course of illness over time rather than a snapshot of the present. That means a detailed timeline of episodes — their onset, duration, character and what preceded them — alongside sleep, energy and attention; family history; every prior medication trial with its dose, duration, benefit and side effects; and, with your permission, records and the observations of people who know you well.
Competing explanations are weighed against that timeline: unipolar depression, bipolar-spectrum illness, ADHD, anxiety, trauma, thyroid and other medical contributors, and the effects of substances or medications. The goal is not to force a label but to find the account that best explains what has actually happened.
Treatment
- Mood stabilization. Careful selection among lithium, anticonvulsant mood stabilizers and atypical antipsychotics, with monitoring that is done properly and explained.
- Depressive episodes. Treated with agents appropriate to bipolar depression, and with attention to the risks antidepressants can carry in a bipolar course.
- Psychotherapy. Structured approaches that stabilize daily rhythms, identify early warning signs and build a relapse-prevention plan you and your family can use.
- Image-guided TMS. For persistent depressive symptoms.
- Long-term partnership. Bipolar disorder is a lifelong condition; the aim of treatment is sustained wellness, fewer and milder episodes, and a life not organized around illness.
Unsure whether this describes you?
You do not need to know your diagnosis before getting in touch. A first conversation is the way to find out whether an evaluation would help.