Bipolar disorder is a mood condition marked by distinct episodes of unusually elevated mood or energy (mania or hypomania) and, in many people, periods of depression. The bipolar spectrum includes bipolar I, bipolar II, and cyclothymia.
Bipolar Spectrum Conditions
Dr. David Kirk, ND, provides comprehensive naturopathic care in San Diego and virtually across California, coordinating with your other providers when appropriate. The focus is on understanding your individual patterns of mood, energy, sleep, and contributing factors as part of a comprehensive approach to long-term care.
Watch: What Is Bipolar Disorder?
In this video, Dr. David Kirk, ND, explains what bipolar disorder is, the three main types (bipolar I, bipolar II, and cyclothymia), common symptoms of mania, hypomania, and depression, how bipolar disorder is evaluated, and how he approaches care in San Diego and virtually across California.
Symptoms of Bipolar Disorder
Symptoms vary by person and by episode.
During manic or hypomanic episodes, people may notice unusually elevated or irritable mood, increased energy or activity, decreased need for sleep, racing thoughts, increased talkativeness, increased impulsivity, and difficulty concentrating.
During depressive episodes, people may notice persistent low mood, loss of motivation or interest, fatigue, changes in sleep or appetite, and difficulty concentrating.
When to Seek Emergency Care
If you are in crisis or thinking about harming yourself, call or text 988 (in the U.S.) or go to your nearest emergency room. Seek urgent care for severe mania, such as going without sleep for days, dangerous or out-of-character behavior, or losing touch with reality.
Understanding Bipolar Spectrum Conditions
Bipolar spectrum conditions involve distinct changes in mood, energy, activity, and sleep. The pattern, duration, and severity of these changes can vary considerably between individuals.
Bipolar I involves episodes of mania, which can be severe and may significantly impair daily functioning or require hospitalization. Depressive episodes are common but not required for the diagnosis.
Bipolar II involves episodes of hypomania and major depression. Hypomania is less severe than mania but represents a distinct change from a person's usual mood and functioning.
Cyclothymia involves recurring periods of hypomanic and depressive symptoms that do not meet the full criteria for hypomanic, manic, or major depressive episodes.
What May Influence Mood Episodes?
Bipolar disorder has a strong genetic component, and the factors below may influence the timing or severity of episodes in someone who is already vulnerable. They differ from person to person, and researchers continue to study how they interact.
Sleep disruption
Chronic stress
Medication changes
Substance use
Hormonal changes
Seasonal light changes
References
1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). Bipolar and Related Disorders.
2. National Institute of Mental Health. Bipolar Disorder. https://www.nimh.nih.gov/health/topics/bipolar-disorder
My Treatment Approach
More Time. Deeper Evaluation. A Different Approach to Bipolar Disorder
Bipolar spectrum conditions look different from person to person. A longer evaluation makes it possible to understand your individual pattern of mood, energy, and sleep.
My Approach to Bipolar Disorder
My first appointment typically lasts 2–4 hours. I take a detailed history, review prior records and treatment, and look at how your mood and energy have changed over time, including the role of sleep, stress, medications, and other factors.
The goal is not only to name a diagnosis, but to understand your pattern and what may be influencing it.
What to Expect
Once I have a comprehensive picture of your health, I create an individualized plan. Depending on what the evaluation shows, this may include support for sleep and daily rhythms, stress regulation, nutrition, and other factors.
I am licensed to prescribe in California and can manage medications when appropriate. In many cases, a patient's psychiatrist continues to manage their medications while I focus on other parts of their care, and I coordinate with them. Medication changes are made deliberately and in coordination with the care team, never abruptly. Please never stop or change a medication on your own.
Visits are available in person in San Diego or by video across California.
Two Fundamental Principles
First, remove the obstacles to cure.
Identify and address factors that may be interfering with the body's ability to regulate, recover, and heal.
Second, provide a gentle healing stimulus.
Once obstacles have been addressed, provide individualized support designed to encourage the body's own capacity for regulation and recovery. I often prescribe a homeopathic remedy, an individualized preparation made from a plant, animal, or mineral substance, chosen to match the whole picture of a patient's physical, mental, and emotional symptoms. The aim of this approach is to support the body's own regulation and recovery as part of a broader plan.
More time allows for a deeper evaluation.
A deeper evaluation allows for a more individualized approach.
Results vary, and care is not a substitute for emergency treatment or for psychiatric care.
Collaborative Care
Bipolar disorder can involve serious episodes, so ongoing medical oversight is important. Some patients continue to see a psychiatrist or therapist while working with me. Others work with me as their primary provider for care and medication management, where my license allows. In every case, medication changes are made deliberately, with a plan for monitoring mood and safety, and never abruptly.
Not sure what fits your situation? We can talk through your history, current treatment, and goals at your first visit.
FAQs
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The main difference between Bipolar 1 and Bipolar 2 is the intensity and severity of the elevated mood episodes, with Bipolar 1 involving full mania and Bipolar 2 involving milder hypomania paired with major depression.
Bipolar 1 has at least one full manic episode that lasts for at least seven days, or is severe enough to require immediate hospital care. The manic episode looks like extremely high energy, racing thoughts, rapid speech, reckless behavior (such as major financial risks), and sometimes psychosis like delusions or hallucinations. Major depression does not have to happen, but sometimes does.
Bipolar 2 has a pattern of at least one hypomanic episode and at least one major depressive episode. Hypomania is a less intense form of mania. You feel very energetic and productive, but it does not include psychosis or require a hospital stay. Often the most debilitating part of Bipolar 2 is the presence of a major depressive episode.
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Sometimes referred to as Bipolar 3 Disorder, it continues the lessening of the intensity from Bipolar 1 to 2 to 3, but has more rapid shifts from the elevated feelings to the depression.
During Hypomania, you feel very energetic, creative, happy, or irritable. You may talk fast or need less sleep.
During mild depression, you feel sad, tired, unmotivated, or empty. You may lose interest in things you usually like.
To get a diagnosis, these mood shifts must last for at least two years in adults (or one year in children and teens). Stable moods between shifts rarely last longer than two months.
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Yes. BPD frequently occurs alongside both Anxiety and Depression.
Bipolar Disorder is defined in part by alternating episodes of depression and mania or hypomania. Depressive episodes are a core component of the disorder itself.
Anxiety frequently co-occurs with Bipolar Disorder. Conditions like generalized anxiety disorder (GAD), panic disorder, and social anxiety are very common in people with Bipolar illness.
Having Anxiety or Depression alongside Bipolar Disorder can make mood swings more frequent, intense, or severe.
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Several factors can disrupt mood stability in bipolar spectrum disorders. Biological, psychological, and environmental factors all may play a role.
Changes in sleep-wake cycles, called circadian rhythm disruption, such as shift work, or jet lag can trigger shifts toward mania or depression
Fluctuations in brain chemicals like dopamine, serotonin, and norepinephrine affect energy, focus, and emotional contro
Inherited traits and internal clock genes (such as CLOCK and BMAL1) influence vulnerability to mood episodes.
Oxidative stress and mitochondrial dysfunction in brain cells can lower the brain's resilience against mood swings.
Major changes, grief, relationship breakups, or high-pressure situations often precipitate acute episodes.
Drinking alcohol or using recreational drugs interferes with brain chemistry and lowers medication effectiveness.
Changes in daylight hours during different times of the year can alter body rhythms and provoke depressive or manic symptoms.
Vivid mental images of future events can amplify anxiety, excitement, or depression, leading to emotional instability.
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Mainstream treatment for Bipolar 1 disorder combines long-term medication and psychotherapy to manage severe mood episodes, prevent relapses, and maintain daily stability
In my practice, I have seen homeopathic treatment excel in BPD, when combined with naturopathic treatment. The power of homeopathy is in its ability to focus on the individual’s experience of BPD. What happens during mania? Is it an impulse to buy extravagant things? Or a desire to walk for days? Does it go into a destructive anger? Is there a propensity to rhyme or even rap when speaking? Going into that level of detail is where naturopathic medicine really shines.
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Yes, if there is a prescribing psychiatrist, I prefer to have them on board with my own work, so that they can manage the pharmaceutical portion, and I can manage the naturopathic portion. I sometimes prescribe pharmaceutical medications to my patients, if that is there preference. But most of my patients come to me wanting to reduce or eliminate psychotropic medications.
Therapy is the number one referral I make in my practice. CBT helps patients identify negative thought patterns, manage stress, and recognize personal episode triggers. FFT involves loved ones to improve communication, educate the household on the condition, and spot early warning signs.
Written by Dr. David Kirk, ND, naturopathic doctor in San Diego. Last reviewed November 2026.