Bipolar Disorder treatment in Miami Florida

Santana Mental Health Services provides comprehensive bipolar disorder evaluations and individualized treatment plans for adolescents and adults. Our providers use evidence-based mood-stabilizing medication and psychotherapy, the two approaches with the strongest clinical support, to help patients stabilize mood, reduce the frequency and severity of episodes, and improve quality of life. Care is available both in-office and through secure telehealth services.

Understanding Bipolar Disorder

Bipolar disorder is a chronic mood disorder characterized by recurring episodes of depression and mania or hypomania. It affects approximately 4.4% of U.S. adults across the bipolar spectrum, with onset typically occurring between the ages of 15 and 25. Depression is the most frequent initial presentation, and approximately 75% of symptomatic time is spent in depressive episodes or symptoms. The average delay between a first depressive episode and a correct bipolar diagnosis is approximately 9 years. Bipolar disorder frequently co-occurs with anxiety disorders, substance use disorders, and medical conditions including cardiovascular disease and metabolic syndrome.

Bipolar I disorder

Bipolar I disorder is defined by the occurrence of at least one manic episode - a period of abnormally elevated, expansive, or irritable mood and increased energy lasting at least one week (or requiring hospitalization). Symptoms of mania include grandiosity, decreased need for sleep, racing thoughts, impulsivity, and risk-taking behavior. Psychotic symptoms such as delusions or hallucinations occur in up to 75% of manic episodes. Most people with bipolar I also experience major depressive episodes. The estimated lifetime prevalence of bipolar I is approximately 1%.

Bipolar II disorder

Bipolar II disorder involves at least one hypomanic episode and at least one major depressive episode, with no history of full mania. Hypomania is a milder form of mania lasting at least four days that does not require hospitalization. Bipolar II is no longer considered a milder form of bipolar disorder - the burden of depression in bipolar II is often greater, with depressive symptoms predominating approximately 50% of the time. The estimated lifetime prevalence of bipolar II is approximately 1%.

Bipolar disorder with rapid cycling

Rapid cycling is defined as four or more mood episodes (depressive, manic, hypomanic, or mixed) within a 12-month period. It occurs in approximately 10–20% of people with bipolar disorder and is more common in women. Rapid cycling is associated with greater illness severity and may require more intensive treatment.

Cyclothymic disorder

Cyclothymic disorder involves chronic, fluctuating mood disturbance with recurring periods of hypomanic and depressive symptoms that do not meet the full criteria for a hypomanic or major depressive episode. Symptoms must persist for at least two years in adults (one year in children and adolescents). Although symptoms are less severe, cyclothymic disorder can significantly impair daily functioning and may progress to bipolar I or II.

Bipolar disorder with co-occurring conditions

The majority of individuals with bipolar disorder have at least one co-occurring condition. Anxiety disorders are estimated to be present in approximately 71% of people with bipolar disorder, substance use disorders in approximately 56%, and ADHD in 10–20%. Bipolar disorder is also associated with higher rates of metabolic syndrome, obesity, type 2 diabetes, and cardiovascular disease. Life expectancy is reduced by approximately 12 to 14 years compared with the general population.

Bipolar disorder with mixed features

Many people with bipolar disorder experience episodes in which symptoms of depression and mania or hypomania occur at the same time. For example, a person may feel intensely energized and agitated while also experiencing hopelessness and suicidal thoughts. Mixed features are associated with greater severity, higher suicide risk, and a more complex treatment course.

When to Seek an Evaluation

Consider scheduling an evaluation if you are experiencing significant mood changes that interfere with your ability to function at work, in relationships, or in daily activities. Bipolar disorder is frequently misdiagnosed as unipolar depression, so evaluation is especially important if depression has not responded well to standard antidepressant treatment. Common signs include:

• Distinct periods of unusually elevated mood, energy, or irritability

• Decreased need for sleep without feeling tired

• Racing thoughts, rapid speech, or difficulty staying focused

• Impulsive or risky behavior that is out of character (e.g., excessive spending, reckless driving, risky sexual behavior)

• Grandiosity or inflated self-confidence

• Recurring episodes of depression, especially if they began at a young age or have not responded to antidepressants

• Severe mood swings that shift between highs and lows

• Withdrawal, hopelessness, or loss of interest during depressive episodes

• Thoughts of death or suicide

If you or someone you know is in crisis, call or text 988 (Suicide & Crisis Lifeline) or go to your nearest emergency room. Bipolar disorder carries a significant risk of suicide, approximately 15–20% of people with bipolar disorder die by suicide, and the annual suicide rate is roughly 60 times higher than in the general population.

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How Bipolar Disorder Is Treated

Effective bipolar disorder treatment centers on mood-stabilizing medication as the foundation, with psychotherapy as an important addition. Unlike unipolar depression, bipolar disorder requires long-term medication management to prevent mood episodes and maintain stability. Treatment is personalized based on the type of bipolar disorder, current mood state, symptom severity, co-occurring conditions, and patient preferences.

Medication for Bipolar Disorder

  • Medication is the cornerstone of bipolar disorder treatment. The goals are to treat acute mood episodes (mania, hypomania, or depression), prevent future episodes, and reduce the risk of suicide.

  • Lithium is the oldest and most extensively studied mood stabilizer. It is effective for treating acute mania, preventing both manic and depressive episodes, and is the only mood stabilizer with evidence suggesting a protective effect against suicide. Lithium requires regular blood level monitoring and periodic checks of kidney and thyroid function.

    Valproate (divalproex) is effective for acute mania and maintenance treatment. It requires monitoring of blood levels and liver function and should be avoided in women of childbearing potential due to teratogenicity risk.

    Lamotrigine is particularly effective for preventing depressive episodes and is generally well tolerated. It requires a slow dose titration over several weeks to reduce the risk of a serious skin rash (Stevens-Johnson syndrome, which occurs in approximately 0.02% of patients).

  • Several atypical antipsychotic medications are recommended for bipolar disorder, either alone or in combination with mood stabilizers:

    • Quetiapine — effective for acute mania, bipolar depression, and maintenance treatment

    • Aripiprazole — effective for acute mania and maintenance treatment

    • Lurasidone — FDA-approved for bipolar I depression (monotherapy and adjunctive)

    • Cariprazine — FDA-approved for acute mania and bipolar I depression

    • Olanzapine — effective across mood states but associated with significant weight gain

    • Asenapine — effective for acute mania and maintenance treatment

    Common side effects of atypical antipsychotics include weight gain, sedation, and metabolic changes (elevated blood sugar, cholesterol). Regular monitoring of weight, blood pressure, fasting glucose, and lipid levels is recommended.

  • Antidepressant monotherapy is not recommended for bipolar disorder, especially bipolar I, because it may trigger manic or hypomanic episodes and promote more frequent mood cycling. When antidepressants are used for bipolar depression, they should always be combined with a mood stabilizer or atypical antipsychotic. Antidepressants should be avoided in patients with manic symptoms or mixed features.

  • Finding the right medication or combination of medications takes time and close collaboration with your provider.

    • Mood stabilizers and atypical antipsychotics may begin to improve manic symptoms within the first one to two weeks

    • For bipolar depression, medications may take several weeks to show full benefit

    • Side effects vary by medication and are often manageable with dose adjustments or switching agents

    • Regular monitoring (blood levels, metabolic labs, kidney and thyroid function depending on the medication) is an important part of safe, effective treatment

  • Bipolar disorder is a lifelong condition, and long-term medication is generally recommended to prevent relapse. Stopping medication is one of the most common reasons for recurrence of mood episodes. More than 50% of patients with bipolar disorder are not adherent to treatment at some point, which significantly increases the risk of relapse and hospitalization.

    Any changes to medication should be made gradually and in close collaboration with your provider.

Therapy for Bipolar Disorder

  • Psychoeducation is a foundational component of bipolar disorder treatment. It involves learning about the condition, recognizing early warning signs of mood episodes, understanding the importance of medication adherence, and developing strategies for managing symptoms. Research shows that structured psychoeducation reduces relapse rates and hospitalization.

  • CBT helps patients identify and challenge negative thinking patterns, develop coping strategies, and improve problem-solving skills. A meta-analysis found that CBT for bipolar disorder was associated with fewer depressive symptoms, fewer relapses, and improved social and occupational functioning compared with usual treatment.

  • Interpersonal and social rhythm therapy (IPSRT) focuses on stabilizing daily routines and sleep-wake cycles, improving medication adherence, and reducing interpersonal stress — all of which can help prevent mood episodes. IPSRT is specifically designed for bipolar disorder and may be particularly helpful for reducing depressive symptoms.

  • Family-focused therapy involves the patient and family members in treatment. It addresses communication patterns, problem-solving, and education about bipolar disorder. Research shows it is effective for reducing depressive symptoms, relapse rates, and hospitalization risk.

  • Dialectical behavior therapy (DBT) integrates cognitive behavioral techniques with mindfulness strategies to target emotional dysregulation, suicidality, and self-harm. It may be helpful for patients with bipolar disorder who struggle with intense emotional reactions or self-destructive behaviors.

  • For most patients with bipolar disorder, the best outcomes come from combining medication with structured psychotherapy.

    Medication stabilizes mood and prevents episodes, while therapy helps patients develop the skills, routines, and self-awareness needed to manage the condition long-term. Your provider will work with you to choose a treatment plan that fits your symptoms, goals, and preferences.

Telehealth for Bipolar Disorder Treatment

Bipolar disorder evaluations and follow-up appointments are available through secure telehealth. Research supports the use of telemental health via videoconferencing for bipolar disorder, with studies demonstrating clinical benefits and noninferiority to in-person care. Telehealth can help improve access to specialized bipolar disorder treatment, particularly for patients in areas with limited mental health resources or those who face barriers to attending in-person appointments.

Certain aspects of bipolar disorder assessment, such as evaluating speech patterns, energy level, and psychomotor changes, may require additional attention during video visits. Your provider is trained to conduct thorough assessments through telehealth and will recommend in-person evaluation when clinically appropriate.

Take the next step toward mood stability. Book a secure telehealth appointment today and get support from the comfort of home, on a schedule that works for you.

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Frequently asked questions

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  • Yes. Bipolar disorder is a well-established medical condition recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) under Bipolar and Related Disorders. It involves dysregulation of brain circuits that control mood, energy, and behavior. With appropriate treatment, most people with bipolar disorder can achieve significant symptom improvement and lead productive lives.

  • Medication is the foundation of bipolar disorder treatment and is recommended for virtually all patients. Unlike unipolar depression, bipolar disorder cannot be effectively managed with psychotherapy alone. However, structured psychotherapy combined with medication significantly improves outcomes — reducing relapse rates, improving medication adherence, and helping patients develop skills to manage their condition long-term.

  • Both conditions involve depressive episodes, but bipolar disorder also includes episodes of mania or hypomania — periods of abnormally elevated mood, energy, and activity. This distinction is critical because the treatments are different. Antidepressant monotherapy, which is a standard treatment for unipolar depression, is not recommended for bipolar disorder because it may trigger mania or worsen mood cycling. If depression has not responded to antidepressant treatment, or if there is a history of elevated mood episodes, an evaluation for bipolar disorder may be appropriate.

  • Yes. Without treatment, bipolar disorder tends to follow a progressive course with more frequent and severe mood episodes over time. Untreated bipolar disorder is associated with worsening cognitive and functional impairment, higher rates of substance use, cardiovascular disease, and a significantly elevated risk of suicide. Early diagnosis and consistent treatment are associated with a more favorable prognosis.

  • Yes. Bipolar disorder is a chronic condition that requires ongoing management. While mood episodes may come and go, the underlying vulnerability to mood instability persists. Long-term medication, combined with psychotherapy and healthy lifestyle habits, is the most effective strategy for maintaining stability and preventing relapse.

  • Lithium is the most extensively studied medication for suicide prevention in bipolar disorder. Large observational studies have found that lithium treatment is associated with significantly lower rates of suicide, self-harm, and psychiatric hospitalization. While randomized trial data have been limited by small sample sizes, the overall body of evidence supports lithium's protective effect, and it is recommended by clinical guidelines for patients at elevated suicide risk.

  • Yes. Both initial evaluations and ongoing follow-up appointments are available through secure video telehealth. Research supports the use of telemental health for bipolar disorder management, with demonstrated clinical benefits comparable to in-person care.