Living with big swings in mood and energy — soaring highs and heavy lows — can be exhausting and confusing, for you and for the people who love you. Bipolar disorder is common, it is well understood, and with the right care most people steady out and live full lives. You are welcome here.

What bipolar disorder is

Bipolar disorder is a condition marked by shifts between two kinds of episodes: highs (mania or the milder hypomania) and lows (depression). It affects roughly 4 in 100 adults at some point in life (Merikangas et al., 2011; National Institute of Mental Health, n.d.). In bipolar I, the highs reach full mania; in bipolar II, the highs are hypomania paired with significant depression. The pattern is different for everyone, and naming it accurately is the first step toward steady, effective care.

Signs and symptoms

During a high, people may notice:

• Less need for sleep, but lots of energy.
• Racing thoughts, fast speech, or jumping between ideas.
• Feeling unusually confident, irritable, or “wired.”
• Impulsive choices — spending, risk-taking, or decisions that are out of character.

During a low, people may notice:

• Deep sadness, emptiness, or loss of interest.
• Low energy, trouble concentrating, changes in sleep or appetite.
• Feelings of guilt or worthlessness, and sometimes thoughts of death or suicide.

If you are having thoughts of harming yourself, please reach out right away using the resources at the bottom of this page.

How it is understood and evaluated

There is no blood test for bipolar disorder. Because the low periods often look like ordinary depression, it is commonly missed or mistaken for depression alone — sometimes for years. A careful evaluation that asks about both the highs and the lows, your history, and your family history is how we get the diagnosis right, which matters because the treatment is different from depression.

It is not unusual for an accurate diagnosis to take years. Because bipolar disorder is so often mistaken for ordinary depression, many people go a long time before the full picture is recognized — in one national survey, more than a third of people with bipolar disorder waited 10 years or longer for the correct diagnosis (Hirschfeld et al., 2003). The sooner the pattern is seen, the sooner the right treatment can help.

Brief mood screening — and why it helps

A short, structured questionnaire is one of the simplest ways to catch what a single conversation can miss. Brief emotional and behavioral assessments — billed under code 96127, and including familiar tools such as the PHQ-9 for depression and the GAD-7 for anxiety — take only a few minutes, are scored the same way every time, and give your provider objective information to build on; we administer and score these on the CNS Vital Signs platform (CNS Vital Signs, n.d.). For mood disorders specifically, a brief mood screen can surface the “highs” that are easy to miss when someone comes in feeling low.

We encourage every client to complete a brief mood screen as part of getting started. Our team can provide a brief mood screening questionnaire for you to complete before your visit — just ask when you schedule.

A brief, rapid mood-screening questionnaire can also help flag bipolar patterns quickly, and we recommend this kind of screening as part of a thorough evaluation. The rapid mood screeners currently in use are proprietary and are not available in the public domain, so we are not able to offer one for free download here; your provider can administer an appropriate screen during your visit.

How it is treated — and how we approach it at OhanaPsych

Bipolar disorder responds well to treatment (Grande et al., 2016). National and international guidelines recommend mood-stabilizing medications — such as lithium, divalproex (valproate), and lamotrigine — and certain atypical antipsychotics — such as quetiapine, lurasidone, and aripiprazole — as first-line options, chosen to fit whether we are treating a high, a low, or preventing future episodes (Yatham et al., 2018). Antidepressants alone are generally not recommended, because without a mood stabilizer they can sometimes tip a person into a high. Lithium, in particular, has been shown to reduce the risk of suicide in people with mood disorders (Cipriani et al., 2013).

Medication usually works best alongside steady routines, protected sleep, and talk therapy; structured psychotherapy added to medication reduces relapses and helps stabilize symptoms (Miklowitz et al., 2021). Some medications — like lithium — call for simple, periodic lab checks, which we arrange and review with you. In our practice we hold this work with aloha and patience, with the goal of restoring lōkahi (balance and harmony) so you can stay connected to your ʻohana, your work, and the things you love. We coordinate care with your therapist and primary-care team so everyone is rowing in the same direction.

Getting care by telehealth

Most of our care is delivered by secure video, so you can begin from a private, comfortable place of your own. Some parts of care — such as certain controlled medications — still follow the federal Ryan Haight Act and DEA rules and may call for an in-person step; we will tell you clearly if that applies to you.

Lasting access by telehealth

As we complete the final stages of becoming a Rural Health Clinic (RHC), telehealth for mental-health care is here to stay with us. Under Medicare’s rural-health rules, RHCs are permanently authorized to provide behavioral and mental-health care by telehealth — including into your home, anywhere in Hawaiʻi — not under the temporary flexibilities that expire and must be renewed. For our patients, that means dependable, lasting telehealth access to the care you need.

Wherever you live, OhanaPsych is your statewide practice. We provide care across the entire state of Hawaiʻi by telehealth, reaching every island — Hawaiʻi Island, Maui, Oʻahu, Kauaʻi, Molokaʻi, Lānaʻi, and Niʻihau. If you would rather be seen in person, you have that option at our offices in Hilo and Honolulu.

When to reach out

You do not need to be in crisis to reach out — new patients are welcome. Call (808) 777-9460 or start your request online.

If you or someone you love is thinking about suicide or self-harm, get help right away. Call or text the 988 Suicide & Crisis Lifeline (call or text 988, or chat at 988lifeline.org). In Hawaiʻi, Hawaiʻi CARES is available by calling or texting 988, or at 808-832-3100 / 800-753-6879. In a life-threatening emergency, call 911.

Medically reviewed by George Mackel, MSN, APRN, NP-C, PMHNP-BC, CARN-AP — President & Owner, OhanaPsych / Ohana Care Clinic.
Last reviewed: June 28, 2026. Citations verified: June 28, 2026.

This page is general health education from OhanaPsych. It is not a substitute for a personal evaluation by a qualified clinician who knows your situation, and reading it does not create a provider–patient relationship. If you think you may have a mental health condition, reach out to us or another licensed provider. In an emergency, call 911.

References

CNS Vital Signs. (n.d.). CNS Vital Signs computerized rating instruments. https://www.cnsvs.com/WhitePapers/CNSVS-RatingInstruments.pdf

Cipriani, A., Hawton, K., Stockton, S., & Geddes, J. R. (2013). Lithium in the prevention of suicide in mood disorders: Updated systematic review and meta-analysis. BMJ, 346, f3646. https://doi.org/10.1136/bmj.f3646

Grande, I., Berk, M., Birmaher, B., & Vieta, E. (2016). Bipolar disorder. The Lancet, 387(10027), 1561–1572. https://doi.org/10.1016/S0140-6736(15)00241-X

Hirschfeld, R. M. A., Lewis, L., & Vornik, L. A. (2003). Perceptions and impact of bipolar disorder: How far have we really come? Results of the National Depressive and Manic-Depressive Association 2000 survey of individuals with bipolar disorder. Journal of Clinical Psychiatry, 64(2), 161–174. https://doi.org/10.4088/JCP.v64n0209

Merikangas, K. R., Jin, R., He, J.-P., Kessler, R. C., Lee, S., Sampson, N. A., … Zarkov, Z. (2011). Prevalence and correlates of bipolar spectrum disorder in the World Mental Health Survey Initiative. Archives of General Psychiatry, 68(3), 241–251. https://doi.org/10.1001/archgenpsychiatry.2011.12

Miklowitz, D. J., Efthimiou, O., Furukawa, T. A., Scott, J., McLaren, R., Geddes, J. R., & Cipriani, A. (2021). Adjunctive psychotherapy for bipolar disorder: A systematic review and component network meta-analysis. JAMA Psychiatry, 78(2), 141–150. https://doi.org/10.1001/jamapsychiatry.2020.2993

National Institute of Mental Health. (n.d.). Bipolar disorder. https://www.nimh.nih.gov/health/statistics/bipolar-disorder

Yatham, L. N., Kennedy, S. H., Parikh, S. V., Schaffer, A., Bond, D. J., Frey, B. N., … Berk, M. (2018). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disorders, 20(2), 97–170. https://doi.org/10.1111/bdi.12609