Bipolar disorder
Bipolar care is a system, not a prescription.
Bipolar disorder punishes improvisation. The practices that keep people stable for decades are unglamorous: a mood stabilizer whose levels and labs are actually checked, a sleep pattern watched like a vital sign, mood charted in the plain weeks and not just the bad ones, and a prescriber who plays the long game across 30-minute follow-ups instead of reacting to whichever week you happen to be in. That system is what this page describes, because the system, more than any single medication, is the treatment.
PsychMed Care is the medication management practice of Solutions Psychiatry. If you are looking for therapy, or therapy and medication together, the full practice is at psych.us.
The foundation
Mood stabilization first, everything else second
The evaluation is the full 60 minutes: the episode history in your own words, what hypomania actually looked like from the inside, what your depressions cost, and what every past medication did, including the ones that helped and the ones that quietly made things worse.
The stabilizers
Lithium, valproate, and lamotrigine are the backbone medications, each with a different profile: lithium's unmatched record against relapse and suicide, valproate's strength in mixed and irritable presentations, lamotrigine's gentleness and its tilt toward the depressive pole. Which one leads depends on your episode pattern, your body, and your history, and the choice is explained in those terms.
The supporting shelf
Atypical antipsychotics earn their place for acute episodes, for maintenance in some patterns, and for sleep protection in hard stretches, weighed honestly against their metabolic costs, which are monitored rather than discovered late. Nothing joins the list without a stated job.
Antidepressants, handled with care
In bipolar depression, an antidepressant without stabilization underneath can tip the system it was meant to lift. That does not make them forbidden; it makes them sequenced, stabilized first, watched closely, and retired if the rhythm of your mood says they are costing more than they pay.
The screen at the door
The MDQ and a careful history screen every depression evaluation here for bipolarity, because the most dangerous bipolar prescription is the one written by someone who never asked. If bipolar disorder is the story, the plan changes from the first visit, not the fifth.
The monitoring cadence
Labs on a calendar, not on a hunch
Mood stabilizers are serious medications with knowable risks, and the deal here is that the monitoring actually happens: levels and organ labs drawn through LabCorp on a schedule set when the medication starts, results reviewed with you, and doses adjusted against numbers rather than vibes. The functional psychiatry page describes the lab discipline in full; in bipolar care it is not optional garnish, it is the price of using the strongest tools safely.
What gets checked
- Lithium: blood levels, kidney function, and thyroid, because lithium talks to all three and each one answers back.
- Valproate: blood levels, liver function, and blood counts, on the same principle: the organs doing the work get watched.
- Metabolic panel: weight, glucose, and lipids tracked when antipsychotics are aboard, because stability bought with metabolic damage is a loan, not a cure.
What gets charted
- Mood, in the plain weeks. A simple chart, kept between visits, so a pattern is visible before it is an episode. Crisis memories are vivid and misleading; the chart is neither.
- Sleep, as the early warning. Two short nights in a row is data. In bipolar care it may be the first data there is, and it earns a call, not a wait-and-see.
- The side-effect ledger. Tremor, thirst, cognitive dulling, weight: named at every follow-up, because the side effect nobody mentions is the one that ends treatment quietly.
The follow-up rhythm
Long game, short intervals
Follow-ups run 30 minutes, and the cadence tightens whenever anything changes: a new medication, a dose move, a season that history says is dangerous for you. Between visits, the chart and the sleep line keep the record honest. Many bipolar patients also work with a therapist of their own, and that coordination is welcomed here: with your permission, your therapist hears the medication plan and I hear what the sessions surface, because the split system, two clinicians guessing about each other, is how warning signs fall through the middle. If you want therapy and medication from one clinician instead, that is the full practice at psych.us, with the same prescriber.
Adjustments in bipolar care are deliberately slower than anywhere else in this practice. A stabilizer is judged across months, not weeks, and doses move in smaller steps, because the cost of overshooting is an episode. Deprescribing exists here too, but it is the most careful version of it: a medication that has held someone stable for years is never stopped on a good quarter's enthusiasm. Any reduction is planned across seasons, with the chart running, the sleep watched, and a restart plan agreed in advance. Stability is hard-won. We treat it that way.
The lab calendar
Levels, kidney, thyroid, liver, metabolic: the monitoring that makes stabilizers safe.
Where the rhythm lives
Thirty-minute follow-ups, tightened whenever the chart says to.
Sleep, protected on purpose
The insomnia page, written for everyone, matters double here.
Prevention is a calendar
Episodes have seasons, and seasons can be planned for
Bipolar episodes are rarely random. They cluster: around sleep disruption, around seasons for many patients, around the anniversaries and deadlines and long flights that scramble a rhythm. Your chart, kept across ordinary months, is what makes your clusters visible, and once they are visible they become plannable. A patient whose history says spring is dangerous does not schedule a medication taper in spring. A patient crossing six time zones for work gets a sleep protection plan before the trip, not a rescue after it. This is the unglamorous core of long-term bipolar care: not reacting brilliantly to episodes, but arranging the year so fewer of them start.
Substances belong in the same honest ledger. Alcohol and cannabis both destabilize the rhythm this care works to protect, alcohol by fragmenting sleep, cannabis by blurring the early warning signs until they are no longer early. You will be asked, with the AUDIT-C among the intake screeners, and the answer shapes the plan without judgment: sometimes the most effective mood stabilizer available is subtracting the thing that keeps knocking the system over. Where use has become its own condition, it is treated as one, sequenced with the bipolar care rather than after it, because the two do not queue politely in real life.
The people around you are part of the system too, with your permission and on your terms. A partner or family member who knows your early warning signs, and knows that two short nights earn a phone call here, is an early intervention no medication can match. What gets shared, and with whom, is your decision, recorded and revisited. Stability is a team statistic even when the prescription has one name on it.
A note on other prescribers: dentists, urgent care clinicians, and well-meaning specialists all add medications, and several common ones, steroids and certain antibiotics among them, can stir a stable bipolar system. Every addition anywhere gets reported here before it starts when there is time, and right after when there is not. Your list has one reader who reads all of it, and that reader needs to know.
“In bipolar care, stability is not a smaller life. It is what makes a bigger one possible.”
Start with a 60-minute evaluation and a monitoring plan in writing