Treatment of Bipolar Disorder

Updated: June 16, 2022

A psychiatrist who specializes in diagnosing and treating mental health conditions is the appropriate person for treating bipolar and related disorders. Bipolar disorder is a lifelong condition. Treatment is aimed at managing symptoms. Depending on your requirements, treatment may include:

Medications:

You may need to start taking medications to balance your moods right away.

Continued treatment:

Even during periods when you feel better, you need to continue with your medications as it is a lifelong treatment with medications. Skipping maintenance treatment may lead to high risk of  re- occurrence of symptoms or having minor mood changes turn into full-blown mania or depression.

Day treatment programs:

While you get symptoms under control, a day treatment program is recommended for you. These programs provide the support and counseling you need.

Substance abuse treatment:

To manage bipolar disorder, you also need substance abuse treatment if you have problems with alcohol or drugs.

Hospitalization:

If you are having a manic or major depressive episode such as you feel suicidal or you become detached from reality, hospitalization is recommended for you. Getting psychiatric treatment at a hospital can help keep you calm and safe and stabilize your mood. The primary treatments for bipolar disorder include medications and psychological counseling (psychotherapy) to control symptoms. The treatment also may include education and support groups for counseling.

Medications:

Several medications are used to treat bipolar disorder. The types and doses of medications prescribed are based on your particular symptoms.
Medications may include:

Mood stabilizers:

Usually to control manic or hypomanic episodes, mood-stabilizing medication are used. These include lithium, valproic acid, divalproex sodium, carbamazepine and lamotrigine.

Antipsychotics:

If symptoms of depression or mania persist in spite of treatment with other medications, adding an antipsychotic drug such as olanzapine, risperidone, quetiapine, aripiprazole, ziprasidone, lurasidone or asenapine may help. Some of these medications are prescribed alone or along with a mood stabilizer.

Antidepressants:

Because an antidepressant can sometimes trigger a manic episode, it can be used to help manage depression. It is usually prescribed along with a mood stabilizer or antipsychotic.

Antidepressant-antipsychotic:

Symbyax is a combination of the antidepressant fluoxetine and the antipsychotic olanzapine. It works as a depression treatment and a mood stabilizer.

Anti-anxiety medications:

Benzodiazepines may help with anxiety and improve sleep, but should be used on a short-term basis.

Finding the right medication:

Some trial and error method can be used for finding the right medication. As some medications need weeks to months to take full effect, you need to try it in patient. Generally only one medication is changed at a time to identify which medications work to relieve your symptoms with the least bothersome side effects. Medications also may need to be adjusted as your symptoms change.

Side effects of Medications:

Often there are mild side effects which get improve as you find the right medications and doses that work for you, and your body adjusts to the medications. But if you have bothersome side effects, consult your doctor or mental health professional. Do not make any changes or stop taking your medications by your own without consulting your doctor. If you stop your medication, you may experience withdrawal effects or your symptoms may worsen or return. You may become very depressed, feel suicidal, or even go into a manic or hypomanic episode.

Medications and Pregnancy:

Certain medications used for bipolar disorder are associated with birth defects and can pass through breast milk to your baby.  Medications such as valproic acid and divalproex sodium, should not be used during pregnancy. Birth control medications when taken along with certain bipolar disorder medications, may lose their effectiveness. If you are taking medication to treat your bipolar disorder and planning to become pregnant, talk to your doctor before your pregnancy.

Psychotherapy:

Psychotherapy is a essential part of bipolar disorder treatment which include:

Interpersonal and social rhythm therapy (IPSRT):

IPSRT aims on the stabilization of daily routine, such as sleeping, waking and mealtimes. A consistent routine helps better mood management. People with bipolar disorder may benefit from establishing a daily routine for sleep, diet and exercise.

Cognitive behavioral therapy (CBT):

CBT can help identify which factor triggers your bipolar episodes. The aim is identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones. Effective ways to manage stress and to cope with upsetting situations can be learned from this.

Psychoeducation:

This is about learning bipolar disorder which can help you and your loved ones understand the condition. You get the best support, identify issues, make a plan to prevent re-occurance and stick with treatment if you are aware of the condition and its consequences.

Family-focused therapy:

Family support and communication can help you stick with your treatment plan and help you and your loved ones recognize and manage warning signs of mood swings.

Other Treatment Options:

Electroconvulsive therapy (ECT):

During this therapy, electrical currents are passed through the brain, intentionally triggering a brief seizure. This can make possible changes in brain chemistry that can reverse symptoms of certain mental illnesses. If you do not get better with medications, can not take antidepressants for health reasons such as pregnancy or are at high risk of suicide,ECT may be an option for bipolar treatment.

Transcranial magnetic stimulation (TMS):

This is an option for those who do not respond to antidepressants.