Bipolar Disorder Treatments to Manage Symptoms
Medically reviewed by Dakari Quimby, PhD
Bipolar disorder is a chronic mental health condition. It is possible to overcome the highs and lows of bipolar disorder with lifelong treatment. Treatment for bipolar disorder includes prescription medication, psychotherapy, lifestyle changes, and more.
In this article, learn about bipolar disorder treatments.
Illustration by Joules Garcia for Verywell Health
List of Bipolar Disorder Treatments
Treatment is essential to managing bipolar disorder symptoms. When left untreated, bipolar disorder can progress and adversely impact your relationships, employment, and daily functioning, and lead to an increased risk of suicide.
The following are the main treatments for bipolar disorder.
Medication Options
Bipolar disorder is being recognized as a progressive illness. Early and adequate treatment with medication after the first manic episode is very important.
The medication lithium is a mood stabilizer that helps reduce the severity of mood swings. It is considered the gold standard for bipolar disorder treatment, with a large body of research supporting lithium as a first-line treatment for bipolar disorder.
However, lithium is not the only drug that treats bipolar disorder. Researchers are increasingly recommending complex combination pharmacotherapy, meaning taking multiple medications at once. This approach can help reduce side effects and improve long-term outcomes.
Other medications for bipolar disorder include:
Antipsychotics: These drugs reduce psychosis, mania, and agitation associated with bipolar disorder. Examples include Zyprexa (olanzapine), Seroquel (quetiapine), Latuda (lurasidone), Vraylar (cariprazine), and Risperdal (risperidone).
Benzodiazepines: This class of drugs is a depressant for the central nervous system and includes Klonopin (clonazepam) and Ativan (lorazepam). These drugs can help with symptoms of mania in bipolar disorder, particularly during the crisis stage.
Mood stabilizers: These medications reduce the severity of mood swings. Some providers may consider prescribing anti-seizure medications (also called anticonvulsants or antiepileptics) with mood-stabilizing effects. Examples of mood stabilizers include valproate, Carbatrol (carbamazepine), Trileptal (oxcarbazepine), Lamictal XR (lamotrigine), Topimax (topiramate), and Gralise (gabapentin).
Some healthcare providers may prescribe antidepressants for bipolar disorder. However, this approach is controversial because, in some cases, antidepressants can trigger manic episodes. Research on the topic has not found antidepressants an effective bipolar disorder treatment. That said, a few studies have found them helpful in short-term treatment.
Therapy Types and Techniques
Therapy is an integral part of bipolar disorder treatment and can improve results when used alongside medication.
Psychotherapy can be done one-on-one or in groups and is helpful during the depression and maintenance phases of bipolar disorder.
Types of psychotherapy that benefit people with bipolar disorder include:
Interpersonal and social rhythm therapy: This type of therapy was developed specifically to treat bipolar disorder. It is a structured form of treatment that focuses on increasing medication adherence, managing responses to stressful events, and limiting disruptions from social and circadian rhythms.
Cognitive behavioral therapy (CBT): This approach is one of the most common and well-researched types of psychotherapy (talk therapy) used for treating depression, anxiety, bipolar disorder, and other mental health conditions. CBT is a structured, time-limited therapy that teaches a person to recognize maladaptive thought patterns and change their thoughts to change their behavior.
Family-focused intervention: This type of therapy involves both the individual being treated for bipolar disorder and their family. Family-focused interventions can improve family communication, recognition of bipolar symptoms, and medication adherence.
With therapy, people with bipolar disorder have been shown to have reduced relapses, improved medication adherence, improved functioning, increased recognition of early warning signs, better self-management skills, better family communication, and more.
Illness Education
Illness education, also called psychoeducation, involves healthcare providers teaching their patients about bipolar disorder as a condition and how it will affect their life. Education is an integral part of manic or depressive episode prevention, management, and recovery.
Some examples of topics covered in psychoeducation sessions include:
Bipolar disorder signs, symptoms, and progression
Importance of medication adherence
Life charting
Mood charting
Symptom recognition
Trigger identification
Electroconvulsive Therapy (ECT)
Electroconvulsive therapy (ECT) is sometimes called electroshock therapy. According to research, ECT can help manage severe cases of acute mania, mixed episodes, and bipolar depression. It is also beneficial for catatonia (being unreactive to one's surroundings) and drug-resistant bipolar disorder.
Light Therapy
Light therapy involves sitting in front of a light box daily to help reset circadian rhythms and regulate neurotransmitters.
It is most well-known as a treatment for seasonal affective disorder (SAD); however, it can also help treat bipolar disorder, particularly among people who are prone to depressive episodes during the winter months.
Repetitive Transcranial Magnetic Stimulation (rTMS)
Repetitive transcranial magnetic stimulation (rTMS) is a treatment for depression in which a qualified healthcare provider uses magnetic waves to stimulate the brain. It can be helpful in the depressive phase of bipolar disorder and has a lower risk of side effects than ECT.
Treatment Response to Bipolar Disorder Symptoms
Symptoms and treatment for bipolar disorder are different depending on whether a person is in a manic phase (elevated or euphoric mood), depressive phase (low energy and mood), or a period between phases.
For example, psychotherapy is not recommended (or possible) when someone is in a manic phase.
Medications can also change based on symptoms. Benzodiazepines are depressants and may be used short-term during an acute manic phase to help with agitation. Antidepressants may help during a depressive phase but are not recommended long-term as they can trigger manic phases in some people.
Usually, healthcare providers prescribe one or more medications, such as lithium, in combination with psychotherapy for long-term bipolar disorder management. Any other fluctuations in treatment will depend on symptoms and should prompt a consultation with your healthcare team.
What to Do During a Manic Episode
A manic episode involves an extreme mood swing to euphoria, risk-taking, decreased sleep, racing thoughts, delusions, suicidal thoughts, and more symptoms that disturb a person's functioning.
Often, the person experiencing the manic episode has trouble recognizing this in themselves, so close family and friends should encourage the person to seek help or call a mental health hotline on their loved one's behalf.
Treatment for a manic episode can involve:
Temporary medication change to reduce symptoms of psychosis, agitation, and mania
Treatment in a residential or inpatient mental health facility
Education in mood charting and journaling after the acute episode to prevent and identify future manic episodes
Complementary Bipolar Disorder Treatments
Up to 50% of adults with bipolar disorder use some complementary treatment alongside medical treatment.
Lifestyle and complementary treatments for bipolar disorder include:
Getting regular exercise
Practicing sleep hygiene
Eating a nutrient-dense and balanced diet
Planning enjoyable activities that give feelings of achievement
Engaging in light therapy
Taking n-acetylcysteine supplements (the supplement form of an amino acid called cysteine)
Abstaining from alcohol and other substances, which can make bipolar disorder worse
Bipolar Disorder Support During Treatment
Living with bipolar disorder, particularly during a manic or depressive phase, is immensely difficult. It's essential to seek support to help you recover from such episodes.
An important stage in bipolar treatment is choosing the setting. Depending on the severity of symptoms, a healthcare provider may recommend a residential or inpatient facility for those having severe symptoms and requiring extra support to ensure their safety and recovery.
Where to Find Bipolar Disorder Treatments
Treatment for bipolar disorder is typically guided by a psychiatrist (a medical doctor who specializes in diagnosing and treating mental disorders). This is done in combination with other health professionals, such as counselors, therapists, and social workers.
People with bipolar disorder and their families can also seek help from national or local support groups and advocacy organizations. Some of these organizations can connect you with clinical trials for new bipolar treatments.
Resources for bipolar support include:
Summary
Bipolar disorder is a chronic and progressive mental health condition characterized by manic and/or depressive phases. People with bipolar disorder require lifelong treatment, which typically includes a combination of prescription medications, psychotherapy, and lifestyle changes.
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