Bipolar Disorder Treatment
Treatment and Therapy for Bipolar Mania and Bipolar Depression
If you suffer from panic attacks, obsessive thoughts, unrelenting worries, or an incapacitating phobia, you may have an anxiety disorder. But you don’t have to live with anxiety and fear. Treatment can help, and for many anxiety problems, therapy is a good place to start. Certain types of therapy, such as cognitive behavioral therapy and exposure therapy, are particularly beneficial. These therapies can teach you how to control your anxiety levels, stop worrisome thoughts, and conquer your fears.
Bipolar disorder is a lifelong condition. It runs an unpredictable course of ups and downs. When left untreated, these ups and downs can be devastating. The recurring manic and depressive episodes that characterize the disease make it difficult to lead a stable, productive life. In the manic phase, you may be hyperactive and irresponsible. In the depressive phase, it may be difficult to do anything at all. Early diagnosis and treatment can help you avoid these problems.
Successful treatment of bipolar disorder depends on a combination of factors. Medication alone is not enough. In order to get the most out of treatment, it's important to educate yourself about the illness, communicate with your doctors and therapists, have a strong support system, make healthy lifestyle choices, and stick to your treatment plan.
Recovering from bipolar disorder doesn’t happen overnight. As with the mood swings of bipolar disorder, treatment has its own ups and downs. Finding the right treatments takes time and setbacks happen. But with careful management and a commitment to getting better, you can get your symptoms under control and live fully.
What can I do to help me feel better?
- Know the difference between your symptoms and your true self. Your health care providers can help you separate your true identity from your symptoms by helping you see how your illness affects your behavior. Be open about behaviors you want to change and set goals for making those changes.
- Educate your family and involve them in treatment when possible. They can help you spot symptoms, track behaviors, and gain perspective. They can also give encouraging feedback and help you make a plan to cope with any future crises.
- Work on healthy lifestyle choices. Recovery is also about a healthy lifestyle, which includes regular sleep, healthy eating, and the avoidance of alcohol, drugs, and risky behavior.
- Find the treatment that works for you. Talk to your health care provider about your medications' effects on you, especially the side effects that bother you. There are many options for you to try. It is very important to talk to your health care provider first before you make any changes to your medication or schedule.
Source: Depression and Bipolar Support Alliance
Getting an accurate diagnosis is the first step in bipolar disorder treatment. This isn’t always easy. The mood swings of bipolar disorder can be difficult to distinguish from other problems such as major depression, ADHD, and borderline personality disorder. For many people with bipolar disorder, it takes years and numerous doctor visits before the problem is correctly identified and treated.
Making the diagnosis of bipolar disorder can be tricky even for trained professionals, so it’s best to see a psychiatrist with experience treating bipolar disorder rather than a family doctor or another type of physician. A psychiatrist specializes in mental health, and is more likely to know about the latest research and treatment options. For help finding psychiatrists, psychologists, and other mental health professionals in your community, see Resources section below.
What to expect during the bipolar disorder diagnostic exam
A diagnostic exam for bipolar disorder generally consists of the following:
- Psychological evaluation – The doctor or bipolar disorder specialist will conduct a complete psychiatric history. You will answer questions about your symptoms, the history of the problem, any treatment you’ve previously received, and your family history of mood disorders.
- Medical history and physical – There are no lab tests for identifying bipolar disorder, but your doctor should conduct a medical history and physical exam in order to rule out illnesses or medications that might be causing your symptoms. Screening for thyroid disorders is particularly important, as thyroid problems can cause mood swings that mimic bipolar disorder.
In addition to taking your psychiatric and medical history, your doctor may talk to family members and friends about your moods and behaviors. Often, those close to you can give a more accurate and objective picture of your symptoms.
Medical conditions and medications that can mimic the symptoms of bipolar disorder
- Thyroid disorders
- Adrenal disorders (e.g. Addison’s disease, Cushing’s syndrome)
- Antianxiety drugs
- Drugs for Parkinson’s disease
- Vitamin B12 deficiency
- Neurological disorders (e.g. epilepsy, multiple sclerosis)
There are several types of bipolar disorder. Each type is identified by the pattern of episodes of mania and depression. The treatment that is best for you may differ depending on the type of bipolar disorder you have. Your doctor will look carefully to determine where your symptoms fit.
- Bipolar I Disorder ( mania and depression) – Bipolar I disorder is the classic form of the illness, as well as the most severe type of bipolar disorder. It is characterized by at least one manic episode or mixed episode. The vast majority of people with bipolar I disorder have also experienced at least one episode of major depression, although this isn’t required for diagnosis.
- Bipolar II Disorder ( hypomania and depression) – Mania is not involved in bipolar II disorder. Instead, the illness involves recurring episodes of major depression and hypomania, a milder form of mania. In order to be diagnosed with bipolar II disorder, you must have experienced at least one hypomanic episode and one major depressive episode in your lifetime. If you ever have a manic episode, your diagnosis would be changed to bipolar I disorder.
- Cyclothymia (hypomania and mild depression) – Cyclothymia is a milder form of bipolar disorder. Like bipolar disorder, cyclothymia consists of cyclical mood swings. However, the highs and lows are not severe enough to qualify as either mania or major depression. To be diagnosed with cyclothymia, you must experience numerous periods of hypomania and mild depression over at least a two-year time span. Because people with cyclothymia are at an increased risk of developing full-blown bipolar disorder, it is a condition that should be monitored and treated.
Bipolar disorder is commonly misdiagnosed as depression since most people with bipolar disorder seek help when they’re in the depressive stage of the illness. When they’re in the manic stage, they don’t recognize the problem. What’s more, most people with bipolar disorder are depressed a much greater percentage of the time than they are manic or hypomanic.
Being misdiagnosed with depression is a potentially dangerous problem because the treatment for bipolar depression is different than for regular depression. In fact, antidepressants can actually make bipolar disorder worse. So it’s important to see a mood disorder specialist who can help you figure out what’s really going on.
Indicators that your depression is really bipolar disorder:
- You’ve experienced repeated episodes of major depression.
- You had your first episode of major depression before age 25.
- You have a first-degree relative with bipolar disorder.
- When you’re not depressed, your mood and energy levels are higher than most people’s.
- When you’re depressed, you oversleep and overeat.
- Your episodes of major depression are short (less than 3 months).
- You’ve lost contact with reality while depressed.
- You’ve had postpartum depression before.
- You’ve developed mania or hypomania while taking an antidepressant.
- Your antidepressant stopped working after several months.
- You’ve tried 3 or more antidepressants without success.
If your doctor determines that you have bipolar disorder, he or she will explain your treatment options and possibly prescribe medication for you to take. You may also be referred to another mental health professional, such as a psychologist, counselor, or a bipolar disorder specialist. Together, you will work with your healthcare providers to develop a personalized treatment plan.
Comprehensive treatment for bipolar disorder
A comprehensive treatment plan for bipolar disorder aims to relieve symptoms, restore your ability to function, fix problems the illness has caused at home and at work, and reduce the likelihood of recurrence. A complete treatment plan involves:
- Medication – Medication is the cornerstone on bipolar disorder treatment. Taking a mood stabilizing medication can help minimize the highs and lows of bipolar disorder and keep symptoms under control.
- Psychotherapy – Therapy is essential for dealing with bipolar disorder and the problems it has caused in your life. Working with a therapist, you can learn how to cope with difficult or uncomfortable feelings, repair your relationships, manage stress, and regulate your mood.
- Education – Managing symptoms and preventing complications begins with a thorough knowledge of your illness. The more you and your loved ones know about bipolar disorder, the better able you’ll be to avoid problems and deal with setbacks.
- Lifestyle management – By carefully regulating your lifestyle, you can keep symptoms and mood episodes to a minimum. This involves maintaining a regular sleep schedule, avoiding alcohol and drugs, following a consistent exercise program, minimizing stress, and keeping your sunlight exposure stable year round.
- Support – Living with bipolar disorder can be challenging, and having a solid support system in place can make all the difference in your outlook and motivation. Participating in a bipolar disorder support group gives you the opportunity to share your experiences and learn from others who know what you’re going through. The support of friends and family is also invaluable. Reaching out to people who love you won’t mean you’re a burden to others.
Most people with bipolar disorder need medication in order to keep their symptoms under control. When medication is continued on a long-term basis, it can reduce the frequency and severity of bipolar mood episodes, and sometimes prevent them entirely.
If you have been diagnosed with bipolar disorder, you and your doctor will work together to find the right drug or combination of drugs for your needs. Because everyone responds to medication differently, you may have to try several different medications before you find one that relieves your symptoms.
- Check in frequently with your doctor. It’s important to have regular blood tests to make sure that your medication levels are in the therapeutic range. Getting the dose right is a delicate balancing act. Close monitoring by your doctor will help keep you safe and symptom-free.
- Continue taking your medication, even if your mood is stable. Don’t stop taking your medication as soon as you start to feel better. Most people need to take medication long-term in order to avoid relapse.
- Don’t expect medication to fix all your problems. Bipolar disorder medication can help reduce the symptoms of mania and depression, but in order to feel your best, it’s important to lead a lifestyle that supports wellness. This includes surrounding yourself with supportive people, getting therapy, and getting plenty of rest.
- Be extremely cautious with antidepressants. Research shows that antidepressants are not particularly effective in the treatment of bipolar depression. Furthermore, they can trigger mania or cause rapid cycling between depression and mania in people with bipolar disorder.
Research indicates that people who take medications for bipolar disorder are more likely to get better faster and stay well if they also receive therapy. Therapy can teach you how to deal with problems your symptoms are causing, including relationship, work, and self-esteem issues. Therapy will also address any other problems you’re struggling with, such as substance abuse or anxiety.
Three types of therapy are especially helpful in the treatment of bipolar disorder:
- Cognitive-behavioral therapy
- Interpersonal and social rhythm therapy
- Family-focused therapy
In cognitive-behavioral therapy (CBT), you examine how your thoughts affect your emotions. You also learn how to change negative thinking patterns and behaviors into more positive ways of responding. For bipolar disorder, the focus is on managing symptoms, avoiding triggers for relapse, and problem-solving.
Interpersonal and social rhythm therapy
Interpersonal therapy focuses on current relationship issues and helps you improve the way you relate to the important people in your life. By addressing and solving interpersonal problems, this type of therapy reduces stress in your life. Since stress is a trigger for bipolar disorder, this relationship-oriented approach can help reduce mood cycling.
For bipolar disorder, interpersonal therapy is often combined with social rhythm therapy. People with bipolar disorder are believed to have overly sensitive biological clocks, the internal timekeepers that regulate circadian rhythms. This clock is easily thrown off by disruptions in your daily pattern of activity, also known as your “social rhythms.” Social rhythm therapy focuses on stabilizing social rhythms such as sleeping, eating, and exercising. When these rhythms are stable, the biological rhythms that regulate mood remain stable too.
Living with a person who has bipolar disorder can be difficult, causing strain in family and marital relationships. Family-focused therapy addresses these issues and works to restore a healthy and supportive home environment. Educating family members about the disease and how to cope with its symptoms is a major component of treatment. Working through problems in the home and improving communication is also a focus of treatment.
Most alternative treatments for bipolar disorder are really complementary treatments, meaning they should be used in conjunction with medication, therapy, and lifestyle modification. Here are a few of the options that are showing promise:
- Light and dark therapy – Like social rhythm therapy, light and dark therapy focuses on the sensitive biological clock in people with bipolar disorder. This easily disrupted clock throws off sleep-wake cycles, a disturbance that can trigger symptoms of mania and depression. Light and dark therapy for bipolar disorder regulates these biological rhythms—and thus reduces mood cycling— by carefully managing your exposure to light. The major component of this therapy involves creating an environment of regular darkness by restricting artificial light for ten hours every night.
- Mindfulness meditation – Research has shown that mindfulness-based cognitive therapy and meditation help fight and prevent depression, anger, agitation, and anxiety. The mindfulness approach uses meditation, yoga, and breathing exercises to focus awareness on the present moment and break negative thinking patterns.
- Acupuncture – Acupuncture is currently being studied as a complementary treatment for bipolar disorder. Some researchers believe that it may help people with bipolar disorder by modulating their stress response. Studies on acupuncture for depression have shown a reduction in symptoms, and there is increasing evidence that acupuncture may relieve symptoms of mania also.
More help for bipolar disorder
- Bipolar Disorder Signs and Symptoms: Recognizing Mania, Hypomania and Bipolar Depression
- Helping Loved Ones with Bipolar Disorder: Bipolar Disorder in Children, Teens, and Family Members
- Bipolar Medication Guide: Medications and Drugs for Bipolar Disorder Treatment
- Finding a Therapist Who Can Help You Heal: Getting the Most out of Therapy and Counseling
Self-help for bipolar disorder. There are many things you can do to stabilize your mood and stay well. Making healthy choices for yourself can make a huge difference in how you feel. Read Bipolar Support and Self-Help
Bipolar disorder diagnosis and treatment
- Suicide Prevention: How to Help Someone who is Suicidal
- Suicide Help: Dealing with Suicidal Thoughts and Feelings
Resources and references
Bipolar disorder diagnosis
How Is Bipolar Disorder Diagnosed? – Learn about the diagnosis of manic depression, including other conditions that should be ruled out. (University of Maryland Medical Center)
You've Just Been Diagnosed... – Describes what to expect after you’re diagnosed with a mood disorder. Includes treatment information and questions to ask your doctor. (Depression and Bipolar Support Alliance)
Bipolar disorder treatment options
Finding Peace of Mind: Treatment Strategies for Depression and Bipolar Disorder – Overview of treatment options for bipolar disorder, including medication, support, and therapy. (Depression and Bipolar Support Alliance)
Psychotherapy: How it Works and How it Can Help – Covers goals of psychotherapy for bipolar disorder, how to find a therapist, what to expect at an appointment, and how to evaluate your therapy sessions. (Depression and Bipolar Support Alliance)
Finding a bipolar disorder treatment provider
Find A Mental Health Professional – Features resources and advice for finding the right bipolar disorder treatment provider. (Depression and Bipolar Support Alliance)
Finding a Mental Health Specialist: What to Look For and Questions to Ask – Advice for people with bipolar disorder on picking a therapist or psychiatrist. (PsychEducation.org)
Bipolar disorder support groups in the U.S.
Support Group Locator – Find a support group in different parts of the U.S. or online. (Depression and Bipolar Support Alliance)
Find a Support Group – Search for a support group for children and adolescents with bipolar disorder. (Child & Adolescent Bipolar Foundation)
Bipolar disorder support groups worldwide
Support Groups Outside the U.S. – Search for bipolar disorder support groups located outside the United States. (Depression and Bipolar Support Alliance)
Self-Help Groups in the UK (Bipolar UK)
Support Groups in Australia (Black Dog Institute)
Finding Help in Canada (Mood Disorders Society of Canada)
Hospitalization for bipolar disorder
Guide to Psychiatric Hospitalizations – Learn why hospitalization for bipolar disorder may be necessary and find recommended treatment facilities. (Depression and Bipolar Support Alliance)
State-by-State Information on Psychiatric Advance Directives – Find information on preparing an advanced directive that specifies your treatment preferences if you are incapacitated by mania or depression. (The National Resource Center on Psychiatric Advance Directives)