Bipolar disorders
Careful diagnosis across the whole course of illness — and treatment designed to keep you well, not just to end the current episode.
Bipolar disorder is among the most consequential diagnoses in psychiatry to get right — and among the most frequently missed. Dr. Pellionisz has spent four years treating bipolar disorders at UCSF’s Bipolar Clinic and inpatient service, and it is the center of this practice.
Who this is for
- People with an established diagnosis of bipolar I or bipolar II disorder who want expert, continuous care.
- People with recurrent depression that keeps returning, or that responded to antidepressants briefly and then stopped.
- People who have been called “treatment-resistant” without a clear explanation of why.
- People whose mood, sleep and energy change in ways that never quite fit the diagnosis they were given — including those who recognize no obvious “highs.”
- Families and clinicians seeking a second opinion on a complex or contested diagnosis.
How we evaluate
The evaluation reconstructs the course of illness over time rather than a snapshot of the present. That means a detailed timeline of episodes — their onset, duration, character and what preceded them — alongside sleep, energy and attention; family history; every prior medication trial with its dose, duration, benefit and side effects; and, with your permission, records and the observations of people who know you well.
Competing explanations are weighed against that timeline: unipolar depression, bipolar-spectrum illness, ADHD, anxiety, trauma, thyroid and other medical contributors, and the effects of substances or medications. The goal is not to force a label but to find the account that best explains what has actually happened.
Treatment
- Mood stabilization. Careful selection among lithium, anticonvulsant mood stabilizers and atypical antipsychotics, with monitoring that is done properly and explained.
- Depressive episodes. Treated with agents appropriate to bipolar depression, and with attention to the risks antidepressants can carry in a bipolar course.
- Psychotherapy. Structured approaches that stabilize daily rhythms, identify early warning signs and build a relapse-prevention plan you and your family can use.
- Image-guided TMS. For persistent depressive symptoms.
- Long-term partnership. Bipolar disorder is a lifelong condition; the aim of treatment is sustained wellness, fewer and milder episodes, and a life not organized around illness.
Unsure whether this describes you?
You do not need to know your diagnosis before getting in touch. A first conversation is the way to find out whether an evaluation would help.