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From manic episodes to sustained stability — mood monitoring and pharmacotherapy
Bipolar disorder affects 1–2% of the population and carries significant mortality from suicide, medical comorbidity, and functional impairment. Accurate diagnosis distinguishes bipolar I (mania), bipolar II (hypomania + depression), and cyclothymia from unipolar depression — a critical distinction because antidepressants can destabilize bipolar patients. Dr. Ruja's clinic emphasizes mood charting, long-term pharmacotherapy (lithium, valproate, lamotrigine, atypical antipsychotics), and psychoeducation for adherence and early warning sign detection.
Kathmandu Neurology Clinic & Cognitive Center
Authored and reviewed by Dr. Ruja Shrestha (MBBS, MD (Psychiatry), NMC 19766). Evidence-based, no fabricated outcomes.
Bipolar disorder affects 1–2% of the population and carries significant mortality from suicide, medical comorbidity, and functional impairment. Accurate diagnosis distinguishes bipolar I (mania), bipolar II (hypomania + depression), and cyclothymia from unipolar depression — a critical distinction because antidepressants can destabilize bipolar patients. Dr. Ruja's clinic emphasizes mood charting, long-term pharmacotherapy (lithium, valproate, lamotrigine, atypical antipsychotics), and psychoeducation for adherence and early warning sign detection.
Reviewed by Dr. Ruja Shrestha, MBBS, MD — Consultant Psychiatrist & CBT Therapist (NMC 19766), Kathmandu Neurology Clinic. For evaluation, book an appointment.
Bipolar disorder is under-diagnosed for years to decades, most commonly misdiagnosed as unipolar depression. The clinic screens all depressed patients for mania/hypomania history using the MDQ (Mood Disorder Questionnaire) and detailed lifetime mood history. Bipolar I requires ≥1 manic episode (≥7 days or requiring hospitalization); bipolar II requires ≥1 hypomanic episode (≥4 days) plus ≥1 major depressive episode. Cyclothymia involves chronic fluctuating mood with hypomanic and depressive symptoms not meeting full criteria.
Mood stabilizers are the foundation: lithium remains the gold standard with anti-suicide evidence; valproate for rapid cycling and mixed states; lamotrigine for bipolar depression prevention; atypical antipsychotics (quetiapine, olanzapine, lurasidone) for acute episodes and maintenance. The clinic uses systematic mood charting, lithium level monitoring (0.6–0.8 mmol/L), thyroid and renal function surveillance, and metabolic monitoring for atypical antipsychotics. Psychoeducation about prodromal warning signs enables early intervention before full relapse.
Guidelines referenced:
NICE CG185 — Bipolar disorder: assessment and managementYatham LN et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines for bipolar disorder. Bipolar DisordGeddes JR, Miklowitz DJ. Treatment of bipolar disorder. LancetContent on this website is for general educational purposes only and does not constitute medical advice, diagnosis, or treatment. It is not a substitute for evaluation by a qualified healthcare professional. Always seek the advice of your physician or other qualified provider with any questions regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read on this website. In case of a medical emergency, contact emergency services immediately. No doctor–patient relationship is established by use of this site or by contacting the clinic through the site.