Bipolar disorder can be difficult to spot; symptoms with which patients present often appear quite similar to unipolar depression, anxiety, or other psychiatric illnesses. There exists great variety in presentation, history, and associated symptoms within the bipolar spectrum. A symptom-based approach to treatment can help guide therapeutic decisions when dealing with complex mood disorders. In order to optimize treatment, it is necessary to understand the neurobiological basis of symptoms and the pharmacologic mechanisms of action involved in correcting that abnormal neurobiology.

Many neural circuits are hypothetically linked to symptoms. However, bipolar disorder may not be just the result of irregularities in one or several of these circuits, but may more accurately be a manifestation of unstable and/or excessive neurotransmission more generally. Ions, receptors, and channels that regulate neurotransmission are hypothesized as sites of pharmacologic action for many of the drugs that are effective at relieving and possibly preventing symptoms of bipolar disorder. Successfully targeting the right systems in individual cases as well as selecting and combining treatments for optimal outcomes is psychopharmacological art.

Throughout treatment, it is critical to track and monitor patients to determine the effectiveness of the patient's treatment plan and to evaluate the progression of illness. Also throughout treatment, psychotherapy can be a critical adjunct component, improving quality of life beyond what pharmacotherapies are able to accomplish alone.