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Treating Bipolar Disorder

Reviewed by: HU Medical Review Board | Last reviewed: September 2023

Bipolar disorder (BPD) is a lifelong, or chronic, mental health condition that causes dramatic swings between mania and depression. Mania involves feelings of extreme elation or irritation along with very high energy levels. Depression, on the other hand, involves feelings of intense sadness, disinterest, and loss of pleasure.1,2

Treatments for BPD vary by the person. This is because certain medicines work better for some people than for others. A combination of prescription medicines, therapy, and lifestyle changes are usually needed for successful treatment.1,2

Treatment is personalized based on each person’s needs which factors in the severity of a person’s symptoms, their age, and their other health conditions.1,2

Levels of care

People with BPD usually need outpatient care their whole life. A team of healthcare professionals provides this care. Outpatient care may include doctor’s office visits, therapist appointments, and telehealth (online) appointments.3

Many people with BPD also need inpatient care during severe episodes of mania or depression. Inpatient care includes hospital stays to keep the person safe.2,3

Going from from hospital to home is an important aspect. Stays at residential facilities or community centers can help people transition from hospital care to home care.2,3

Prescription medicines for bipolar disorder

There are many medicines available to treat BPD. The most common ones are:1,2

  • Mood stabilizers – Lithium, valproate, carbamazepine, and lamotrigine
  • Antipsychotics – Aripiprazole, asenapine, cariprazine, lurasidone, quetiapine, risperidone

Less often, doctors may treat BPD that involves severe depression with antidepressants. Other medicines may be included based on what symptoms are present.1,2

A person with BPD may take 1 or more medicines to control their moods and find symptom relief. Anyone taking mood stabilizers or antipsychotics needs regular checkups with the prescriber. Their doctor will monitor how well the drugs control symptoms and whether the side effects are manageable. It is also important that they regularly see their primary provider to prevent and treat other conditions.2

All BPD treatments work best when taken consistently whether feeling symptoms or not. Mood stabilizers and antipsychotics do not work as well when taken only during severe (acute) episodes.1,2

Talk therapy

Several forms of talk therapy can help people with BPD manage their symptoms. Therapy may also help their loved ones understand the condition better. The types of therapy most often included in treatment for bipolar include:1,2

  • Cognitive behavioral therapy (CBT)
  • Family therapy
  • Psychotherapy focused on self-care and stress management

Electroconvulsive therapy

Electroconvulsive therapy (ECT) was once known as shock therapy. It may help bipolar depression that has not improved with other treatments alone. It also may be a good option for people who cannot take mood stabilizers or antipsychotics. This includes pregnant people, older adults, and sometimes children and teenagers.1,2,4

Self-management techniques

Self-management techniques may also be called lifestyle changes. These techniques play an important role in helping a person manage their bipolar symptoms. Most doctors recommend lifestyle changes such as:2

  • Sticking to a regular sleep and meal schedule
  • Eating healthy foods
  • Using stress management methods
  • Regular exercise
  • Avoiding alcohol and recreational drugs

Complementary and integrative health

Complementary and integrative health includes a wide variety of nonprescription treatments for BPD. These treatment options include:1,2,5

  • Yoga, tai chi, meditation, and breathing techniques to reduce stress
  • Equine (horse) therapy
  • Dietary supplements such as omega-3 fatty acids and folate, speak with your doctor before starting any supplements as they may interact with medicines.

Emerging treatments

There is a great need for new and improved treatments for BPD. Some of the cutting-edge research topics related to the condition are:6-12

  • Bright light therapy
  • Botox and ketamine treatment for bipolar depression
  • Blood tests to diagnose bipolar disorder
  • Genetic testing to find its causes

Talk with your doctor or therapist about which bipolar treatments may be right for you, your lifestyle, and your symptoms. Before beginning treatment for BPD, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.

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