How to treat bipolar disorder with medications and therapy to get the help you need
- Treatment of bipolar disorder typically involves mood stabilizers, antidepressants, and/or antipsychotics.
- Bipolar disorder is also treated through therapy like cognitive-behavioral therapy and family-based therapy.
- Other treatment options for bipolar disorder include day treatment programs, hospitalization, and following a healthy lifestyle.
- This article was medically reviewed by David A. Merrill, MD, PhD, psychiatrist, and director of the Pacific Brain Health Center at Pacific Neuroscience Institute at Providence Saint John's Health Center.
Bipolar disorder is a mental health condition that causes significant and sudden changes in mood that involve episodes of mania and sometimes depression.
There is no cure for bipolar disorder, so patients must learn to manage their symptoms through a combination of medication and therapy.
As with any mental health condition, treatment for bipolar disorder is best guided by a health professional. And with the right combination of meds and therapy, people with bipolar disorder can learn to control their impulses and lead a fruitful life.
Medications for bipolar disorder
Daily prescription medication is a part of almost every bipolar treatment plan. Medication is typically prescribed alongside therapy, as an initial treatment option.
It can take two to six weeks to see the full effects of any psychiatric drug. About 40% of patients with bipolar do not adhere to their medications, resulting in exacerbated symptoms. Even if you feel your mood is stable, you should never stop taking medication prescribed for bipolar disorder without the supervision of your care provider.
"It's important to work with your prescribing physician, usually a psychiatrist, and maintain consistent communication about any symptoms you might be experiencing," says Myra Altman, MD, Vice President of Clinical Care at mental health wellness platform Modern Health.
Mood stabilizers
The first line of treatment for bipolar disorder often ends up being a mood-stabilizing medication, says Christine Crawford, MD, a psychiatrist and Associate Director of Medical Student Education at Boston Medical Center
In fact, about 50% of people diagnosed with bipolar take a mood-stabilizing medication.
Contrary to popular belief, the goal of mood stabilizers isn't to numb your feelings, but to keep them from swinging too far in either manic or depressive directions. They also help with impulse control.
While researchers are still unsure exactly how mood stabilizers work, it is thought they decrease abnormal brain activity. These drugs stabilize and calm areas of the brain that have become overstimulated and active as well as prevent this state from occurring.
Common mood stabilizers include lithium (Lithobid) and sodium valproate (Depakote).
Antidepressants
Some people, especially those with type II bipolar, experience more depressive episodes than manic episodes. Therefore, in addition to mood stabilizers, these individuals may be prescribed an antidepressant or antipsychotic medication. About 34% of bipolar patients are on antidepressants.
A 2018 paper in the International Journal of Bipolar Disorders noted that there is some concern over whether antidepressants can cause people with bipolar disorder to experience rapid cycling, meaning they have four or more manic depressive episodes a year. This is why doctors prescribe antidepressants in addition to other medication and not as a primary treatment.
Based on a 2018 review published in the International Journal of Bipolar Research, selective serotonin reuptake inhibitors (SSRI) — a class of antidepressants — such as fluoxetine (Prozac) and sertraline (Zoloft) are considered more stabilizing for people with bipolar disorder than tricyclic antidepressants, such as desipramine (Norpramin), imipramine (Tofranil), nortriptyline (Pamelor).
For more information, read about how antidepressants work.
Antipsychotics
Antipsychotics are the second most common form of medication used to treat bipolar disorder after mood stabilizers. Those who experience more intense manic episodes — characterized by high energy and impulsive decision-making — may be prescribed an antipsychotic medication.
These medications control dopamine activity in the brain. Dopamine is a neurotransmitter produced by your body that allows you to experience pleasure. By controlling dopamine activity, medications can limit the intensity of the risk/reward impulses a manic episode can cause.
Common antipsychotics include:
- Clozapine (Clozaril)
- Risperidone (Risperdal)
- Olanzapine (Zyprexa)
Anti-anxiety medications
If you have another mental health condition, such as generalized anxiety disorder, in addition to bipolar disorder, you may also be prescribed an anti-anxiety medication.
A 2015 medical review published in Lancet Psychiatry assessed the data of 40 separate studies. It found that 45% of people with bipolar disorder will also experience an anxiety disorder at some point in their lifetime.
Anti-anxiety medication in the benzodiazepines family such as clonazepam (Klonopin), lorazepam (Ativan), and diazepam (Valium) may be prescribed to work with a mood stabilizer, like lithium, to control anxiety if you have bipolar.
Side effects
Side effects of medication will not only vary across individuals but also depend on which combination of drugs you are taking, Altman says. Potential side effects might include:
- Nausea
- Fluctuations in weight
- Tremors
- Fatigue
- Decreased sex drive
More serious issues, such as kidney damage, can be longer-term side effects of these medications.
"Your doctor will be able to help adjust or alter your treatment if you are pregnant, nursing, or face a change in your medical condition that might impact your medication plan," Altman says.
Psychotherapy
Psychotherapy, or talk therapy, refers to treatment techniques that involve speaking to a mental health professional in order to better understand one's feelings, symptoms, and how to address them.
"Therapy is a very important part of all psychiatric patients," says Crawford. "If you have manic episodes that have resulted in significant consequences in your life, therapy can help you work through that."
Common forms of psychotherapy used to treat bipolar disorder include:
Cognitive-behavioral therapy
Cognitive-behavioral therapy (CBT) is a form of therapy that focuses on awareness and cognition, says Crawford. CBT is effective for people who have bipolar disorder because it encourages them to understand how their thought patterns relate to feelings, emotions, and then translate into actions.
For example, CBT can help someone identify symptoms of a depressive episode, like feeling worthless. While normally that feeling may cause someone to stay in bed — and thus, reaffirm the belief they're worthless — CBT encourages a patient to choose an alternative coping mechanism to respond to that emotion like journaling.
A 2017 data analysis published in PLoS One compiled results from 19 randomized controlled trials and compared participants with bipolar who received CBT treatment in addition to medication with participants in control groups who did not receive CBT but still received medication. The analysis concluded that CBT was moderately more effective than medication alone in improving depressive symptoms, mania severity, and lowering the relapse rate.
Family-focused therapy
Family-focused therapy (FFT) allows people with bipolar to incorporate family members or significant others into the treatment process. This helps loved ones become more knowledgeable about symptoms, side effects, and ways they can help.
Crawford believes family-focused therapy to be incredibly important. "Think about it like a three-legged stool. For some people, the three legs would be social support [like family], medication, and therapy. If you don't have all three legs in place and they aren't [each] structurally strong, things aren't going to be that great for the patient."
Plus, Crawford says, "Having social support just makes a person feel more connected and less isolated. We know that people who have more social support tend to have better outcomes."
For example, a 2019 review published in Focus found that people with bipolar disorder who underwent family-based therapy in addition to individualized treatment experienced fewer relapses — or losing control of symptoms — required fewer hospitalizations, and experienced fewer symptoms of depression than people who received individualized therapy alone.
Interpersonal and social rhythm therapy
Interpersonal and social rhythm therapy (IPSRT) is designed to help people improve their moods by understanding and working with biological rhythms like their sleeping patterns. It helps patients develop techniques to consistently take medications and manage symptoms during stressful life events. It also reduces disruptions in sleep and appetite patterns that may trigger symptoms by encouraging a patient to sleep more or eat better.
A 2007 medical review published in Dialogues of Clinical Neuroscience analyzed the results of two studies involving a total of 468 patients with bipolar disorder. It found that in both studies, IPSRT, alongside medication, reduced the number of episodes over two years.
Other treatment options
For those who find medication and therapy are not alleviating their symptoms, other treatment options are available. These include:
Hospitalization
"Whenever there is a concern about keeping a person safe or concern that they may cause other people harm, that can be considered a cause for hospitalization," Crawford says.
If someone with bipolar is experiencing an episode of intense mania or depression, this can impair their judgment and put them at risk of harming themselves or others. For example, mania can cause thoughts of self-harm and result in high-risk behaviors, such as spending a lot of money, taking recreational drugs, and having unprotected sex. That's when they should consider submitting themselves to a hospital.
Hospitalization removes people with bipolar from an environment where they place themselves at risk. Hospitalization can also provide opportunities for meeting with a therapist and receiving a thorough mental health assessment by a team of professionals.
If a person is hospitalized for bipolar, they will stay until their symptoms stabilize. This could take anywhere from a few days to a week or two according to Crawford.
Day treatment programs
Day treatment programs are for people with bipolar disorder who don't need to be hospitalized but still require acute care.
These programs, which take place at dedicated mental health rehabilitation or hospital facilities, provide a full day of therapy and medical treatment. Day programs sometimes integrate group therapy or holistic wellness treatments.
The length of day treatment programs varies depending on the patient and their symptoms.
Lifestyle changes
No lifestyle change can act as a substitute for treatment from a medical professional. However, some research indicates certain lifestyle choices can improve bipolar disorder outcomes.
Avoid smoking and using controlled substances as they may make symptoms of bipolar disorder worse. A disrupted sleep cycle can also trigger bipolar episodes.
Exercise
A 2016 paper published in Translational Psychology studied a group of 50 teenagers who worked out for 20 minutes on a stationary bike. After the exercise, the participants underwent an MRI. Results found that in the 30 teenagers who had bipolar disorder, the brain centers that control attention and impulse control both improved, at least temporarily. This indicates exercise may temporarily relieve symptoms of bipolar.
Data on how exercise impacts bipolar is conflicting because it appears that people with bipolar disorder may be more likely to live a sedentary lifestyle, and therefore, would benefit from more exercise whether or not they have bipolar.
Nutrition
Nutrition also plays a role in bipolar symptoms. A 2012 study in the Journal of Clinical Psychology found strong evidence that omega 3 nutritional supplements can help treat depressive symptoms of bipolar — though not symptoms of mania.
There is some clinical evidence that alongside medication and therapy, a healthy diet with healthy fats, vitamin D, folic acid, and zinc may enhance feelings of control in those with bipolar.
Takeaways
While bipolar disorder is a lifetime condition, that doesn't mean that those affected can't live a fulfilling life. Proper treatment can help one enhance their quality of life and manage their symptoms. Most treatments for bipolar disorder include some combination of medication and therapy, but It's important to speak with a doctor to find the right treatment plan for you and your goals.
As Altman says, "Just because you have been diagnosed with bipolar, does not mean you need to be defined by your condition."