Bipolar disorder affects an estimated 2.8% of U.S. adults, yet it remains one of the most frequently misdiagnosed conditions in mental health care — often confused with standard depression for years before an accurate diagnosis is reached. The older term “manic depression” is still widely used, but it only names part of what people with this condition experience across the full arc of their illness. At Nova Health Recovery in Alexandria, Virginia, we work with patients living with bipolar disorder, including many who have tried multiple treatment approaches without adequate relief.
What “Manic Depression” Actually Means
“Manic depression” was the clinical term used for decades before psychiatry adopted the name bipolar disorder. Both labels describe the same condition: a mood disorder defined by pronounced shifts between emotional highs — mania or its milder form, hypomania — and depressive lows. The terminology changed because “bipolar” more accurately captures the variability of mood states involved, but many patients still identify with the older term, particularly those diagnosed before the shift became widespread.
The defining characteristic is not simply mood variability. Everyone’s mood fluctuates. What distinguishes bipolar disorder is the severity, duration, and functional impact of its episodes — shifts that are qualitatively different from ordinary emotional responses to life events, and that often require clinical intervention.
The Three Main Types of Bipolar Disorder
Not everyone with bipolar disorder experiences the same pattern of symptoms. The National Institute of Mental Health identifies several distinct types, each defined by the nature and intensity of mood episodes.
Bipolar I Disorder involves full manic episodes lasting at least seven days — or shorter if the episode is severe enough to require hospitalization or emergency care. Depressive episodes typically follow and last at least two weeks. Bipolar I is generally the most straightforward to diagnose because the manic episodes are visible and functionally disruptive.
Bipolar II Disorder is defined by hypomanic episodes — elevated or irritable mood with increased energy, but less intense than full mania — alternating with major depressive episodes. Because hypomania does not produce the severe dysfunction of full mania, Bipolar II is frequently underdiagnosed. The depressive phase is usually what brings people to seek help, and without a clear history of hypomanic episodes in the clinical record, the diagnosis can default to major depression.
Cyclothymia, or cyclothymic disorder, describes a milder and longer-lasting pattern of hypomanic and depressive symptoms that persists for at least two years without meeting the full criteria for Bipolar I or II. People with cyclothymia carry an elevated risk of developing a more severe form of the disorder over time.
What Happens During a Manic Episode
During mania, a person may feel unusually energized, require very little sleep, and have thoughts that race faster than they can be organized. They may talk rapidly, pursue multiple projects simultaneously, and make significant impulsive decisions — financial, interpersonal, or otherwise — without apparent concern for consequences.
One complicated aspect of mania is that it does not always feel like a problem from the inside. During a hypomanic episode especially, a person may feel sharper, more creative, and more productive than usual. This subjective sense of capability is part of why people with bipolar disorder sometimes resist treatment — the elevated phases can feel preferable to the depression that often follows, even when those phases are causing real damage to relationships, finances, and work.
What the Depressive Phase Looks Like
The depressive episodes in bipolar disorder can be clinically indistinguishable from major depressive disorder (MDD). According to the Mayo Clinic, depression symptoms include persistent low mood or emptiness, loss of interest in activities that previously brought pleasure, changes in sleep and appetite, fatigue, difficulty concentrating, feelings of worthlessness or guilt, and, in severe cases, thoughts of death or suicide.
A clinically significant distinction: treating bipolar depression with antidepressants alone — without a mood stabilizer — can trigger a manic episode or accelerate cycling between mood states. This is one of the core reasons accurate diagnosis before beginning any treatment matters as much as it does.
Why Bipolar Disorder Is Frequently Misdiagnosed
Because the depressive phase most often drives people to seek care, and because hypomanic or manic episodes are not always volunteered or even recognized as symptoms, bipolar disorder has historically been underdiagnosed — sometimes for many years in the same patient.
The result is that patients sometimes spend extended periods being treated for unipolar depression, receiving medications that may not be suited to their actual condition, and in some cases contributing to mood instability rather than reducing it. A thorough evaluation that accounts for the full pattern of a person’s mood history — not just the current episode — is essential to getting this right. At Nova Health Recovery, that complete clinical picture is where every conversation begins.
When Standard Treatments Fall Short
A meaningful portion of people with bipolar disorder, particularly those experiencing bipolar depression, do not respond adequately to first-line treatments. Mood stabilizers and standard psychiatric medications help many patients significantly, but not everyone achieves sufficient relief.
Research has documented ketamine’s potential for bipolar depression, particularly in patients who have not responded to other medications. Ketamine works through the glutamate system — the brain’s primary excitatory neurotransmitter network — which is a different neurological pathway than most conventional psychiatric medications target. This distinction may explain why ketamine sometimes produces a meaningful response in patients who have not benefited from serotonin- or dopamine-acting treatments. The National Institute of Mental Health has noted that ketamine-class treatments can rapidly restore pleasure-seeking behavior, a function that is particularly impaired during bipolar depressive states. To understand more about how this mechanism functions, see our overview of how ketamine for depression works.
Full transparency is required here: ketamine is not FDA-approved for bipolar disorder. Its use in this context is off-label, and candidacy requires a thorough clinical evaluation. Patients in an active manic phase are not candidates. Results vary by individual, and this treatment is not appropriate for everyone.
What We Offer at Nova Health Recovery
We offer ketamine treatments in Alexandria, VA for patients with bipolar depression who have not found adequate relief through standard treatment. Our typical loading protocol involves four to six infusions delivered twice per week over two to three weeks. Patients spend approximately 90 to 120 minutes in our Alexandria office per visit — covering check-in, the active infusion, and a recovery period. A trusted driver is required after every infusion; patients may return to normal activities the following day.
For patients who have completed an in-clinic series and are looking to sustain their results, we also offer at-home ketamine options: oral troches (rapidly dissolving tablets taken under the tongue) and a compounded ketamine nasal spray. These are never the starting point — they are evaluated individually and require an in-person clinical assessment first.
At Nova Health Recovery, Dr. Christopher Sendi, M.D., is board certified in addiction medicine, obesity medicine, internal medicine, emergency medicine, and pain management, with more than 21 years of clinical experience. He approaches every evaluation with your complete history in view, including specific attention to the full arc of mood episodes that bipolar disorder requires.
Two Practical Barriers Worth Addressing
The cost question. We do not accept insurance directly. We can provide a SuperBill — a detailed itemized receipt — that you may submit to your insurer for potential reimbursement. Coverage for off-label ketamine use varies by plan; we recommend contacting your insurer in advance, and our team can help with documentation questions. For specific pricing, please call us — we do not publish costs online because treatment plans are individualized.
Hesitation after prior disappointments. Patients who have been through multiple treatments without enough improvement often arrive with real skepticism, and that skepticism is earned. At Nova Health Recovery, we do not push any particular path. We provide a thorough evaluation, explain what the evidence does and does not support, and support you in making your own decision. No outcomes are guaranteed, and we will not suggest otherwise.
Frequently Asked Questions
Is manic depression the same thing as bipolar disorder? Yes. “Manic depression” is the older clinical name for what is now called bipolar disorder. Both terms describe the same condition — a mood disorder characterized by alternating episodes of elevated mood and depression. The terminology changed to better reflect the full range of mood states involved, but both names remain in common use.
Can bipolar disorder look like regular depression? It often does, particularly when someone seeks care during a depressive episode and does not clearly report prior periods of elevated mood or decreased need for sleep. A thorough intake that specifically asks about hypomanic or manic periods — increased energy, racing thoughts, impulsive decisions, reduced sleep — helps distinguish bipolar disorder from unipolar depression.
Is ketamine safe for people with bipolar disorder? Ketamine may be considered for certain patients with bipolar depression following a careful clinical evaluation. It is not appropriate during an active manic phase, and individual candidacy depends on your full psychiatric and medical history. We discuss safety, contraindications, and realistic expectations during the evaluation before any treatment is recommended. You can also review common questions on our ketamine therapy FAQ page.
How do I get started if I have been diagnosed with bipolar disorder and am not responding well to my current treatment? The first step is a consultation. We review your diagnosis, your full history of prior treatments, your current symptoms, and your overall health before discussing whether IV ketamine may be a reasonable option for your situation. Please call us at 703-952-1876 or submit a request through our website.
Does bipolar disorder change over time? For some people, episodes become more frequent over time without adequate treatment. Symptoms and patterns also shift across a person’s lifetime, which is why maintaining an ongoing relationship with a qualified provider matters more than a single initial diagnosis.
Key Takeaways
- “Manic depression” is the older clinical term for bipolar disorder — both names describe the same condition involving distinct episodes of elevated and depressed mood.
- Bipolar disorder is frequently misdiagnosed as major depression, particularly when hypomanic or manic episodes are not clearly identified in the patient’s history.
- Treating bipolar depression with antidepressants alone, without a mood stabilizer, can worsen the condition — accurate diagnosis before treatment begins is essential.
- For patients with bipolar depression who have not responded to standard treatments, IV ketamine may be worth discussing with a qualified provider; it is used off-label and results vary by individual.
- At Nova Health Recovery in Alexandria, Virginia, we offer IV ketamine infusions and at-home ketamine options following a thorough clinical evaluation to determine candidacy.
Living with bipolar disorder — especially when standard treatments have not provided enough relief — is genuinely difficult, and it is reasonable to want a direct conversation about what else may be available. Call us at 703-952-1876 or schedule a consultation through our website. We will review your history carefully and give you a straight answer about what we think we can offer.
References
National Institute of Mental Health. Bipolar Disorder. https://www.nimh.nih.gov/health/topics/bipolar-disorder
National Institute of Mental Health. Rapid Agent Restores Pleasure-Seeking Ahead of Other Antidepressant Action. https://www.nimh.nih.gov/news/science-updates/2014/rapid-agent-restores-pleasure-seeking-ahead-of-other-antidepressant-action
National Library of Medicine / PMC. Ketamine & Bipolar Disorder. https://pmc.ncbi.nlm.nih.gov/articles/PMC10098148/
Medical Disclaimer
The information in this blog is for educational purposes only and does not constitute medical advice. Bipolar disorder is a complex condition requiring diagnosis and individualized treatment by a licensed mental health or medical provider familiar with your complete history. Ketamine is used off-label for bipolar depression and is not FDA-approved for this specific indication. Individual results vary, and this treatment is not appropriate for all patients. If you are experiencing a mental health crisis or thoughts of self-harm, please call or text 988 to reach the Suicide and Crisis Lifeline or go to your nearest emergency room.