How Bipolar Disorder Is Treated

Mood stabilizers and antipsychotics are the most common treatments

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Bipolar disorder is treated with a combination of prescription medication, psychotherapy, other therapeutic interventions, and lifestyle management. Treatment recommendations for this condition include maintenance treatment and acute interventions for episodes of mania and depression. At times, hospitalization may be necessary. 

Talking with a therapist

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Prescription Medications 

Bipolar disorder usually requires treatment with prescription medications. Prescriptions often include mood stabilizers and/or antipsychotics.

Your doctor would determine the best prescription therapies for you based on your most prominent symptoms, side effects, and how well the medications work for you. It’s possible that you could need adjustments to your treatments over time. 

Commonly prescribed medications include: 

Lithium: Often described as the gold standard in treating bipolar disorder, lithium is considered a mood stabilizer. It is often used as maintenance therapy, and it can be used for acute episodes as well.

Anticonvulsants/mood stabilizers: Several anti-epilepsy drugs (AEDs) are also indicated to treat bipolar disorder. Valproate, divalproex, lamotrigine, and carbamazepine are anticonvulsants used as mood stabilizers in the treatment of bipolar disorder.

The dose indicated for the treatment of bipolar disorder is not the same as the dosing that’s recommended when used for treating epilepsy.

Atypical antipsychoticsOlanzapine, quetiapine, lurasidone, cariprazine, and risperidone (among others) are antipsychotic medications indicated for treating bipolar disorder.

These medications can be used during episodes of psychosis associated with bipolar disorder, and they can be part of a maintenance therapy plan for some people who have bipolar disorder.

Antidepressants: In general, antidepressants are not recommended as monotherapy (used as the only prescription) to treat bipolar disorder. In fact, antidepressants can cause mood destabilization, provoking mania in people who have bipolar disorder.

However, depressive episodes can be severe for people who have bipolar disorder. According to the American Psychiatric Association guidelines, depressive episodes can be managed with the addition of lamotrigine, lithium, and the cautious use of certain antidepressants along with mood stabilization.

Lithium, valproate, or lamotrigine are typically recommended in the maintenance treatment of bipolar disorder. Sometimes other medications are added as an adjunct, or rarely, instead of these treatments.

Acute Treatments

With bipolar disorder, you may experience episodes of worsening symptoms, including major depression, extreme mania, and/or psychosis. These episodes may warrant a change in your medications and/or in-patient psychiatric care.

In addition, sometimes a benzodiazepine may need to be added to the treatment regimen for the short term. These medications can be taken orally (by mouth), but when an episode is severe, they may be administered intramuscularly (IM).

Rapid Cycling 

Sometimes bipolar disorder is described as rapid cycling. With rapid cycling, the symptoms of depression and mania occur frequently. Typical maintenance treatments may not be as effective in the treatment of rapid cycling.

Therapies 

Psychotherapy plays a substantial role in the management of bipolar disorder. Different therapies include cognitive behavioral therapy (CBT), psychoeducation, and family therapy. Each of these involves an approach that is tailored specifically for bipolar disorder.

You and your doctor and therapist may work together to determine the best type of therapy for you:

  • Education: Learning about bipolar disorder can empower you to communicate about the effects of your condition with your healthcare team. Understanding your condition can also help you gain control of your disease management.
  • CBT: This type of therapy is focused on restructuring maladaptive thoughts and behaviors to gain better control of emotions. When used along with prescription medication in the management of bipolar disorder, CBT has been shown to improve mood stabilization and reduce the recurrence of symptoms compared to prescription medication alone.
  • Family therapy: Families are affected by bipolar disorder, and can help improve medication adherence and a better overall outcome. Family therapy in bipolar disorder is specifically designed to address issues to optimize management of the condition, including education.

Over the years, you might benefit from some or all of these types of therapies. Be sure to give yourself time to find a therapist with whom you feel comfortable.

Additional Treatments

Some other therapeutic interventions have been examined in the management of bipolar disorder. Light therapy, electroconvulsive therapy (ECT), and transcranial magnetic therapy have been used as part of the treatment of bipolar disorder.

  • Light therapy: Light therapy involves exposure to bright light, usually at home in the morning. Light therapy has been found to be beneficial in reducing symptoms of bipolar disorder for some people, particularly in patients with a seasonal (winter) pattern to their depressions. Dosing and frequency are not well established.
  • ECT: Electroconvulsive therapy is an interventional procedure done under general anesthesia. During this procedure, electrical impulses are administered through the scalp to induce a seizure. This intervention can be used to treat severe or refractory depression and mania in bipolar disorder.
  • Repetitive transcranial magnetic stimulation (rTMS): This is a non-invasive procedure in which stimulation is applied at intervals to the outside of the skull. It has been found to be beneficial in the treatment of certain depressions, and it is being examined as a potential treatment for bipolar disorder as well.

Lifestyle 

Lifestyle practices can help prevent factors that could exacerbate your condition—including excessive stress. According to the National Institute of Mental health, staying healthy by managing any medical problems you have, getting regular exercise, and eating healthy can help.

Keeping track of your symptoms, taking your medications as prescribed, and staying in regular contact with your mental healthcare team can help you avoid worsening symptoms and recognize changes in symptoms that could require intervention.

A Word From Verywell

If you or a loved one are diagnosed with bipolar disorder, you can have a satisfying quality of life with appropriate treatment. You may need acute management of your condition if you experience an exacerbation of your symptoms. And your maintenance therapy may need to be modified as the effects of your condition change over the years.

Successful treatment of bipolar disorder relies on teamwork between you and your healthcare providers. You and your doctor can discuss a way for you to track your symptoms, such as a diary or a calendar, so that you can monitor how well your treatment is working and identify times when you might need a different intervention. 

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