What we treat
Psychiatric evaluation and medication management for bipolar I, bipolar II, and cyclothymia
Bipolar disorder is a mental health condition marked by episodes of abnormally elevated or depressed mood, energy, and activity. Unlike ordinary ups and downs, these episodes last days to weeks and interfere with work, school, and relationships. According to the National Institute of Mental Health, about 4.4% of U.S. adults experience bipolar disorder at some point in their lives. The average age of onset is the mid-20s, though it can begin at any age.
Bipolar disorder is a treatable condition with strong genetic and biological roots. Willpower and positive thinking do not control it. With an accurate diagnosis and consistent treatment, many people reach and maintain stability.
Bipolar disorder is a spectrum, and the subtype guides treatment:
Mania and hypomania: A mood that is clearly different from your baseline, elevated or irritable; much less need for sleep; racing thoughts and rapid speech; a surge of activity and plans; distractibility; and risky decisions around money, driving, substances, or sex. Mania can include psychotic symptoms. Hypomania is shorter and less severe, and it can feel good, which is one reason people put off treatment.
Depression: Persistent low or empty mood, loss of interest, changes in sleep and appetite, fatigue, guilt or worthlessness, trouble concentrating, and thoughts of death or suicide. Depressive episodes in bipolar disorder are often long and severe, and they are usually the reason people first seek help.
Many people live with these symptoms for years before anyone asks the right questions. If some of this sounds familiar, an evaluation is a reasonable next step even if you are not sure it is bipolar disorder.
Bipolar disorder is often diagnosed years after symptoms begin. In the meantime, many people are treated for depression, anxiety, or a personality disorder. The most common error is treating bipolar II as ordinary depression: an antidepressant given without a mood stabilizer can trigger hypomania or speed up cycling, and the person is left feeling that treatment failed.
That is why the first visit with Dr. Fredes is a 60-minute evaluation. She maps your full mood history, including any hypomanic periods, family history, age of onset, and how you responded to past medications. Getting the diagnosis right at the start helps avoid years of treatment for the wrong condition.
Medication is the core of bipolar treatment. Sleep, stress, substance use, and coordination with your other providers matter too, and Dr. Fredes addresses them at every visit:
Lithium remains the best-studied mood stabilizer. It treats both manic and depressive episodes and lowers suicide risk. It requires regular blood tests to check levels, kidney function, and thyroid function. Side effects such as thirst, tremor, or weight gain can often be managed with dose changes.
Anticonvulsant mood stabilizers such as valproate and lamotrigine are alternatives or additions to lithium. Valproate is useful for acute mania and rapid cycling; lamotrigine is often preferred for bipolar depression. Each has its own monitoring needs and side effect profile.
Atypical antipsychotics (quetiapine, aripiprazole, lurasidone, and others) are FDA-approved for bipolar disorder and are especially useful in acute manic or mixed episodes. Several are also approved for maintenance. Dr. Fredes will go over metabolic effects and long-term tolerability with you.
Antidepressants are used carefully. Alone, they can trigger hypomania or cycling. Combined with a mood stabilizer, they can treat the depressive phase. Whether to use one depends on your subtype and your history.
Sleep medication may be used short-term, because sleep loss both accompanies and can trigger a mood episode. Protecting sleep early sometimes keeps an episode from building.
Dr. Fredes starts at low doses, increases gradually, and reassesses at each follow-up. What works for one person may not suit another, so open communication about how a medication is working matters.
Most people with bipolar disorder do best staying on medication long-term to prevent relapse, much as people with diabetes or high blood pressure take medication for years. Stopping abruptly is one of the fastest ways to trigger an episode, and even short gaps can unsettle someone who has been stable for years. If a medication is not working or cost is a problem, tell us rather than stopping on your own. There are generic options and patient assistance programs.
Learn your own early warning signs: less need for sleep, increased spending or activity, racing thoughts, withdrawal, or irritability. Contact your psychiatrist when you notice them rather than waiting for a full episode. A support system of family, friends, a therapist, and sometimes a peer support group makes the condition easier to manage. Isolation makes it harder.
When to seek emergency care: If you are experiencing severe manic symptoms with impulsive or risky behavior, psychotic symptoms, suicidal ideation, or inability to care for yourself, go to the emergency room or call 911. These situations warrant immediate medical intervention.
No. Everyone has mood changes. Bipolar episodes last days to weeks, follow a pattern over time, and interfere with work, school, or relationships. Ordinary mood swings are shorter, less extreme, and do not derail daily life. The difference is one of severity, duration, and impairment.
Bipolar disorder is a lifelong condition, but it is treatable. With consistent medication, attention to sleep and stress, and regular follow-up, many people go years between episodes. The goal is to manage it well enough that it no longer runs your life.
Most people with bipolar disorder benefit from long-term medication to prevent relapse. Some taper under close psychiatric supervision after years of stability; others need medication indefinitely. Stopping on your own carries a high risk of relapse. Your psychiatrist will work with you on the right long-term plan.
Common triggers include sleep loss, major stress, seasonal changes, substance use, hormonal changes, and medication changes (especially stopping a mood stabilizer or adding an antidepressant without one). Episodes can still occur when triggers are controlled, which is why consistent medication matters.
Yes. The average age of onset is the mid-20s, but bipolar disorder can first appear in the 40s or 50s. Later-onset cases often present as depression and are easy to misdiagnose, so a careful history of past hypomanic periods and family history matters.
Bipolar II includes hypomanic episodes (elevated mood, less need for sleep, more activity) alternating with depression. Major depressive disorder has no hypomanic component. The distinction matters because an antidepressant alone can trigger hypomania in bipolar II; treatment needs to include a mood stabilizer.
Yes, bipolar disorder runs in families. A parent or sibling with bipolar disorder raises your risk, though genetics alone do not determine who develops it. Stress, trauma, and life events also play a role. A family history does not mean you will develop it, but it is a reason to take symptoms seriously and get evaluated early. It is also an important diagnostic clue.
Contact your psychiatrist right away, even outside office hours. If you cannot reach them, call a crisis line or go to the emergency room. If you have psychotic symptoms or thoughts of harming yourself or others, seek emergency care immediately. Manic episodes can escalate quickly, and early intervention can prevent a crisis.
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If you suspect bipolar disorder, or you have the diagnosis and treatment is not working, schedule a consultation with Dr. Fredes.