Bipolar disorder is a chronic psychiatric condition characterised by episodes of significant mood disturbance — depression, mania, or hypomania — that differ markedly from the person's baseline functioning. It is one of the most complex conditions in psychiatry, both to diagnose accurately and to manage over the long term.
Bipolar disorder involves distinct episodes — lasting days to months — in which mood, energy, thought patterns, behaviour, and functioning change substantially in ways recognisable as different from the person's usual self.
Bipolar I disorder — at least one full manic episode: abnormally elevated or irritable mood, markedly increased energy, reduced need for sleep, grandiosity, racing thoughts, and behaviour with potentially serious consequences.
Bipolar II disorder — at least one hypomanic episode and at least one major depressive episode. Bipolar II is frequently misdiagnosed as unipolar depression, particularly when hypomanic episodes go unrecognised.
Cyclothymia — numerous periods of hypomanic and depressive symptoms over at least two years, without meeting full criteria for either.
Mixed features — simultaneous presence of depressive and manic or hypomanic symptoms — a clinically significant presentation requiring particular care in treatment planning.
Bipolar disorder frequently co-occurs with anxiety disorders and substance use disorders. Distinguishing bipolar depression from unipolar depression has direct treatment implications.
During depressive episodes: persistent low mood, loss of interest, fatigue, cognitive slowing, sleep disturbance, and in severe cases suicidal ideation. Depression is statistically the dominant phase in bipolar II and occupies the majority of symptomatic time in most patients.
During manic or hypomanic episodes: elevated or irritable mood, significantly increased energy, reduced need for sleep without fatigue, rapid speech, racing thoughts, distractibility, and in mania — impulsive or risky behaviour with significant financial, relational, professional, or legal consequences.
Accurate diagnosis requires careful longitudinal assessment — not only of the current presentation but of the patient's full psychiatric history, including previous mood episodes that may not have been recognised. Many patients spend years receiving a diagnosis of unipolar depression before bipolar disorder is correctly identified.
At IsraClinic, the assessment includes a detailed clinical interview covering current symptoms, episode history, family psychiatric history, and functioning; psychological assessment to clarify personality and cognitive factors; neurological examination and laboratory testing to exclude organic contributions; and collegial review before diagnosis is confirmed.
Bipolar disorder is managed over the long term. The goals are mood stabilisation, relapse prevention, minimisation of interepisode symptoms, and preservation of functioning and quality of life.
Pharmacotherapy forms the cornerstone of bipolar treatment. Mood stabilisers, atypical antipsychotics, and where indicated antidepressants — each selected on the basis of the patient's specific diagnosis, phase, and medical profile — are prescribed and monitored carefully. Medication selection in bipolar disorder requires particular precision: antidepressants used without a mood stabiliser can precipitate mania or mixed states. Digital prescriptions are issued through the Yarpa system.
Psychotherapy is an important component of long-term management. Cognitive Behavior Therapy (CBT) adapted for bipolar disorder addresses episode recognition, early warning signs, and behavioural regulation. Family psychotherapy supports the patient's close environment and improves long-term outcomes. Schema therapy may be appropriate where personality or relational difficulties are a significant factor.
All treatment follows the Psychoergonomic Method — ensuring every clinical decision takes into account this specific patient's history, psychotype, life context, and goals.
Bipolar disorder is frequently undiagnosed or misdiagnosed for years. If you experience significant mood episodes — whether depression, elevated mood, or periods of unusually high energy — particularly if there is a family history of bipolar disorder or if previous antidepressant treatment has not produced stable results, a comprehensive psychiatric assessment is appropriate.
IsraClinic accepts patients for in-person consultation in Tel Aviv and online, in Russian, English, and Hebrew. No referral is required.
Clinical Reviewer: Dr. Mark Zevin, MD — Senior Psychiatrist, IsraClinic | Last reviewed: 2026
Bipolar disorder is one of the most frequently misdiagnosed conditions in psychiatry. If you have questions about your diagnosis or treatment, our team is available in Russian, English, and Hebrew.