Expert Telehealth Care for Bipolar Disorder in New York
Bipolar disorder affects approximately 2.8% of U.S. adults — about 7 million people — according to the National Institute of Mental Health. It is one of the most frequently misdiagnosed psychiatric conditions, often identified as depression, anxiety, or a personality disorder before an accurate diagnosis is reached. The average time from first symptoms to correct diagnosis is more than six years. With proper evaluation and careful medication management, however, people with bipolar disorder can achieve sustained stability and live full, meaningful lives.
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At Strong Enough Mental Health, Salvatore Marchica, PMHNP-BC, provides comprehensive telehealth evaluation and evidence-based medication management for bipolar disorder for adolescents and adults across New York State.
What is Bipolar Disorder?
Bipolar disorder is a mood disorder characterized by significant shifts in mood, energy, activity level, and the ability to function — shifts that go far beyond the typical emotional ups and downs most people experience. These represent distinct mood episodes that can last days to months and significantly disrupt relationships, work, and daily life.
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Bipolar disorder occurs in several forms:
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Bipolar I Disorder: Defined by at least one manic episode, which may be preceded or followed by hypomanic or major depressive episodes. Manic episodes can be severe enough to require hospitalization.
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Bipolar II Disorder: Characterized by a pattern of depressive episodes and hypomanic episodes — but no full manic episodes. Bipolar II is frequently underdiagnosed because hypomanic periods may feel positive or productive.
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Cyclothymic Disorder: A milder form involving numerous periods of hypomanic and depressive symptoms that do not meet full episode criteria.
What Are The Signs And Symptoms of Bipolar Disorder?
During a Manic Episode
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Abnormally elevated, expansive, or unusually irritable mood lasting at least one week
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Significantly decreased need for sleep without feeling tired
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Racing thoughts and rapid, pressured speech
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Inflated self-esteem or grandiosity
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Increased goal-directed activity — taking on multiple large projects simultaneously
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Impulsive or risky behavior — excessive spending, sexual behavior, substance use
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Easily distracted — attention pulled to irrelevant or trivial stimuli
During a Hypomanic Episode
Similar to mania but less severe and shorter in duration (minimum four days). Hypomania does not cause the level of impairment associated with full mania and does not include psychotic features — but it is a recognizable, distinct shift from a person's usual mood and functioning.
During a Depressive Episode
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Genetics: Bipolar disorder is strongly heritable — having a first-degree relative with bipolar disorder significantly elevates risk
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Neurobiological factors: Differences in brain structure, neurotransmitter systems, and circadian rhythm regulation
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Stressful life events: Trauma or significant disruptions can trigger first mood episodes in vulnerable individuals
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Substance use: Alcohol and drug use can precipitate mood episodes and significantly complicate treatment
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Sleep disruption: Irregular sleep is both a symptom and a trigger of bipolar mood episodes
How is Bipolar Disorder Diagnosed?
Diagnosing bipolar disorder requires a careful, comprehensive evaluation of mood history — including past episodes of elevated energy and mood that may have been overlooked, minimized, or attributed to personality. Because bipolar disorder so often presents with depression first, and because individuals frequently do not identify hypomanic periods as problematic, accurate diagnosis requires detailed clinical history-taking. At Strong Enough Mental Health, Salvatore takes the time needed to build an accurate clinical picture before any treatment decisions are made.
What Are Possible Treatments For Bipolar Disorder?
Medication for Bipolar Disorder
Bipolar disorder requires careful, consistent medication management — the goal being mood stabilization that prevents both manic and depressive episodes while supporting quality of life. All medication decisions at Strong Enough Mental Health are made collaboratively, with regular monitoring and open communication at every step.
Mood Stabilizers — The Cornerstone of Bipolar Treatment
Mood stabilizers are the foundation of pharmacological treatment for bipolar disorder, reducing the frequency and severity of both manic and depressive episodes.
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Lithium (Lithobid, Eskalith) — The gold-standard mood stabilizer with decades of evidence for bipolar I and II. Also has the strongest evidence for suicide prevention in bipolar disorder. Requires regular blood level monitoring and kidney and thyroid checks.
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Valproate/Divalproex (Depakote) — Highly effective for manic episodes and rapid cycling. Requires liver function and blood level monitoring. Not recommended in people who may become pregnant.
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Lamotrigine (Lamictal) — Particularly effective for preventing bipolar depression; less effective for mania. Requires slow titration to minimize risk of a rare but serious rash (Stevens-Johnson syndrome).
Atypical Antipsychotics
Several atypical antipsychotics carry FDA approval for bipolar disorder and are frequently used alongside or instead of traditional mood stabilizers.
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Quetiapine (Seroquel) — FDA-approved for acute mania, bipolar depression, and maintenance; also helpful for sleep
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Lurasidone (Latuda) — FDA-approved specifically for bipolar depression
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Cariprazine (Vraylar) — FDA-approved for acute mania and bipolar depression
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Aripiprazole (Abilify) — FDA-approved for acute mania and maintenance
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Olanzapine (Zyprexa) — Effective for mania; monitored closely for metabolic side effects
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Ziprasidone (Geodon)
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Risperidone (Risperdal)
Important Considerations for Bipolar Medication
Antidepressants used alone — without a mood stabilizer — can trigger manic or hypomanic episodes in bipolar disorder and are generally avoided or used only with careful monitoring. Regular, consistent follow-up appointments are essential to managing bipolar disorder well. At Strong Enough Mental Health, we take a careful, evidence-informed approach to every decision — and always make changes collaboratively.