Bipolar disorder is misdiagnosed in both directions, and both errors do harm.
Missed, it is treated as depression, and antidepressants given alone can make it worse: more episodes, more agitation, a course that looks like “treatment resistance.” Over-diagnosed, it labels mood swings that come from temperament, trauma, substance use or a chaotic life as a lifelong brain disease, and commits a person to years of medication for an illness they do not have. We think the diagnosis deserves more than a questionnaire. It deserves a history taken from the beginning, with attention to what an episode actually looked like, how long it lasted, what preceded it, and what runs in the family.
The four perspectives are the tool for exactly this problem. Mania and true bipolar depression are diseases, and they are treated as such, with mood stabilizers chosen for the individual and with lithium still on the table when it is the right drug. Mood instability of temperament, or the turbulence of an unresolved life story, is not a disease and does not get better by adding a second mood stabilizer.
A 60-minute evaluation by video, or 90 minutes when the diagnosis itself is in question (a comprehensive evaluation or second opinion), with prior records reviewed in advance. We reconstruct the course of your illness episode by episode, screen carefully for hypomania, substance effects and medical causes, review every mood medication you have taken and what it did, and look at the family history properly. You leave with a diagnosis stated plainly, including “not bipolar” when that is the answer, and a plan: which medication, at what target level, with what monitoring, and what to watch for.
Cost and insurance. Covered by the plans we accept; self-pay rates are on our insurance page.
Yes. When the history does not support the diagnosis we say so, in writing, and explain what we think is going on instead. Taking a label away is as much a part of our work as giving one.
Yes, when it is the right drug. Lithium remains one of the most effective treatments in psychiatry; we use it with the monitoring it requires.
Screening questionnaires raise the question; they do not answer it. The diagnosis rests on the history of actual episodes, their length, what preceded them, and the family history.