Bipolar disorder has a long history of being treated as something else. The reason is structural rather than careless, and understanding it tells you what an assessment is for.
Why it gets treated as depression for years
People come for help when they are depressed. Nobody books an appointment because they felt unusually well.
A period of elevated mood is rarely experienced as illness at the time. It is experienced as energy, confidence, productivity, needing less sleep and getting more done — or as irritability and restlessness that gets attributed to stress. Looking back, people describe it as “a good spell” or “when I was finally on top of things”. It does not get mentioned in a ten-minute appointment about low mood, because it does not feel like a symptom.
So the consultation covers the depression, an antidepressant is started, and the diagnosis recorded is recurrent depression. That can continue for a long time, and the record then carries forward — each new clinician reading the last one’s conclusion.
Two things make it more likely that something has been missed. A history of antidepressants that worked briefly and then stopped working, or that produced an odd agitated response. And a family history of bipolar disorder, which is among the most useful pieces of information anyone brings to an assessment.
Why the distinction changes the treatment
This is the practical reason it matters, rather than a question of labels.
An antidepressant given on its own to someone with bipolar disorder can precipitate a switch into mania or hypomania. NICE’s guidance on bipolar disorder is explicit that if someone develops mania or hypomania while taking an antidepressant, clinicians should consider stopping the antidepressant.
Long-term treatment differs too. NICE recommends lithium as the first-line long-term treatment, with antipsychotics such as aripiprazole, asenapine, olanzapine, quetiapine or risperidone where lithium is not effective or not tolerated. None of that follows from a diagnosis of recurrent depression.
So a wrong diagnosis here is not a filing error. It can mean years of a treatment that does not work and may make things worse.
What the assessment is actually looking for
The initial appointment is a 60 minutes video consultation with a GMC-registered consultant psychiatrist. For a possible bipolar diagnosis it goes in a particular direction, and it takes longer to be confident than with most conditions.
The psychiatrist is looking for a history of elevated mood, and will ask about it in concrete terms rather than asking whether you have ever felt manic. How much sleep did you need in that period, and did you feel tired? What did you spend? What did you start? Did people say you were talking too fast, or that you seemed different? Was there irritability rather than elation? Did anything happen that you would not normally do?
They will ask about the shape of the illness over years, not just the current episode — when the first episode was, what the pattern has been, what triggered each one, and what happened with each treatment. Bipolar disorder is diagnosed on course over time, which is why a single snapshot is a weak instrument.
They will ask for collateral information where you are willing. A partner, parent or close friend often remembers the elevated periods clearly, precisely because they were on the outside of them. Where a diagnosis is genuinely in the balance, this is frequently what settles it.
And they will look at what else explains the picture — thyroid disease, the effects of alcohol or stimulants, steroid treatment, ADHD, emotionally unstable personality traits, and the ordinary variability of mood in someone under sustained pressure. Several of these can look like hypomania and none of them is treated like it.
An honest outcome is sometimes uncertainty. Where there is not yet enough to support the diagnosis, the right answer is a working formulation, a plan for what would confirm or exclude it, and a mood record kept over months. Any service that offers you a confident bipolar diagnosis after one remote appointment with no other information is overreaching.
What the treatment involves
NICE’s recommendations divide into three situations.
For mania or hypomania, an antipsychotic first — haloperidol, olanzapine, quetiapine or risperidone — with a different one from that list if the first is not effective or not tolerated, and lithium added if needed. If you are taking an antidepressant, stopping it is considered.
For bipolar depression, the options include fluoxetine combined with olanzapine, or quetiapine on its own, or olanzapine, or lamotrigine, with lamotrigine added if the response is inadequate.
For long-term treatment, lithium first, as above.
Valproate sits under significant restrictions and it is worth knowing why before it is discussed. Because of the risk of serious harm to a baby in pregnancy, and evidence of an effect on male fertility, the MHRA has required since January 2024 that valproate is not started in anyone under 55 unless two specialists independently document that there is no other effective or tolerated treatment, or that compelling reasons apply. In February 2025 the MHRA removed that two-clinician review requirement for men already taking it, replacing it with personalised care plans, while keeping it for new prescriptions. Women of childbearing potential also require annual risk acknowledgement forms. These are not formalities and they are not negotiable.
Lithium requires monitoring, and this is where remote care runs into its limit. Lithium levels are checked a week after starting, a week after every dose change, and weekly until stable, with NICE giving a target of 0.6 to 0.8 mmol/L for people taking it for the first time. After that, levels every three months in the first year, then every six months, along with weight, kidney function, thyroid function and calcium every six months.
That is a standing commitment to blood tests and physical checks, arranged locally. A private online service cannot run it alone. Where those arrangements are not already in place with a GP, starting lithium remotely is not appropriate, and saying so is part of a competent assessment.
When the NHS is the better route
Most pages on this site describe a service you might pay for. This one comes with a clearer caveat than most.
Bipolar disorder is usually a long-term condition, and the things that help most over a lifetime are the things NHS secondary care is built to provide: a consistent team who know you, blood monitoring organised as routine, a crisis team when an episode starts, care coordination, and admission when it is needed. A remote private clinic provides none of that. It provides appointments.
If you are acutely unwell, this is not the right service. An acute manic episode needs urgent local care, not a video appointment in three days’ time — contact your GP urgently, call NHS 111 and choose the mental health option in England, or go to A&E. If there is immediate risk to life, call 999. Samaritans are free on 116 123, day and night.
If you are already under a community mental health team, stay with it. A private opinion alongside it is reasonable, but replacing it rarely is.
Where a private assessment does earn its place is narrower and real: when you suspect the recurrent-depression label is wrong and want that question examined properly by a consultant; when you are stable, not under secondary care, and want a medication review; or when the NHS wait for an opinion is long and the uncertainty is itself doing damage. NHS or private psychiatry sets out that comparison in more detail, and psychiatric medication review covers what a review involves.
Therapy, and what this clinic does not do
The NHS describes talking therapy such as CBT as part of treatment for bipolar disorder, alongside medication, with a plan that combines both.
Happy Clinic does not provide psychological therapy. In England you can refer yourself to NHS talking therapies without going through a GP. In Scotland, Wales and Northern Ireland, your GP is the quickest route to the local equivalent. Bipolar UK runs peer support groups and a support line, and for a long-term condition that kind of ongoing contact is often worth more than any single appointment.
Fees
An initial psychiatric assessment is £400 for 60 minutes. Follow-up and review appointments are £200 for 20 minutes. A repeat prescription request for existing patients is £150, subject to clinical review. Fees are paid in advance, and prescriptions issued during an appointment are included, though pharmacy charges are not. Fees checked September 2026 — see the fees page for the current list.
Appointments are provided by Happy Clinic, which is registered with the Care Quality Commission (CQC). Onlinepsychiatrist.co.uk is an information site and does not provide clinical care itself.
Speak to a Consultant Psychiatrist
Book a secure video consultation with Happy Clinic, for adults aged 18 and over anywhere in the UK. No GP referral is needed and appointments are often available within days.
This page is general information and is not a substitute for personal medical advice. Consultations, diagnosis and prescriptions are provided by Happy Clinic, which is registered with the Care Quality Commission (CQC). If you are in crisis, call 999, go to A&E, call NHS 111 or call Samaritans free on 116 123.