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bipolar I disorder. Even in cases where the only manic state is observed, a depressive state often appears in the course of the disease, and the diag-nosis of bipolar I disorder is made even when no depressive state is seen7).On the other hand, bipolar disorder with both hypomanic state and depressive state is called bipolar II disorder.If left untreated, bipolar I disorder can lead to multiple cycles of manic and depressive states, during which the foundation of one’s life, such as relationships, social trust, work and family, is greatly damaged. However, treatment and coping strategies for bipolar disorder have been formu-lated, and in many cases, it is possible to control the illness and lead a social life.When a depressive patient visits a clinic, the criteria for a depressive episode are checked after ruling out depression due to general medical diseases or depression due to substances or drugs. In addition, the presence or absence of a history of manic or hypomanic states should be checked. To diagnose major depressive disorder, it is necessary to confirm the absence of a history of manic or hypomanic states. However, it is not easy to accu-rately diagnose past hypomania, and the diagnosis of bipolar II disorder, in particular, tends to vary among doctors8). The depressive state of bipolar disorder is characterized by a family history of bipolar disorder, young age of onset (less than 25 years old), and psychotic symptoms (e.g., auditory hallucinations, delusions)9), but these alone cannot be used to diagnose bipolar disorder, and there is still no test that can help differentiate between the two. In Japan, near-infrared spectroscopy (optical topography) is covered by insurance as an aid in the differential diagnosis of depression, but there is little evidence that this method is actually useful for differential diagnosis, and worldwide, this method is not considered to be useful for differenti-ating depression from bipolar disorder10). Although many other biomarkers for differentiating depres-sion and bipolar disorder have been studied, none have been confirmed in multiple studies and have established diagnostic significance11).Both manic and depressive states may present with psychotic states such as delusions, auditory hallucinations, or catatonic states such as stupor.When manic states first appear, it may be diffi-cult to distinguish them from schizophrenia if psychotic symptoms are in the foreground. In addi-tion, patients who initially present with a short-term psychotic disorder may subsequently develop bipolar disorder.Treatment goalsIn the treatment of the major depressive disorder, the goal is to cure the depressive state, and in most cases, the treatment is terminated after about one year of recovery. On the other hand, in the case of bipolar disorder, the manic and depressive states will eventually be cured even if left untreated, but the manic and depressive states recur in most cases, so the goal of treatment is to prevent these episodes, and the key to treatment is how to prevent the manic and depressive states after they are cured. If treatment is stopped after the manic state is ameliorated, relapse will occur repeatedly, resulting in significant social damage and may also cause cognitive dysfunction12).It is not easy to continue medication for a lifetime in a state of remission when symptoms have subsided, and a combination of pharmacotherapy and psychosocial intervention that promotes accep-tance of the disease is necessary. Patients go through various stages before accepting the disease, such as doubting the doctor’s diagnosis, doctor shopping searching for another, better diagnosis, self-stigma, and anxiety about relapse. Therefore, it is important to monitor how the patient perceives the disease and to provide psychotherapeutic treat-ment according to the stage of the disease.Medications other than antipsychotics used in the treatment of bipolar disorder are called mood stabilizers. The mood stabilizers used in Japan include lithium and three antiepileptic drugs: lamo-trigine, valproate, and carbamazepine13).Atypical antipsychotics such as quetiapine, olan-zapine, and aripiprazole are also used. In addition to these drugs, the atypical antipsychotic lurasi-done was approved in Japan in 2020 as an effective treatment for depressive symptoms in bipolar disorder14). In addition, aripiprazole for long-acting injection has a new indication for the prevention of recurrent manic episodes in bipolar I disorder15).19TreatmentPharmacotherapy