Bipolar disorders are recurrent mental health conditions characterized by episodes of mania, hypomania, and depression. Diagnosis is often difficult due to symptom overlap with other psychiatric disorders, particularly depression. The condition commonly presents in primary care as depression or anxiety and is frequently accompanied by comorbidities like substance use and anxiety disorders. DSM-5 specifiers for mixed features and anxious distress help improve diagnostic accuracy. First-line treatment includes mood stabilizers (eg, lithium, valproic acid) and antipsychotics, with maintenance therapy recommended indefinitely. Antidepressant monotherapy is contraindicated in bipolar I, mixed states, and mania. Nonpharmacologic strategies—such as psychoeducation, therapy, and lifestyle modifications—are essential for long-term management.

Managing bipolar disorder requires individualized pharmacologic and psychosocial strategies across all illness phases. Lithium is a key agent for classic mania, while quetiapine, lurasidone, and lamotrigine are effective for depression and maintenance. Close monitoring is necessary due to risks like suicidality, metabolic effects, and movement disorders. Coordinated care with psychiatrists, validated screening tools, and consistent follow-up improve diagnostic accuracy and risk management. Psychotherapy, strong support systems, and relapse prevention planning enhance treatment adherence and reduce hospitalizations in this chronic, relapsing condition.

Reference: Marzani G, Price Neff A. Bipolar Disorders: Evaluation and Treatment. Am Fam Physician. 2021 Feb 15;103(4):227-239. PMID: 33587568.