Bipolar disorder is a brain disorder also known as manic-depressive illness. It’s not curable but it is treatable. It’s a chronic disorder requiring lifelong treatment and attention. Treatment will vary depending on the type of bipolar disorder. What works for one person may not work as well for another. Bipolar disorder symptoms can be managed effectively with an appropriate treatment plan. Communicate openly with your doctor to find the plan best suited for you.
The changing moods and symptoms of bipolar disorder may respond differently to different medications. It’s common to try several drugs before finding the ones that work best for you. The National Institute of Mental Health (NIMH) explains that the most common types of medications used to treat bipolar disorder are mood stabilizers, atypical antipsychotics, and antidepressants.
Mood stabilizers are the first line of medical treatment. These drugs, which include lithium (Eskalith, Lithobid) and anticonvulsants, help stabilize moods. Anticonvulsants used to treat bipolar disorder can include:
- divalproex sodium (Depakote)
- lamotrigine (Lamictal)
- topiramate (Topamax)
- oxcarbazepine (Trileptal)
When taking some of these medicines, such as lithium, you need to get regular blood tests. Regular blood tests help ensure effective and safe levels of the drug in your body. If the blood levels of these medications are not high enough, then you will not receive their full potential benefit. Alternatively, the drugs can cause side effects to other organs if levels get too high. Side effects can include:
- memory problems
- dry mouth
- increased urination
- hair loss
- weight gain
- thyroid problems
According to the National Alliance on Mental Illness (NAMI), about 30 percent of individuals who try lithium as a treatment will not be able to tolerate it.
Atypical antipsychotics can be used with mood stabilizers. These drugs usually treat manic or mixed episodes. These drugs include olanzapine (Zyprexa), aripiprazole (Abilify), and risperidone (Risperdal). Common side effects of atypical antipsychotics include:
- weight gain
- skin rash
- blurred vision
Standard antidepressants are also used to treat bipolar disorder. Examples include fluoxetine (Prozac), buproprion (Wellbutrin), and sertraline (Zoloft). These medications are usually given with mood stabilizing drugs because they can trigger manic episodes in some people. Side effects of antidepressants can include:
- sexual problems
- dry mouth
Talk with your doctor about any medications you are on for bipolar disorder. Know the possible dangerous side effects, and let them know if any occur. There are risk factors for any medications. Your doctor will discuss the various risks and potential benefits with you to decide what medications are best.
Finding the right medication can be highly effective in treating bipolar disorder, though it’s often most effective when combined with psychotherapy. With insurance plans increasingly covering more mental health expenses, more medications used to treat bipolar disorder are being covered. This makes them more affordable and available to more people.
Psychotherapy, or talk therapy, is often used with drugs for bipolar disorder. A therapist can provide emotional support along with education about the disorder to you and your family. They may also help you avoid relapses and manage symptoms.
There are different kinds of therapy that may be helpful, including cognitive behavioral therapy, family therapy, interpersonal therapy, and psychoeducation.
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy is the branch of psychotherapy most frequently used to treat bipolar disorder. During CBT, people with bipolar disorder learn effective coping methods for dealing with the disorder, reducing the impact that the disorder has on them.
When one member of the family has bipolar disorder, it can heavily affect the rest of the family. Family members of those with bipolar disorder are also more likely to develop the disorder, or depression. During family therapy, those with bipolar disorder and family members work with a therapist to learn effective communication skills. For instance, they are taught to recognize signs of impending episodes or upcoming relapses. They also learn what to do when those with bipolar disorder seem to be struggling.
Interpersonal therapy focuses on current relationship issues caused by the disorder and seeks to help people with bipolar disorder improve their relationships with the core people in their life. By strengthening relationships, stress decreases, helping to treat one risk that leads to manic episodes.
It’s often combined with social rhythm therapy, which focuses on stabilizing social rhythms like sleeping, eating, and physical activity.
Psychoeducation works by teaching those who have bipolar disorder more about their mental health condition. By understanding the disorder, people with bipolar disorder can develop skills to better manage their symptoms. For instance, learning to recognize early signs of an impending episode can help reduce it. This therapy can also help identify personal triggers and develop a treatment plan.
Psychotherapy is often highly effective in treating bipolar disorder. It is also often used in conjunction with medication.
Electroconvulsive therapy (ECT), formerly known as shock therapy, is sometimes used for people with treatment-resistant bipolar disorder. When ECT is given, you take a muscle relaxant and are under short-term anesthesia. An electrical impulse is briefly administered. It’s a same day procedure with a quick recovery. However, there can be serious side effects with ECT, such as memory loss. Discuss the possible side effects with your doctor if you are considering this treatment.
Nonmedication supplements are also a possible treatment for bipolar. They are less common than the usual medications and psychotherapy. You might want to talk with your doctor about less traditional treatments if standard treatment doesn’t work for you.
Herbal supplements should not be taken without first talking with your doctor. These natural supplements can interact with medications and other treatments and may have adverse effects.
Natural supplements and vitamins thought to help treat bipolar disorder include:
- Fish oil. Studies have shown positive results when fish oil is used to help treat depression, though no specific correlations have been found with mania.
- Amino acids. Some studies have shown that amino acids can help to regulate mood, and can boost production of neurotransmitters like serotonin or dopamine.
In addition to taking supplements or vitamins, that are several other alternative remedies and lifestyle changes people with bipolar disorder can make to help manage bipolar disorder. These include:
- regular exercise
- plenty of sleep
- avoidance of unhealthy relationships
- healthy, balanced diet
- avoidance of alcohol and illegal drugs
Treatment for bipolar disorder in children and teenagers is often different than treatment in adults. Since children and teenagers are thought to have more unstable moods to begin with, they sometimes don’t get the treatment they need.
Children and teenagers may have different reactions to the same medications used to treat bipolar disorder in adults. They should take the fewest number of medications and in the smallest doses possible.
Find therapists who specialize in working with children. In this case, family therapy can also be particularly helpful for children and teens with bipolar disorder and their families.
As children get older, their bipolar disorder — and thus treatment — can change.
If you have a child with bipolar disorder, keep a chart of their moods, behaviors, and sleep patterns. Try to keep them on a routine sleeping and eating schedule as much as possible.
Those with bipolar disorder aren’t the only ones who feel the effects of this condition. People who care for or have relationships with someone with bipolar disorder may also experience challenges. They may experience guilt, grief, worry, disruptions in their own routine, and reckless behavior from the loved one with bipolar disorder.
In this way, individual or family therapy can also help those who have a relationship with someone who has bipolar disorder.
Support groups for people who have loved ones with a mental illness are available and can be extremely helpful. Ask your therapist or physician about support groups that might be right for you, whether you are someone with bipolar disorder or care for someone who has it.
Researchers continue to study new forms of treatment for bipolar disorder. The specific causes of bipolar disorder are also being researched.
There is currently no cure for bipolar disorder. However, the condition is treatable. With medical treatment, alternative remedies, and multiple options for psychotherapy currently available to treat this condition, treatment for bipolar disorder is more accessible than ever. If you’re currently being treated for bipolar disorder, consult your doctor before adding in new supplements or medications to your treatment plan.
If you exhibit symptoms or think you may have bipolar disorder, ask your doctor for a referral to a therapist.
You asked, we answered
- Does bipolar disorder worsen if left untreated (without medication)?
Yes, the current state of the evidence tells us that mood episodes may result in the gradual accumulation of damage to the brain. This results in episodes that progress from reactive (for example, due to stress) to spontaneous — which become more frequent, severe, and ultimately resistant to treatment. This is why it is so important to work with your doctor to adequately treat bipolar disorder.- Timothy J. Legg, PhD, PMHNP-BC