Understanding Bipolar Disorder Treatment, From Therapy to Medications

The right plan can make all the difference.
Illustration of someone seeking bipolar disorder treatments.
Bipolar disorder treatment commonly includes therapy and medications. Ponomariova_Maria / Getty Images

When left untreated, bipolar disorder has the potential to wreak havoc on your emotional and physical well-being. But the right bipolar disorder treatments can completely change your life.

Bipolar disorder is a mental health condition that is characterized by intense fluctuations in a person’s mood, energy, and activity levels, affecting their judgment, ability to think clearly, relationships, and daily life in general—and it affects nearly 3% of people in the U.S., according to the National Institute of Mental Health (NIMH).

If you think you have bipolar disorder, realize that taking the steps to get diagnosed is really courageous. While acknowledging that you may have a mental health condition can be overwhelming, getting on the road to treatment is crucial for your mind and body.

As with any health condition, there isn’t one magic remedy to ease the symptoms of bipolar disorder. Bipolar disorder treatment depends on several factors, like the type of bipolar disorder you have, the severity of your symptoms, whether or not you have another mood disorder, your personal health history, and more. In general, experts recommend a combination of psychotherapy and medication to help stabilize a person’s mood. Here’s what you need to know about the range of bipolar disorder treatments, according to doctors who specialize in helping people with the complex condition.

What are the types of bipolar disorder?

There are four types of bipolar disorder, which are based on the types of mood episodes you experience. For instance, manic episodes typically involve having extremely elevated mood and energy levels for at least seven days, according to the NIMH. Hypomanic episodes are less extreme than manic ones, but also involve having a lot of energy and elevated moods for at least four days, the Cleveland Clinic explains. Depressive episodes, on the other hand, occur when you feel intense sadness, indifference, or hopelessness for at least two weeks, so you might have little energy or lose interest in activities you typically enjoy.

Depending on your symptoms, you may be diagnosed with one of the following types of bipolar disorder, per the NIMH:

  • Bipolar I means you have at least one manic episode that lasts about seven days and one depressive episode that typically lasts two weeks. You may also have a shorter manic episode and be diagnosed with bipolar I if your symptoms are really severe, like if you need to be hospitalized to receive immediate treatment.
  • Bipolar II means you’ve had at least one major depressive episode and a hypomanic episode, but have never had a manic episode.
  • Cyclothymic disorder is on the bipolar disorder spectrum and involves having periods of hypomanic and depressive symptoms that aren’t classified as full episodes but last for at least two years.
  • Unspecified bipolar disorder is when you have bipolar disorder mood symptoms that don’t fit in with the other types of bipolar disorder described above.

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What bipolar disorder treatments are commonly used?

If you or someone you love might have bipolar disorder symptoms, the first step is to see a doctor, licensed therapist, or psychiatrist if you have access to one, as they can help diagnose the condition and pinpoint the best treatment plan for you. Many primary care physicians can help diagnose and prescribe medication for bipolar disorder, but they may also refer you to a psychiatrist who specializes in mood disorders.

Since bipolar disorder is a lifelong condition, treatments focus on helping you maintain a balanced mood state. Thankfully, there are plenty of effective ways to manage bipolar disorder to help you feel more in control of your life, Po Wang, M.D., director of the Stanford Bipolar Disorders Clinic, tells SELF. Generally, your doctor will discuss treatment options with you and explain why a recommended medication or therapy is considered best for the type of bipolar you have, your current symptoms, and your overall lifestyle. “How we treat the patient depends on what the patient needs,” Dr. Wang says, emphasizing that treating bipolar disorder requires a collaborative approach between you and your doctor, so the process may take some experimentation until you find the best fit.

Francis Mondimore, M.D., director of the Johns Hopkins Mood Disorders Clinic and associate professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine, tells SELF that medication is generally the foundation of treatment, but psychotherapy and psychoeducation—which is rooted in better understanding the condition and how it affects thoughts and behaviors—can help people with bipolar disorder avoid relapses and do better over time.

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Medication for bipolar disorder

In general, bipolar disorder is treated with medication, according to the Cleveland Clinic. This can involve some trial and error, and it can take weeks to months for a medication to fully take effect. Right now, the U.S. Food & Drug Administration (FDA) has approved medications to treat bipolar I and II. That means there’s not enough research on medications that can best treat cyclothymic disorder or unspecified bipolar disorder. However, your doctor may still prescribe medication to help you manage your specific symptoms.

Whoever you see for treatment may prescribe one or more of a few types of medication, depending on what you’re personally experiencing. In general, bipolar disorder medications fall into the following categories:

Mood-stabilizing drugs

Mood stabilizers—such as lithium, valproic acid, carbamazepine, lamotrigine, and more—help improve both manic and depressive symptoms, and these are considered the frontline treatment for bipolar I and II. Some mood stabilizers, like lithium, can treat and prevent mood episodes while others, such as lamotrigine, only help prevent them.

According to the NIMH, mood stabilizers generally work by limiting abnormal brain activity, meaning these drugs affect the actual pathology of the disease instead of only the symptoms, Nassir Ghaemi, M.D., professor of psychiatry at Tufts University School of Medicine, tells SELF. The length of time it takes for mood stabilizers to take effect depends on the specific drug you use, as well as the severity of your symptoms. For example, lithium can help with symptoms in about a week, but carbamazepine can help treat bipolar disorder symptoms after several weeks.

As with any medication, it’s a good idea to ask your doctor about side effects and what to look out for so you can flag a negative response if you experience one. For example, drinking alcohol while taking lithium can decrease its effectiveness or increase potential negative effects like sedation, according to the National Alliance on Mental Illness (NAMI).

Antipsychotics

Severe manic or depressive episodes can cause symptoms of psychosis, in which you may lose touch with reality and have delusions or hallucinations, according to the NIMH. Antipsychotic medications, which are often used to treat people with psychotic disorders1, such as schizophrenia, can help in that situation. Dr. Mondimore says these drugs have mood-stabilizing qualities, so they’re frequently prescribed to people with bipolar disorder as well.

There are two types of antipsychotics: first-generation (typical) and second-generation (atypical), the NIMH explains. Some common first-generation antipsychotics include chlorpromazine, haloperidol, perphenazine, and fluphenazine; second-generation drugs include olanzapine, risperidone, quetiapine, aripiprazole, ziprasidone, lurasidone, cariprazine, and paliperidone.

Antipsychotics generally work by changing the levels of brain neurotransmitters, chemical messengers such as serotonin, which impact mood, according to Jamie Alan, Pharm.D., Ph.D., assistant professor of pharmacology and toxicology at Michigan State University. Both types of antipsychotics treat manic symptoms, but only second-generation antipsychotics are thought to work more broadly to target depression as well, the NIMH explains.

Generally, some symptoms like hallucinations subside within a few days of taking antipsychotics, but it can take up to six weeks to fully benefit from these drugs, according to the NIMH. Sometimes, antipsychotics are prescribed alongside other medications, such as those mood stabilizers we just discussed, to help you feel better faster. “The thought is that the antipsychotic can manage the episodes while the mood stabilizer has time to work,” Dr. Alan tells SELF. “The general consensus is that an antipsychotic and a mood stabilizer provide a greater benefit.”

Antidepressants

Sometimes, people with bipolar disorder may take antidepressants if other medications don’t help completely resolve their low mood episodes. There are plenty of antidepressants out there, but the most common are selective serotonin reuptake inhibitors (SSRIs), which can affect mood by increasing the amount of serotonin in the brain2. (Other antidepressants also work by changing the levels of neurotransmitters, the Mayo Clinic explains.)

But antidepressants can sometimes trigger a manic episode in people with bipolar disorder, according to Dr. Alan. So it’s important that you pay attention to how you feel and talk to your doctor if you notice signs of mania (talking really quickly or having feelings of euphoria, for example), your other symptoms worsen, or you experience severe side effects like not being able to sleep. Some commonly prescribed antidepressants include fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro).

Anti-anxiety medications

Oftentimes, people with bipolar disorder may also develop symptoms of an anxiety disorder, such as generalized anxiety. With a generalized anxiety disorder, you may have trouble controlling your nervous thoughts, worry excessively about common events such as driving to work, and have trouble relaxing or sleeping, according to the NIMH.

A class of drugs called benzodiazepines is commonly used to help treat anxiety, and they work by increasing signaling of GABA, a neurotransmitter that suppresses the activity of your neurons, Dr. Alan says. These medications are a sedative and start to take effect within an hour, so they can help you feel calmer3. It’s important to note that anti-anxiety medications won’t treat your underlying bipolar disorder, but they can help you manage some of the symptoms associated with it if you’re prone to feelings of anxiety.

However, anti-anxiety medications also pose their own risk of side effects and some people can become dependent on benzodiazepines, so your doctor might prescribe them for short periods of time, according to the NIMH. Buspirone is another medication that targets your brain chemicals to reduce anxiety and poses less risk of dependency, according to the NLM.

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Bipolar disorder therapy

Anyone can find talk therapy (known as psychotherapy) helpful—including people with bipolar disorder. “Often, we recommend therapy in tandem with medications,” Dr. Wang says. Your primary care doctor can help you find a therapist who has experience working with people who have bipolar disorder, as they will understand the specific nuances needed to best treat the condition.

You can also check with your insurance network to find someone in your area if you have insurance coverage. Otherwise, there are several ways to find more affordable therapy, like by searching for therapists who accept reduced fees on Open Path and thero.org.

There are several types of therapy that people with bipolar disorder may find helpful:

Psychoeducation

What it is: This will likely be involved in your sessions, regardless of the specific method of therapy you try, according to Paula Zimbrean, M.D., associate professor of psychiatry at Yale University School of Medicine. Psychoeducation, which simply means learning more about your condition, is important when you have bipolar disorder so you can better understand what a mood episode looks and feels like for you4. Psychoeducation teaches people how to spot signs of an impending mood episode so they can let their doctors know and make changes as needed, for example, by switching medications if necessary, Dr. Zimbrean tells SELF.

What to expect: Your therapist or psychiatrist will discuss why sticking to your medication schedule is important, in addition to helping you create a routine that helps minimize your symptoms—such as getting consistent sleep, for example,5 since sleeping too much or too little is known to trigger a mood episode in some people6. You’ll also discuss how to spot signs that you might be entering a mood episode—such as staying up late, changing your appearance, or skipping out on plans—so you can reach out to your doctor before you enter a full-blown manic or depressive state, which can be much more difficult to get out of as the symptoms progress.

Cognitive behavioral therapy (CBT)

What it is: Cognitive behavioral therapy is a form of therapy that focuses on teaching you how to best handle what’s happening in your life at the moment, according to the American Psychological Association. Dr. Zimbrean explains that CBT works by helping people connect their moods and emotions with their thoughts and behaviors. “They learn skills to manage the intense emotions they have during bipolar episodes,” she says. CBT involves developing problem-solving skills and reframing your thoughts so you’re better equipped to handle mood fluctuations when they do happen.

What to expect: In a CBT session, a therapist will help you identify thinking patterns that could affect your mood and behaviors7. For example, if you tend to dwell on negative thoughts like “I’ll always feel this way,” your therapist could help you understand how this line of thinking fuels the cycle of depression. Instead, you may be asked to reframe those thoughts into something more positive, such as “I might feel like I’m bad at everything, but there’s no evidence of that. This is just a symptom of my depressive episode, and I can work through this.” You may also work with your therapist on plans to stay engaged in your normal activities when you’re feeling depressed or to scale back on activities, such as staying out late, that can contribute to mania.

Interpersonal and social rhythm therapy

What it is: Interpersonal and social rhythm therapy (IPSRT) was specifically created to treat bipolar disorder by helping people develop routines to regulate their behavior and certain biological processes, such as sleep8. The goal is to adhere to your medication schedule, improve your social relationships, and reduce bipolar episodes.

What to expect: In an IPSRT session, your therapist might work with you to keep track of your routines, such as your bedtime, wake time, and daily activities, with the goal of helping you understand how changes in these routines can affect your moods. You’ll learn better ways to keep up with your everyday routine and identify solutions for problems you might be having in interpersonal areas of your life, such as your relationships with friends or coworkers.

Family-focused therapy

What it is: Family-focused therapy was initially created to help people develop coping skills they could use at home with their families after being hospitalized due to a bipolar mood episode9. Now, people with bipolar disorder and their families may go to family-focused therapy to learn how to communicate more effectively and problem-solve any diagnosis-related challenges that might come up during treatment.

What to expect: You’ll attend sessions with your family support circle, such as your parents or your spouse. Early on in treatment, your therapist will help your family understand early signs of mood changes and how to help keep them from getting worse. Your family will also learn how to better manage conflict at home, like what to do if you stop taking your medication, for example.

Electroconvulsive therapy (ECT)

What it is: Electroconvulsive therapy is a procedure that is used when a person has severe symptoms and hasn’t fully benefited from other types of bipolar disorder treatments. ECT sends electrical currents to your brain to stimulate a minute-long, controlled seizure, according to the American Psychiatric Association (APA). These pulses essentially alter your brain chemicals to help relieve depression and psychosis symptoms, according to NAMI.

What to expect: This can sound a little intimidating, but you’ll be put under general anesthesia for the procedure, which lasts about 10 minutes, so you’ll be out the whole time, according to the APA. During that time, electrodes are placed on your scalp to stimulate electrical pulses to ignite the seizure. You will generally have about two to three sessions a week for a total of 12 treatments, and it usually takes up to six treatments to feel an improvement in symptoms. There are potential side effects to discuss with your doctor, such as headaches and muscle pain, temporary confusion, and memory loss around the time of the treatment.

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Bottom line: There are so many treatment options for bipolar disorder—and that should give you hope when it comes to living with your diagnosis.

Remember, it may take some time to find the most effective way to manage symptoms, but once you find the right one, it’s possible to live a full, happy, and healthy life with bipolar disorder. “There are so many people who are extremely successful who have bipolar disorder, and no one would suspect they do,” Dr. Zimbrean says. “The key is to learn about the disease and manage it.”

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Sources:

  1. StatPearls, Antipsychotic Medications
  2. StatPearls, Selective Serotonin Reuptake Inhibitors
  3. The Ochsner Journal, Benzodiazepine Pharmacology and Central Nervous System–Mediated Effects
  4. The Primary Care Companion for CNS Disorders, The Clinical Management of Bipolar Disorder: A Review of Evidence-Based Guidelines
  5. Frontiers In Psychiatry, The Long-Term Effectiveness of Psychoeducation for Bipolar Disorders in Mental Health Services. A 4-Year Follow-Up Study
  6. Nature and Science of Sleep, The Role of Sleep In Bipolar Disorder
  7. Psychiatry Online, 6. Evidence-Based Psychotherapies for Bipolar Disorder
  8. Biological Psychiatry, Interpersonal and Social Rhythm Therapy: Managing the Chaos of Bipolar Disorder
  9. Family Process, Family-Focused Therapy for Bipolar Disorder: Reflections on 30 Years of Research

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