Treatment of Bipolar Disorder

Bipolar disorder (BD) is a mood disorder, characterized by alternating episodes of low mood or depression and unnaturally elevated mood or mania along with changes in levels of energy and activity. Treatment of bipolar disorder is readily available, but recovery can be a time-consuming process.

The main treatment for bipolar disorder involves medication, psychotherapy, or electroconvulsive therapy. Read on to know in detail about how is bipolar disorder treated.

Medical Treatment Of Bipolar Disorder

Medicinal treatment of bipolar disorder is primarily aimed at stabilizing mood, and managing anxiety and sleep issues. There are different types of medication available and a psychiatrist usually prescribes one based on the individual’s symptoms and case history.

Typically, medications in the treatment of bipolar disorder are found to be most effective when administered in combination with psychotherapy.

I. Mood stabilizers

In psychopharmacology, mood stabilizers comprise the most effective treatment for bipolar disorder. Research [mfn] Geddes, J. R., & Miklowitz, D. J. (2013). Treatment of bipolar disorder. Lancet (London, England), 381(9878), 1672–1682. https://doi.org/10.1016/S0140-6736(13)60857-0 [/mfn] attests to their efficacy in the treatment of manic episodes and depressive symptoms. Commonly prescribed mood stabilizers in the treatment of bipolar disorder include:

• Lithium
• Valproic acid
• Carbamazepine

II. Anti-seizure medication

Anti-seizure or anticonvulsant medication [mfn] Subbarao, B. S., Silverman, A., & Eapen, B. C. (2022). Seizure Medications. In StatPearls. StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482269/ [/mfn] is prescribed to people with bipolar disorder if they experience a rapid mood cycle. Some commonly prescribed drugs in this category include:

• Carbamazepine
• Gabapentin
• Lamotrigine

III. Antipsychotic medication

Antipsychotic medications are used for brief or long-term treatment of bipolar disorder to control psychotic symptoms experienced by BD patients such as hallucinations, delusions, or mania symptoms. Commonly used antipsychotic medication [mfn] Ertugrul, A., & Meltzer, H. Y. (2003). Antipsychotic drugs in bipolar disorder. The international journal of neuropsychopharmacology, 6(3), 277–284. https://doi.org/10.1017/S1461145703003560 [/mfn] for treating bipolar disorder involves:

• Aripiprazole
• Asenapine
• Cariprazine
• Clozapine
• Lumateperone
• Lurasidone
• Olanzapine
• Quetiapine
• Risperidone
• Ziprasidone

IV. Antidepressants

For the treatment of bipolar disorder, psychiatrists mostly prescribe [mfn] Cascade, E. F., Reites, J., Kalali, A. H., & Ghaemi, N. (2007). Antidepressants in bipolar disorder. Psychiatry [Edgmont (Pa. : Township)], 4(3), 56–58. [/mfn] antidepressants in combination with a mood stabilizer. Antidepressants like selective serotonin reuptake inhibitors (SSRIs) and bupropion are commonly consumed in first-line therapy for bipolar disorder.

Read More About Antidepressants Here

V. Benzodiazepine

Benzodiazepines are sometimes used as adjuncts to mood stabilizers or antipsychotic drugs for the pharmacological treatment of patients with bipolar disorder. However, the prescription of benzodiazepines is always kept at a bare minimum and their use [mfn] Bobo, W. V., Reilly-Harrington, N. A., Ketter, T. A., Brody, B. D., Kinrys, G., Kemp, D. E., Shelton, R. C., McElroy, S. L., Sylvia, L. G., Kocsis, J. H., McInnis, M. G., Friedman, E. S., Singh, V., Tohen, M., Bowden, C. L., Deckersbach, T., Calabrese, J. R., Thase, M. E., Nierenberg, A. A., Rabideau, D. J., … Kamali, M. (2014). Effect of adjunctive benzodiazepines on clinical outcomes in lithium- or quetiapine-treated outpatients with bipolar I or II disorder: results from the Bipolar CHOICE trial. Journal of affective disorders, 161, 30–35. https://doi.org/10.1016/j.jad.2014.02.046 [/mfn] appears to be a marker for a more severe course of illness.

Psychotherapy Treatment Of Bipolar Disorder

Bipolar disorder treatment without medication can also be quite effective. Evidence shows that psychotherapy can enable people suffering from bipolar disorder to identify mood symptoms early for mania and develop coping strategies for depression.

It can also motivate them to follow the treatment plan closely. Moreover, including family education in the treatment of bipolar disorder can improve communication among family members and help patients cope better.

I. Cognitive behavioral therapy

Cognitive-behavioral therapy (CBT) [mfn] Özdel, K., Kart, A., & Türkçapar, M. H. (2021). Cognitive Behavioral Therapy in Treatment of Bipolar Disorder. Noro psikiyatri arsivi, 58(Suppl 1), S66–S76. https://doi.org/10.29399/npa.27419 [/mfn] helps with the symptoms of depressive, dysphoric, and elevated mood episodes. It can also help a patient with bipolar disorder develop an enhanced adherence to drug treatment, as well as learn the skills to prevent future episodes. CBT also treats comorbid conditions associated with bipolar disorder like psychosis, eating and sleep disorders, etc.

Learn More About CBT And Its Uses Here

II. Interpersonal therapy

Interpersonal therapy (IPT) [mfn] Markowitz, J. C., & Weissman, M. M. (2004). Interpersonal psychotherapy: principles and applications. World psychiatry : official journal of the World Psychiatric Association (WPA), 3(3), 136–139. [/mfn] is a time-limited treatment that addresses patterns in social relationships and the capacity for intimacy in people with bipolar disorder. It also addresses mental health issues and interpersonal deficits related to grief, social acceptance, etc.

III. Dialectical behavioral therapy

Treatment of bipolar disorder can also involve dialectical behavior therapy (DBT) [mfn] DiRocco, A., Liu, L., & Burrets, M. (2020). Enhancing Dialectical Behavior Therapy for the Treatment of Bipolar Disorder. The Psychiatric quarterly, 91(3), 629–654. https://doi.org/10.1007/s11126-020-09709-6 [/mfn] which is an effective adjunct treatment that targets emotional dysfunction. It improves emotion regulation and residual mood symptoms in patients with bipolar disorder.

IV. Family-focused therapy

Family-focused therapy [mfn] Miklowitz, D. J., & Chung, B. (2016). Family-Focused Therapy for Bipolar Disorder: Reflections on 30 Years of Research. Family process, 55(3), 483–499. https://doi.org/10.1111/famp.12237 [/mfn] emphasizes the enhancement of skills linked to communication, problem-solving, and decision-making in people with bipolar disorder. It may be administered along with psychoeducation in the treatment of bipolar disorder.

Electroconvulsive therapy

Electroconvulsive therapy (ECT) is used for the treatment of bipolar disorder when other treatment options have proven ineffective. The process involves directing small doses of electrical currents through the brain to deliberately induce a brief seizure. This is done under general anesthesia to alter the balance of specific brain chemicals.

ECT can rapidly remedy bipolar disorder symptoms. This treatment approach is usually safe and controlled with minimum side effects and risks. In fact, about 80.2% [mfn] Popiolek, K., Bejerot, S., Brus, O., Hammar, Å., Landén, M., Lundberg, J., Nordanskog, P., & Nordenskjöld, A. (2019). Electroconvulsive therapy in bipolar depression – effectiveness and prognostic factors. Acta psychiatrica Scandinavica, 140(3), 196–204. https://doi.org/10.1111/acps.13075 [/mfn] of BD patients tend to show a positive response to electroconvulsive therapy.

Self-Help for Bipolar Disorder

In conjunction with bipolar disorder treatment and during recovery, several coping strategies can be practiced to manage the symptoms better.

Consider the following self-help tips to cope with bipolar disorder more effectively:

1. Maintain a good sleep regime and try to get at least 7-8 hours of sleep every night.
2. Take steps to prevent sleep disturbances (for example, turning your phone to silent, turning the lights off, etc.).
3. Eat a healthy and balanced diet.
4. Follow a routine for your daily tasks, such as eating, working, socializing, etc.
5. Try to stay physically active.
6. Practice relaxation techniques such as yoga, meditation, etc.
7. Learn how to identify triggers and sudden mood swings.
8. Seek support from family and friends.
9. Do not hesitate to seek professional help and take your treatment seriously.
10. Consider supplements like fish oil, Rhodiola Rosea, Perforate St. John’s worts, etc.
11. Try maintaining a daily journal and write down your thoughts, feelings, triggers, and symptoms.
12. Pursue any hobbies and interests that make you happy.
13. Avoid consumption of excessive amounts of caffeine or nicotine.
14. Avoid alcohol and recreational drugs.

Takeaway

Bipolar disorder can be a debilitating condition. But early identification and appropriate treatment of bipolar disorder can enable one to fully recover from the condition. As bipolar disorder can affect each person differently, the right treatment plan must be devised, according to each patient’s unique symptoms.

Moreover, the recovery time may also vary for each individual—depending on the symptoms severity, comorbid conditions, treatment compliance, and lifestyle. Nonetheless, patience, hope, and discipline throughout and after the treatment process can lead to improved symptoms and full recovery.

At a Glance

1. Bipolar disorder can be a crippling mental health disorder affecting your life, well-being, and relationships.
2. Treatment of bipolar disorder primarily involves psychotherapy and medication.
3. Bipolar disorder treatment also includes self-help coping strategies like herbal remedies, journaling, exercising, etc.
4. Having patience and discipline throughout and after the treatment process can lead to improvement in symptoms and a full recovery.

Frequently Asked Questions (FAQs)