Bipolar Disorder Treatment
Learn how treatment and therapy for bipolar disorder can help you manage your symptoms and control mood swings.
Understanding bipolar disorder treatment
If you suspect that you’re suffering from bipolar disorder, it’s important to seek help right away. Bipolar disorder is a lifelong condition that 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. An experienced mental health professional can make an accurate diagnosis and start you on the path to recovery.
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, and help yourself by making healthy lifestyle choices that may reduce your need for medication. It’s important to stick to your treatment plan, reassessing with your doctor as changes in your life occur.
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 life to the fullest.
What can I do to start feeling better?
Recognize there’s a difference between your symptoms and your real self. By understanding how bipolar disorder affects your behavior, you can separate the symptoms of your illness from your character. Talk to your health care providers about the behaviors you want to change and then set concrete goals for making those changes.
Educate your loved ones about bipolar disorder. The more your family and close friends know, the better they can help you to cope with symptoms, spot triggers, and handle any crises.
Make healthy lifestyle choices. Recovery is also about creating a healthy lifestyle, which includes staying physically and socially active, getting regular sleep, eating to promote brain health, and avoiding alcohol, drugs, and risky behavior.
Find the treatment that works best for you. Talk to your health care provider about your medications’ effects on you, especially any unpleasant side effects. There are many options for you to try, but it is imperative that you talk to your health care provider first before making any changes to your medication.
Getting an accurate diagnosis
Getting an accurate diagnosis is the first step in your bipolar disorder treatment. And it 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 time 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.
What to expect during the 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 also talk to family members and friends about your moods and behaviors. Often, those close to you are able to give a more accurate and objective picture of your symptoms.
Are your symptoms caused by something else?
Medical conditions and medications that can mimic the symptoms of bipolar disorder include:
- Thyroid disorders
- Neurological disorders
- Vitamin B12 deficiency
- Drugs for Parkinson’s disease
- Anti-anxiety drugs
- Adrenal disorders (e.g. Addison’s disease, Cushing’s syndrome)
Types of bipolar disorder
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 will 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.
Is it bipolar disorder or depression?
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.
Do I have depression or bipolar disorder?
Indicators that your depression is really bipolar disorder include:
- 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
Exploring bipolar disorder treatment options
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 comprehensive bipolar treatment plan involves:
Medication – Medication is the cornerstone of 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 able 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, eating a mood-boosting diet, 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.
Medication treatment for bipolar disorder
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.
The importance of therapy for 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.
Social rhythm therapy is often combined with interpersonal therapy is often combined with social rhythm therapy for the treatment of bipolar disorder. 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.
Complementary treatments for bipolar disorder
Most alternative treatments for bipolar disorder are really complementary treatments, meaning they should be used in conjunction with medication, therapy, and lifestyle changes. Here are a few of the options that show 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 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 – Some researchers believe that acupuncture 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.
Authors: Melinda Smith, M.A., Jeanne Segal, Ph.D., and Robert Segal, M.A. Last updated: November 2019.