Diagnosis, mood stabiliser management, and the blood monitoring these medicines require. Bipolar disorder is one of the most frequently misdiagnosed conditions in psychiatry — usually as depression alone.
People seek help when they are low, not when they are high. The elevated periods feel like energy, productivity and confidence returning — so they are rarely reported, and a diagnosis of depression gets made on half the picture.
This matters because the treatments differ. An antidepressant given alone to someone with bipolar disorder can destabilise the mood rather than settle it — which is why the question about elevated periods is asked carefully, and asked of family too.
The second and third of these are the sentences that change a diagnosis.
I have been on antidepressants for six years. They work for a few months and then they do not.
Engineer, 38There are weeks where I barely sleep and get an enormous amount done. I always thought that was the good part.
Designer, 29My wife says I become a different person for a few weeks each year. I do not see it at the time.
Business owner, 44Mood disorders are among the most clearly biological conditions in psychiatry, which is also why they respond so reliably to the right medication.
Bipolar disorder has one of the highest heritabilities in medicine. A family history of bipolar disorder, of suicide, or of relatives described as having had a breakdown is one of the most useful pieces of information in the assessment.
Reduced need for sleep is one of the earliest signs of an episode starting, and sleep disruption — shift work, travel, a new baby — is one of the commonest triggers. This is why sleep is asked about so closely and protected so firmly.
Bipolar disorder is manageable, and many people live entirely ordinary working lives with it. What determines how well it goes is largely consistency.
Not just how you feel now. The question is what the pattern has been across years — and specifically whether there have ever been sustained periods of the opposite.
With your consent, a family member is often asked separately. Elevated periods are characteristically more visible from outside than from inside, and this single step changes a significant number of diagnoses.
Thyroid, kidney and liver function, and a pregnancy test where relevant. Several mood stabilisers are unsafe in pregnancy, and that conversation happens before prescribing rather than after.
A mood stabiliser, chosen according to which pole dominates, what else is going on medically, and — for women of childbearing age — what is safe. Antidepressants are used cautiously and rarely alone.
Alongside the medication: a sleep routine that is protected rather than negotiable, early-warning signs written down while you are well, and a plan agreed in advance for what happens if they appear.
Lithium and valproate require regular blood levels and organ-function checks. If you are starting one of these, expect tests at defined intervals — this is what makes long-term use safe, and it is the reason to stay with one psychiatrist rather than move between prescribers.
Includes the written diagnosis and treatment plan. Reviews are ₹800.
It is worth asking, particularly if antidepressants have worked briefly and then stopped, if you have had periods of unusually little sleep without tiredness, or if bipolar disorder runs in the family. That is exactly what a second opinion consultation is for.
For bipolar disorder, long-term treatment is usually recommended, and that is said at the start rather than discovered later. The aim is the lowest effective dose with the fewest side effects, reviewed regularly — not a fixed prescription repeated indefinitely.
The assessment and most reviews, yes. You will need local blood tests, and during an acute episode in-person care is usually safer. For a stable person on established medication, video review works well.
Tell us before, not after. Several mood stabilisers carry significant risks in pregnancy and the medication usually needs changing in advance. Stopping treatment abruptly carries its own risk, so this is planned rather than improvised.
If antidepressants have not held
Frequently alongside
Where psychosis is present
Call Tele-MANAS 14416 — free, 24 hours. If someone is in immediate danger, call 112.