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Bipolar disorder: treatment that watches the rhythm

Silvia A. Bernardi, M.D. · Psychiatrist & Neuroscientist · New York & Milan · Updated October 2026

Bipolar disorder is a disorder of mood and of rhythm. Episodes of depression, and of mania or hypomania, are tied to sleep, circadian timing and stress — and are often preceded by changes in sleep that can be detected days before mood shifts. Good treatment combines the right medication with close attention to that rhythm.

Getting the diagnosis right

Bipolar II disorder in particular is frequently diagnosed as ordinary depression for years, because hypomania can feel like simply functioning well. Antidepressants alone can then destabilize mood. A careful history — including how past medications actually behaved — is the first step. Co-occurring ADHD is another frequent complication: Dr. Bernardi has published on bipolar disorder with comorbid ADHD as a possible distinct clinical phenotype, with its own temperamental profile and treatment challenges. In October 2026 she spoke on advancing bipolar disorder care at an Ember Health panel in New York (see Teaching and talks).

How we diagnose and treat it

Listening to the patient comes first: the history of each episode, told in the patient's own words, is the most important diagnostic instrument we have. With the patient's permission, we also speak with family members, who often see the early changes before anyone else does. MindFirst Brain Map reads the full medication history to clarify which mechanisms have helped and which have harmed, and, with consent, MindFirst Sleep follows sleep timing and continuity from the patient's own wearable over months. Together we build a working knowledge of the patient's own prodrome — the particular early signs, in sleep, energy, thinking or behavior, that announce an episode — so that it can be caught early. Medication, chosen and monitored carefully, is part of the plan; so is helping the patient grow into the illness: understanding it, recognizing its signals, and taking ownership of its management over time.

Questions

How is bipolar disorder different from depression?
Bipolar disorder includes episodes of mania or hypomania as well as depression. Bipolar II is often misdiagnosed as depression for years, and treating it with antidepressants alone can worsen mood instability.

Can a wearable help manage bipolar disorder?
Changes in sleep timing and duration often precede mood episodes. Following sleep data from a wearable over months can help detect early warning signs, alongside clinical care.

Is lithium still used?
Yes. Lithium remains one of the most effective treatments for bipolar disorder, particularly for preventing relapse, and requires regular blood monitoring.

Related reading

• Insomnia and sleep problems, measured over months
• Postpartum, perinatal and hormonal psychiatry
• What is a Brain Map?

MIND FIRST sees patients in Midtown Manhattan (Grand Central) and the Financial District, and by telehealth for patients located in New York, Florida or Milan. Dr. Bernardi is licensed to practice medicine in New York, Florida and Italy.