Bipolar Disorder

Hamilton Psychiatric Services in Hamilton, NJ provides expert diagnosis and individualized treatment for bipolar disorder — Bipolar I, Bipolar II, and cyclothymia — helping patients achieve mood stability, restore function, and reclaim quality of life.

Bipolar disorder is a chronic but highly manageable psychiatric condition characterized by dramatic shifts in mood, energy, and activity levels that go well beyond the ordinary emotional ups and downs most people experience. Without proper diagnosis and treatment, these mood episodes — ranging from euphoric highs to debilitating lows — can disrupt relationships, employment, physical health, and overall functioning. At Hamilton Psychiatric Services, Dr. Mirza provides a thorough psychiatric evaluation and builds an individualized treatment plan designed to stabilize mood, prevent future episodes, and support long-term wellness.

Bipolar I Disorder

Bipolar I is defined by the occurrence of at least one full manic episode — a period of abnormally elevated, expansive, or irritable mood lasting at least seven days (or requiring hospitalization) — that is severe enough to cause marked impairment or require hospitalization. During mania, patients may experience drastically reduced need for sleep without feeling tired, racing thoughts, pressured speech, inflated self-esteem or grandiosity, impulsive spending, sexual indiscretion, or risky decision-making. Depressive episodes are common in Bipolar I and often last longer than manic episodes, producing profound sadness, loss of interest in previously enjoyed activities, changes in appetite and sleep, fatigue, difficulty concentrating, and in severe cases, thoughts of death or suicide. Mixed features — where symptoms of mania and depression occur simultaneously — are also possible and can be particularly distressing.

Bipolar II Disorder

Bipolar II is characterized by at least one hypomanic episode and at least one major depressive episode, but without the full manic episodes that define Bipolar I. Hypomania is a less severe form of mania: the elevated or irritable mood is noticeable to others and represents a clear change from baseline behavior, but it does not cause the level of functional impairment associated with full mania and does not require hospitalization. Patients with Bipolar II are often predominantly depressed and may go years without a correct diagnosis because the hypomanic periods can feel productive or even enjoyable, making it less likely they will be reported as a problem. However, Bipolar II is not a milder form of the condition — the depressive burden is significant and the risk of suicide is substantial, underscoring the need for accurate diagnosis and proactive treatment.

Cyclothymia

Cyclothymia is a chronic mood disorder involving numerous periods of hypomanic symptoms and depressive symptoms over at least two years that do not meet the full criteria for hypomanic or major depressive episodes. While the mood shifts in cyclothymia are less extreme than those in Bipolar I or II, the persistent instability can significantly affect daily functioning, relationships, and self-image. Cyclothymia also carries a meaningful risk of progressing to Bipolar I or II, making early psychiatric intervention valuable. Treatment typically involves mood-stabilizing medication and psychotherapy aimed at recognizing mood patterns and building coping strategies.

Recognizing Symptoms of Bipolar Disorder in Adults

Bipolar disorder can present differently across individuals, and symptoms are frequently misattributed to other conditions such as major depression, ADHD, borderline personality disorder, or substance use. Common warning signs across the bipolar spectrum include:

• Periods of unusually high energy, euphoria, or irritability alternating with periods of profound low mood
• Decreased need for sleep during elevated mood phases, or sleeping far more than usual during depressive phases
• Rapid or pressured speech and racing thoughts
• Impulsive or reckless behavior, including financial decisions, substance use, or sexual behavior during elevated periods
• Withdrawal from social activities, loss of motivation, and persistent hopelessness during depressive phases
• Difficulty maintaining employment, relationships, or fulfilling daily responsibilities due to mood cycling
• Recurrent thoughts of death, self-harm, or suicide during depressive episodes

A careful psychiatric evaluation — including a thorough personal and family psychiatric history — is essential to distinguish bipolar disorder from conditions with overlapping presentations. Dr. Mirza takes the time needed to reach an accurate diagnosis before recommending any course of treatment.

Bipolar Disorder in Women: The Role of Hormonal Changes

Women with bipolar disorder are disproportionately affected by hormonal fluctuations throughout their lives. Premenstrual phases, pregnancy, the postpartum period, perimenopause, and menopause can all trigger or intensify mood episodes. Research indicates that women with bipolar disorder are more likely to experience rapid cycling — four or more distinct mood episodes within a twelve-month period — and are more vulnerable to depressive episodes than their male counterparts. Postpartum periods are particularly high-risk, as the combination of sleep deprivation, hormonal shifts, and the psychological demands of new parenthood can precipitate severe manic or depressive episodes. Women who have a personal or family history of bipolar disorder should discuss these risks with a psychiatrist before conception or as early as possible during pregnancy to develop a proactive monitoring and treatment plan.

Treatment for Bipolar Disorder

Bipolar disorder requires long-term psychiatric management. Effective treatment almost always involves a combination of medication and psychotherapy, along with lifestyle strategies that support mood stability.

Mood Stabilizers and Medication Management
Mood-stabilizing medications — including lithium, valproate, and lamotrigine — are the cornerstone of bipolar disorder treatment. Lithium has decades of clinical evidence supporting its effectiveness in preventing both manic and depressive episodes and in reducing suicide risk. Atypical antipsychotic medications are also frequently used, both during acute episodes and as maintenance therapy. For patients with significant depressive features, certain antidepressants may be carefully incorporated under close psychiatric supervision, as antidepressants used without a mood stabilizer can trigger mania or rapid cycling in some patients. Medication management at Hamilton Psychiatric Services includes ongoing monitoring of therapeutic levels, side effects, and overall response, with adjustments made as clinical needs evolve.

Psychotherapy
Evidence-based psychotherapies are a critical complement to medication in bipolar disorder care. Cognitive-behavioral therapy (CBT) helps patients identify distorted thought patterns that emerge during mood episodes and build skills to interrupt escalating cycles. Interpersonal and social rhythm therapy (IPSRT) focuses on stabilizing daily routines — sleep schedules, meal times, and activity levels — which directly influences mood stability. Family-focused therapy can strengthen communication and support networks for both the patient and their loved ones. Dr. Mirza coordinates with psychotherapy providers to ensure a truly integrated approach to care.

Transcranial Magnetic Stimulation (TMS)
For patients with bipolar disorder whose depressive episodes have not responded adequately to medication, TMS therapy may be an appropriate adjunctive treatment. TMS is a non-invasive, FDA-cleared brain stimulation technology that has demonstrated effectiveness for treatment-resistant depression. Dr. Mirza evaluates each patient's clinical history carefully to determine whether TMS is safe and appropriate given the complexities of bipolar depression.

When to Seek Help

Early and consistent psychiatric care is one of the most protective factors in the long-term course of bipolar disorder. You should seek a psychiatric evaluation if you or a loved one has experienced episodes of unusually elevated or irritable mood followed by depressive episodes, has a family history of bipolar disorder or manic episodes, has previously been diagnosed with depression but has not responded well to antidepressants alone, or is experiencing recurrent mood instability that interferes with daily life. If you are having thoughts of suicide or self-harm, please call 988 (the Suicide and Crisis Lifeline) or go to your nearest emergency room immediately.

To schedule a comprehensive psychiatric evaluation with Dr. Mirza at Hamilton Psychiatric Services, call 609-631-7770 or submit an appointment request online. Our office serves patients throughout Hamilton, Trenton, and the surrounding communities in Mercer County, NJ.

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