Maureen Diezman, DNP, PMHNP-BC, is a psychiatric mental health nurse practitioner and a Medical Resource Director at Columbia Mental Health’s Aldie, VA clinic. She works with clients both in person and via telehealth, and offers tailored treatment plans rooted in empathy, clinical insight, and trust. Maureen has a special gift for meeting clients where they are—offering not just medication management but true partnership in healing.

In this Q&A, Maureen shares her expert perspective on bipolar disorder: what it really is (and isn’t), how it’s treated, and why it’s so important to take the condition seriously—and compassionately.

Defining bipolar disorder—what it actually means

If someone doesn’t know much about bipolar disorder, how would you explain it?

Maureen: Bipolar disorder is widely misunderstood, in part because most people learn about it through media—which, understandably, isn’t always accurate. We’ve all heard someone say, “You’re so bipolar!” to describe mood swings. But clinically, that’s not correct.

True bipolar disorder isn’t about shifting moods throughout the day. It’s not a moment-to-moment fluctuation. When patients come in and say they’re having mood swings and they think they have bipolar disorder, I always ask: “What led you to that conclusion?” It’s almost always just someone in their life, not a trained provider.

Bipolar disorder is defined by at least one lifetime episode of mania or hypomania. That’s the clinical marker—these are states of elevated mood that last for several days and come with very specific, observable symptoms.

In between these episodes, people are often stable. And that’s a key point—this is not a constant rollercoaster. It’s more like brief, extreme deviations from a person’s usual baseline.

Mania vs. moodiness

So what does a true manic episode actually look like?

You can’t miss a manic episode. People think they’ve had one because they “felt manic” for an afternoon. But for a clinical diagnosis, you need to have symptoms consistently for several days—at least four days for hypomania and seven days for full mania.

We’re talking about behavior like staying up for 24 hours and still having tons of energy, barely eating, acting impulsively or erratically. One of my former patients spent $5,000 on socks in a single night—that’s the kind of impulsive behavior that signals mania.

There can also be psychotic features—things like delusions. I once had a patient stand on the register at Target announcing he was Jesus returned. That’s not just being “feeling great”—that’s a delusion that can lead to risk to the patient or others.

The trigger and timeline

How do these episodes start? Can they come on suddenly?

There’s usually a trigger, especially for manic or hypomanic episodes. It could be something physiological—like a medical event—or, more commonly, it’s a life stressor: finals, a breakup, losing a job, the death of a loved one. Anything that adds stress to the central nervous system can push someone over the edge.

I tell people: depression often creeps in slowly, over days or weeks. Mania tends to hit faster—you’ll see noticeable changes within 12 to 24 hours. But again, these are not small mood fluctuations. When you’re experiencing a manic episode, something is clearly wrong, and it’s sustained.

The importance of accurate diagnosis

What are the biggest misconceptions about bipolar disorder?

That it’s just “moodiness.” That someone waking up happy and feeling sad by lunchtime must be bipolar. That’s not accurate—and it’s dangerous because it dilutes the seriousness of the condition.

There’s also a lot of confusion between bipolar disorder and borderline personality disorder. People with borderline personality disorder may experience rapid mood shifts throughout the day. But bipolar episodes have a time component: they last days or weeks, not hours.

There’s even a specific diagnosis for people who have more than four episodes in a year—we call that “rapid cycling.” But even that doesn’t mean hour-to-hour mood swings.

Columbia Mental Health’s approach to treatment

What does treatment look like? Where do you start?

The first step is always medication. You have to stabilize someone before therapy can be effective. Fortunately, Columbia Mental Health offers integrated care—I work closely with our therapists, we share notes, message each other, and that kind of collaboration is invaluable.

For medications, it really depends on the person’s symptoms. If someone is having more depressive episodes, I might reach for something like lamotrigine (Lamictal). For someone with severe mania, I might consider Depakote—though there are limitations with certain populations, like women of childbearing age. Antipsychotics—particularly second-generation ones—are also a part of the toolkit. I might also use Rexulti in combination with mood stabilizers for bipolar depression.

Of course, everyone’s medication journey is different. What works for one person may not work for another, which is why these decisions should always be made with a trusted psychiatric provider.

But I always remind patients: I don’t treat diagnoses—I treat symptoms. The label helps us find a starting point, but what matters is what’s actually happening for the individual.

How does therapy play a role in bipolar treatment?

Therapy is essential, but it comes after stabilization. You can’t process triggers or build coping strategies if you’re in the middle of a manic episode.

Once someone is stable, therapy helps them deal with the things that might otherwise throw them off balance—stress, grief, transitions. That resilience work is just as important as the medication. But you need a solid foundation first.

How do you talk to patients about staying on meds long-term?

That’s one of the hardest conversations I have. I had a young man come to me after his first manic episode in college. When I told him he would likely need medication for the rest of his life, he broke down crying. He said, “I don’t want to be sick forever.”

That moment really stuck with me. I told him, “You won’t feel sick forever. We can manage this. You’ll feel like yourself again. But we have to use medication to keep it that way.”

You don’t “therapy-away” bipolar disorder. You manage it. And that means a daily medication regimen, probably for life. That can be heartbreaking to hear, especially for someone in their early twenties. But being honest—compassionately honest—is the only way through it.

The grief of diagnosis

Can you tell us more about the emotional journey people go through after a bipolar diagnosis?

There’s a real grief process. People are mourning the life they thought they’d have—the freedom, the identity of being “healthy.” Acceptance doesn’t happen in a single appointment. It can take months. That same young man asked me at every visit for six months: “Are we sure this is forever?”

You have to let people sit with that. You can’t rush them to acceptance. My job in those moments is to stay with them, support them, and keep reminding them: this is manageable. You can still have a wonderful, fulfilling life. And he does—he got his degree, moved in with his girlfriend, landed a job. Now we just meet to check in and refill his prescription. It’s night and day.

How you know treatment is working

What signs do you look for that someone is improving?

The obvious ones are stabilization of sleep and appetite—those are the first things to go in a manic episode. So when someone tells me they’re sleeping through the night and eating regularly, that’s a big win.

But the deeper marker is emotional acceptance. When someone shows up to appointments, not out of obligation but with a sense of ownership—when they meet my energy, engage in the conversation, and aren’t dreading the visit—that’s when I know we’re getting somewhere.

Eventually, it’s about maintaining stability even when life throws curveballs. One of my patients has been on the same regimen for 30+ years. He’s gone through loss, a divorce, all kinds of challenges—and he’s stayed stable. That’s what success looks like.

Words matter

Anything else you’d like people to know?

Language matters so much. When people casually say “I’m so bipolar” or joke about mental illness or suicide, it’s more harmful than they realize.

You never know what someone is going through. That neighbor who seems totally fine? He might have spent a week in the hospital during a manic episode years ago. It’s not about being “sensitive”—it’s about being respectful. These conditions turn people’s lives upside down. They deserve our compassion, not our punchlines.

Bipolar disorder is manageable—and help is here

Whether you’ve been diagnosed recently or are wondering if bipolar disorder might be part of your experience, Columbia Mental Health is here to support you. With evidence-based medication management, compassionate therapy, and a team that listens, we’ll help you find your footing—and your path forward.