Diagnosis can be difficult. Especially in its milder version (Bipolar II doesn't manifest in full-blown mania), mania can look like ADHD, anxiety, or even a particularly charismatic personality. So depression is diagnosed as ordinary depression, and because the mania side is not treated, stability is not achieved.
Treatment for people with bipolar disorder generally receive a cocktail of medications to treat it. Some people can get away with just one med; I, like many others with bipolar, have to take four medications a day to tweak my chemistry in the right place. It takes a while to adjust the meds correctly, and a few people don't get good control with medications.
Lifestyle changes are as important as well. Avoiding alcohol helps prevent depression. Regular sleep habits help greatly, and stress management methods like cognitive journaling help reduce stress that can throw off one's chemistry. Many people need a therapist or social worker to work through the implications of a life-changing disorder.
Because I'm in good control right now, I see my psychiatrist every two to three months. Generally, he asks me how things are going with the meds and my mood, and then he just chats with me. I sometimes think he gets better information from me by watching me talk than he does with the direct questions because he can observe mania or depression by my tone of voice, pace of speech, and hand gestures. But he also trusts my observations, because I have a good awareness of where I'm at, at least when I'm depressed.
I have to have certain medical tests because of one of the medications I take, lithium carbonate. Lithium can damage the liver and kidneys, so these have to be monitored. It can suppress thyroid, necessitating monitoring of the thyroid as well. In addition, lithium blood levels can grow to toxic levels as a result of dehydration, illness, or even taking ibuprofen or other NSAIDs. I have had mild lithium toxicity; it is not pretty.
I live with the awareness that stressors can catapault me into an episode, and I need to keep an eye on that. I had a severe episode when I was first diagnosed because my department was being disbanded by the university. The COVID-19 stressors, especially when moving classes online, might have triggered some depression (I'm not sure, so it must be minor).
So I'll visit my psychiatrist today. I'll go to the lab Monday and get my blood tests. And all will be well.
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