Understanding Bipolar Disorder
Bipolar disorder is a mood condition, not a personality — and with the right plan, stability is achievable. Willow & Stone is led by Dr. Stacey Forbes, DNP, APRN, PMHNP-BC, a board-certified Psychiatric-Mental Health Nurse Practitioner with nearly two decades of nursing experience. We treat bipolar I and bipolar II with careful, evidence-based medication management alongside an integrative review of sleep, thyroid function, nutrients, and metabolic health — the factors that quietly destabilize mood and are so often left unexamined.
Signs and symptoms
Bipolar disorder involves shifts between depressive episodes and elevated (manic or hypomanic) episodes. It is frequently misdiagnosed as depression, because most people seek help during the low periods.
- ✓Depressive episodes: low mood, exhaustion, hopelessness, loss of interest
- ✓Elevated episodes: less need for sleep, racing thoughts, rapid speech
- ✓Periods of unusually high energy, confidence, or impulsivity
- ✓Risky decisions — spending, driving, or choices out of character
- ✓Irritability and agitation rather than euphoria
- ✓Antidepressants that seemed to "stop working" or made things worse
- ✓A family history of bipolar disorder or unexplained mood instability
Our integrative approach
Bipolar care rewards precision and patience. Our approach is deliberately careful:
Getting the diagnosis right
Bipolar II in particular is often treated as unipolar depression for years. A thorough history — including how you responded to past antidepressants — changes the plan.
Mood stabilization first
Evidence-based mood stabilizers and thoughtful medication sequencing, with the monitoring and lab work these medications genuinely require.
Sleep as treatment
Sleep disruption is both a trigger and an early warning sign for episodes. Protecting your sleep is part of the clinical plan, not an afterthought.
Metabolic & thyroid review
Thyroid function, metabolic health, and nutrient status affect both mood stability and how well medications are tolerated. We track them.
Who we see for bipolar care
Willow & Stone sees adults, teens and children ages 10 and up for bipolar I disorder, bipolar II disorder, cyclothymic disorder and other bipolar-spectrum presentations. People usually come to us at one of four points:
- Something has never added up. Depression that keeps returning, antidepressants that left you wired or cycling, or stretches of very little sleep and big plans that friends noticed before you did. Our bipolar self-check can help you put words to it before the visit.
- You already have a diagnosis and need a new prescriber, a steadier plan, or a fresh look at a regimen that has grown complicated over the years.
- You were told it might be bipolar and aren’t sure. Bipolar disorder is missed in some people and over-called in others; a bipolar second opinion looks at both possibilities.
- You are a parent worried about a teen’s mood changes. See bipolar treatment for teens and children 10+.
If you have recently been in a hospital or an intensive program, bring the discharge summary to your first visit so we can decide together whether scheduled outpatient care is the right next step. For background on symptoms, types and treatment, read our complete guide to bipolar disorder.
Your first visit and what it costs
Care starts with a 90-minute integrative psychiatric evaluation with Dr. Stacey Forbes, in person in Arlington or by secure video. The first visit is $300; follow-up visits are $150. Insurance is accepted for Texas patients (coverage depends on your plan). Outside Texas, care is direct-pay and you receive a superbill you can submit for possible out-of-network reimbursement. Lab tests are billed separately by the lab that runs them. How the costs of bipolar care add up explains each piece.
What the evaluation covers
- A timeline of your moods: the low periods, any stretches of high energy or reduced need for sleep, how long they lasted and what was happening around them. A partner or family member’s view is welcome if you want to bring one.
- Every medication you have tried, especially how you responded to antidepressants, and why anything was stopped.
- Sleep, substance use, physical health, family history and current stressors.
- Medical look-alikes. No blood test or brain scan can diagnose bipolar disorder, but thyroid problems, some medications and substances can mimic or worsen mood symptoms, so labs are ordered as needed to rule them out. See how bipolar disorder is diagnosed.
- Safety: what you would do, and who you would call, if symptoms escalated between visits.
You leave with a working diagnosis (or a clear plan for clarifying one), an explanation of the reasoning, and next steps that you have agreed to.
Medication, monitoring and the rest of the plan
Most people with bipolar disorder need ongoing treatment, and medication is usually central to it. Options are discussed at your evaluation, weighing what has worked before, side effects you want to avoid, other health conditions and, for women, pregnancy plans. Guideline options include lithium, lamotrigine, valproate and several atypical antipsychotics; antidepressants are not used on their own in bipolar disorder because they can trigger mania or rapid cycling. Our guide to bipolar medications explains each class.
These medications need monitoring. Lithium, for example, calls for blood levels plus kidney and thyroid checks, and many antipsychotics call for weight, glucose and lipid checks. Safety labs are ordered as needed and reviewed with you; lab work in bipolar care lists what is checked and why. Pharmacogenomic testing can inform a few specific choices, though it does not apply to lithium and cannot diagnose bipolar disorder.
Medication works best inside a steady routine. We build in sleep protection, a mood chart you bring to visits, attention to alcohol and cannabis, and coordination with a therapist; psychotherapy, including EMDR, is available in-house, and therapies built for bipolar disorder such as IPSRT and family-focused therapy can be arranged with outside therapists. Integrative medication management for bipolar disorder describes how these pieces fit together here. Please never stop a mood stabilizer suddenly on your own: stopping abruptly can be dangerous and raises the risk of a new episode.
Teens and children 10 and up
Bipolar disorder in young people is real but easy to confuse with ADHD, disruptive mood dysregulation disorder (DMDD), anxiety or the ordinary storms of adolescence. A youth evaluation includes the parent’s observations, school information and a careful look at whether changes come in distinct episodes. Parents can start with our guide to bipolar disorder in teens and children, then see what teen bipolar treatment involves at Willow & Stone. For general teen psychiatric care, visit teen and adolescent psychiatry.
In person in Arlington, or by telehealth in seven states
Visits happen at our Arlington office or by secure video for patients physically located in Texas, New Mexico, Florida, Alaska, Arizona, Colorado or Washington at the time of the visit. Mood stabilizers are not controlled substances, so telehealth prescribing for them does not depend on federal controlled-substance rules. Labs can be drawn at a lab near your home. Read more about telehealth bipolar treatment, or, for Texans, bipolar treatment across Texas.
When a higher level of care is needed
Willow & Stone provides scheduled outpatient care and is not an emergency service. Severe mania, psychosis, thoughts of suicide, or being unable to stay safe need same-day emergency care: call 911 or go to the nearest emergency room, or call or text 988 (Suicide & Crisis Lifeline), or text HOME to 741741. If your symptoms need more than outpatient visits can safely provide, such as a hospital stay or an intensive outpatient program, we will tell you directly and help you find it, and we can pick up outpatient care once you are stable.
Ketamine, esketamine, TMS and ECT are not offered at Willow & Stone; when one of them is indicated, we refer you to a program that provides it.
Learn more about bipolar disorder
If you need help right now
If you are in immediate danger, call 911 or go to the nearest emergency room. For urgent support at any hour, call or text 988 (the Suicide & Crisis Lifeline), or text HOME to 741741 for the Crisis Text Line. Reach out to us afterward and we will help you from there.
Frequently Asked Questions
What is the difference between bipolar I and bipolar II?
Bipolar I involves at least one manic episode, lasting at least a week or severe enough to need hospital care. Bipolar II involves hypomania, a shorter and less extreme elevated state, along with major depressive episodes that are often long and disabling. Bipolar II is not a milder illness; people with it often spend more time depressed. It is frequently first diagnosed as depression because people usually seek help during the low periods.
Can bipolar disorder be misdiagnosed as depression?
Yes, and it often is. Most people come in during a low period and never mention the elevated periods, which can feel productive rather than concerning. Clues include a poor or unusual response to antidepressants (feeling agitated, wired, or cycling faster), early onset, and a family history of bipolar disorder. We take a detailed history, and with your permission talk to someone who knows you, specifically to catch this.
Can a psychiatric nurse practitioner diagnose and treat bipolar disorder?
Yes. A board-certified psychiatric-mental health nurse practitioner (PMHNP-BC) such as Dr. Stacey Forbes evaluates, diagnoses and treats bipolar disorder, including prescribing and monitoring mood stabilizers and other medications, within outpatient care. When someone needs hospital-level care, we help arrange it.
How much does bipolar treatment cost at Willow & Stone?
The first visit, a 90-minute evaluation, is $300, and follow-up visits are $150. Insurance is accepted for Texas patients, depending on the plan; elsewhere care is direct-pay with a superbill for possible out-of-network reimbursement. Lab tests are billed by the lab that runs them.
Will I need medication for the rest of my life?
Many people with bipolar disorder do best on long-term maintenance treatment, because it lowers the risk of new episodes, which cause the most damage to health, work and relationships. The plan is individualized and revisited over time, and we explain the reasoning behind every recommendation. Never stop a mood stabilizer suddenly on your own; stopping abruptly raises the risk of relapse.
Do you treat teens with bipolar disorder?
Yes, we see patients ages 10 and up. A youth evaluation includes a parent or guardian, school information, and a careful look at look-alikes such as ADHD, DMDD and anxiety. Consent and confidentiality rules for minors vary by state. Our teen bipolar treatment page explains the process.
Can lifestyle and nutrition really affect bipolar disorder?
They do not replace medication, but they matter. Regular sleep, limiting alcohol and cannabis, metabolic health and thyroid function all affect mood stability and how well medications are tolerated. Our integrative approach addresses these alongside, never instead of, evidence-based psychiatric treatment.
Do you treat bipolar disorder by telehealth?
Yes, for patients whose condition can be managed safely in outpatient telehealth care. We see patients across Texas, New Mexico, Florida, Alaska, Arizona, Colorado and Washington by secure video, with in-person visits at our Arlington office. If a higher level of care is needed, we will tell you directly and help you get there.
What should I do if mania or a crisis starts between visits?
Willow & Stone is an outpatient practice, not an emergency service. If you or someone else is in danger, call 911 or go to the nearest emergency room. For urgent support at any hour, call or text 988 or text HOME to 741741. Let us know afterward so we can adjust your plan.
Your healing begins with a conversation.
Start with a telehealth consultation. Insurance is accepted for Texas patients; outside Texas, care is direct-pay with a superbill.
Schedule Your ConsultationOr call (469) 726-3768