For many people with bipolar disorder, the depressive episodes last longer and do more damage than the highs. Bipolar depression often responds differently to treatment than unipolar depression, and it needs a psychiatrist managing mood stability alongside it.
Every psychiatrist at WIP-DC and WIP-Rockville treats bipolar disorder, including bipolar I and bipolar II depression. When bipolar depression hasn’t responded to standard medications, IV ketamine is an option we offer, used off-label and directed by your psychiatrist. We serve patients across Washington, DC, Maryland, and Northern Virginia.
Bipolar depression can look like ordinary depression. What sets it apart is a history of mania or hypomania. Consider seeing a psychiatrist if you or a loved one has:
If you are having thoughts of suicide, call or text 988 or go to the nearest emergency room.
Getting the diagnosis right matters, because treating bipolar depression like unipolar depression can make it worse. According to the National Institute of Mental Health, about 2.8% of U.S. adults have bipolar disorder in a given year, and about 4.4% at some point in their lives.
Bipolar disorder has two main types, and depression is central to both.
At least one full manic episode: days of elevated or irritable mood, high energy, little need for sleep, and risky behavior, sometimes needing hospitalization. Most people with bipolar I also have depressive episodes.
Episodes of major depression and hypomania, a milder high that doesn’t reach full mania. People with bipolar II typically spend much more time depressed than hypomanic.
Bipolar II is often missed. Hypomania can feel like a good stretch of energy and productivity rather than a symptom, so many people are diagnosed with depression, or treatment-resistant depression, for years before bipolar II is recognized. If antidepressants haven’t worked, have made you agitated, or seem to stop working, it’s worth asking a psychiatrist whether bipolar II is part of the picture.
Both bipolar I and bipolar II depression are treated at WIP, with medication management and, when appropriate, IV ketamine used off-label.
In unipolar depression, antidepressants are usually the first step. In bipolar depression, antidepressants on their own can be less effective and may trigger mania or faster mood cycling in some people. That is why a psychiatrist needs to manage the depression and mood stability together, and why some treatments used for unipolar depression aren’t the right fit here.
Low-dose infusions under medical monitoring, often in a first series over 2–3 weeks. Ketamine can improve depressive symptoms within hours to days, which matters when bipolar depression has gone on for months. Used off-label for bipolar depression, in coordination with your ongoing medication plan.
Several medications are FDA-approved for bipolar depression, including quetiapine, lurasidone, cariprazine, lumateperone, and olanzapine with fluoxetine. Your psychiatrist chooses and adjusts them with you.
Therapy focused on routines, sleep, and early warning signs helps prevent future episodes. We coordinate with your therapist.
What about Spravato? Spravato is FDA-approved for treatment-resistant depression and for major depression with suicidal thoughts, not for bipolar depression. For bipolar depression, WIP uses IV ketamine off-label when appropriate.
Ketamine is FDA-approved as an anesthetic. Its use for bipolar depression is off-label. Your psychiatrist will review the evidence, risks, and alternatives with you.
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WIP-DC: 4325 49th Street NW, Suite 200, Washington, DC 20016
WIP-Rockville: 1801 Rockville Pike, Suite 110, Rockville, MD 20852
Prefer to start from home? See a psychiatrist by video. WIP offers telepsychiatry for patients located in DC, Maryland, and Virginia.
Bipolar depression is the depressive phase of bipolar disorder. It can look like ordinary depression, but it happens in someone who also has periods of mania or hypomania, and it needs a different treatment plan.
Bipolar II involves episodes of major depression and hypomania, a milder high than full mania. Depression usually dominates, and it is often mistaken for unipolar or treatment-resistant depression. Like bipolar I depression, it needs a psychiatrist managing mood stability, and IV ketamine can be an off-label option when standard medications haven’t worked.
IV ketamine can be an option for bipolar depression that hasn’t responded to standard medications. It often works within hours to days. Its use for bipolar depression is off-label, and your psychiatrist will review the evidence and risks with you.
No. Spravato (esketamine) is FDA-approved for treatment-resistant depression and for major depression with suicidal thoughts, not for bipolar depression. For bipolar depression, WIP uses IV ketamine off-label when appropriate.
Antidepressants on their own can be less effective in bipolar depression and may trigger mania or faster mood cycling in some people. Treatment needs a psychiatrist managing mood stability alongside the depression.
Several, including quetiapine, lurasidone, cariprazine, lumateperone, and the combination of olanzapine and fluoxetine. Your psychiatrist will choose based on your history and side effects.
At WIP-DC in Spring Valley (4325 49th St NW, Suite 200, Washington, DC 20016) and WIP-Rockville (1801 Rockville Pike, Suite 110, Rockville, MD 20852). Every WIP psychiatrist treats bipolar disorder, and follow-ups are available by telehealth.
Schedule a consultation to discuss your symptoms and treatment options. Call (202) 525-5123 for WIP-DC or (240) 995-6005 for WIP-Rockville.
