Bipolar Disorder Treatment
Treating bipolar disorder effectively involves a combination of psychotherapy, appropriate medications, support, and self-care. Several types of therapy may be used to treat bipolar disorder, and medications include antidepressants, mood stabilizers, and antipsychotics, which help to relieve symptoms of depression, minimize mania, and stabilize mood between episodes. With commitment to a treatment plan, support from family, and good self-care, bipolar disorder can be managed.
Types and Symptoms of Bipolar Disorder
How bipolar disorder is treated depends on several factors, including the type. Bipolar disorder is characterized by episodes of depression and episodes of mania, a state of mind and pattern of feelings, thoughts, and behaviors that is in many ways the opposite of depression. There are four main types of bipolar disorder:
Bipolar I. Bipolar I disorder causes episodes of major depression, but also episodes of mania. The manic episodes may be severe and may even cause psychosis, a break from reality.
Bipolar II. With bipolar II, a person experiences depression and episodes of less severe mania, called hypomania.
Cyclothymic Disorder. Cyclothymia causes less intense periods of depression and hypomania. There are many episodes over the course of two years for adults or one year for children and teens.
Bipolar Disorder, Unspecified. When someone has some of the symptoms of bipolar disorder but does not fully meet the diagnostic criteria for severity, duration, or number of episodes, they may be diagnosed with an unspecified type of bipolar.
Depressive episodes of bipolar disorder show the same signs as major depression, or low-grade depression in the case of cyclothymia. These include sadness, fatigue, changes in appetite and sleep habits, difficulty thinking, and thoughts of suicide. Mania causes feelings of euphoria, increased energy, less sleep, a jumpy feeling, agitation, racing thoughts and speech, an inflated sense of self-confidence, and risky behaviors.
Treating Bipolar Disorder
Bipolar disorder is a complicated mood disorder with contradictory episodes of euphoria and elation followed by depression. This requires both bipolar depression treatment and mania treatment, as well as overall comprehensive treatment. The best way to treat the condition is to start with a professional diagnosis, followed by the development of a treatment plan that involves a psychiatrist, therapist, and the patient. Family members may be involved as well. Treatment usually includes a combination of psychotherapy, medication, and self-care and management with support from loved ones.
Psychotherapy for Bipolar Disorder
The best, most comprehensive treatment plan for bipolar disorder includes psychotherapy, not just medication. Bipolar drugs can make a big difference for someone struggling with this condition, but they cannot cure it and cannot help a patient learn how to recognize and change negative thoughts and behaviors. This is why therapy is so important. A therapist can help a patient be more self-aware, recognize negative patterns in thoughts, and make positive changes in behaviors. There are a few different types of therapy that may be used with bipolar patients:
- Cognitive behavioral therapy (CBT). CBT is a common type of therapy used to treat a range of conditions. It involves learning to identify negative thoughts and behaviors and to change them into more positive substitutes. CBT therapists also teach patients coping strategies they can use on their own, such as breathing exercises for relaxation.
- Interpersonal and social rhythm therapy (IPSRT). A major challenge for someone living with bipolar disorder is shifting mood. IPSRT helps patients stabilize the rhythms of daily life to better manage mood. This means establishing a routine for each day that the patient can stick with, for eating, sleeping, exercising, and working, so that it is easier to maintain a stable mood. IPSRT also focuses on relationships, helping patients relate better to others and have more stable relationships, which in turn can help stabilize mood.
- Eye movement desensitization and reprocessing (EMDR). EMDR is most often used for people struggling with past trauma, but it can help patients with depression and bipolar disorder too. It involves watching an object move back and forth while processing the trauma. Studies have found that EMDR reduces symptoms of trauma, depression, and mania in patients with bipolar disorder.
- Family-focused therapy and family psychoeducation. Having support from family is helpful in treating bipolar disorder. One way in which a family can be involved and supportive is in attending family therapy sessions. These help the patient and family learn to communicate and relate better. Family psychoeducation is more focused on educating family members about the condition and how to help support the patient at home.
Support groups and group therapy. Group therapeutic settings can help patients with bipolar disorder by offering social support from peers. Being able to share experiences in a safe environment with others struggling with the same issues helps patients better implement other aspects of therapy and treatment.
Bipolar Depression Medication
Bipolar disorder cannot typically be treated effectively with therapy alone. It is a brain condition as well as a mental health condition, and medications can make big improvements in relieving symptoms. For bipolar depression, antidepressants are useful and work in the same way as they do for patients diagnosed with major depression.
There are several different classes of antidepressants. Doctors typically first prescribe selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs), because these are newer drugs that generally cause fewer side effects. Older classes of antidepressants include tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs), and atypical antidepressants. Which drug works best depends on the individual patient. It may take a few tries to get the best medication that causes the fewest side effects.
Taking an antidepressant alone is not generally recommended for bipolar patients. This is because it may trigger a manic episode, or it simply may not work on its own. The best balance of medications may take some trial and error for each individual, but it typically involves an antidepressant along with a mood stabilizer, an antipsychotic, or both.
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Bipolar Drugs – Mood Stabilizers and Antipsychotics
For the best and most effective management of symptoms, a patient with bipolar disorder is usually prescribed a mood stabilizer or an antipsychotic along with an antidepressant. Examples of mood stabilizers include Depakote and Depakene (divalproex sodium and valproic acid), Lithobid (lithium), and Tegertol or Equetro (carbamazepine). Mood stabilizers help to reduce the severity of episodes of mania or hypomania.
Antipsychotics may be needed to relieve symptoms of psychosis, such as delusions and paranoia, but they also work to stabilize mood and minimize mania. Examples of antipsychotics that may be prescribed to treat bipolar disorder are Risperdal (risperidone), Zyprexa (olanzapine), Latuda (lurasidone), Seroquel (quetiapine), and Abilify (aripiprazole). Symbyax is a drug that combines an antipsychotic with an antidepressant that is specifically approved to treat bipolar depression.
Alternative Therapies for Bipolar Disorder
Supplemental therapies, like acupuncture, animal therapy, or art therapy can be useful in treating bipolar disorder. These kinds of therapies are not recommended as the sole treatment, but they can be positive ways to feel better physically and emotionally while also focusing on comprehensive psychotherapy and medications.
There are also certain types of brain stimulation treatments that have been used with success in some bipolar patients. Electroconvulsive therapy, or ECT, for instance, delivers a minor electric current to the brain. It is typically administered a few times a week and causes few side effects. An emerging treatment, using magnetic stimulation is just beginning to show promise as a treatment for bipolar disorder. Although it needs more study, research has already found that this type of treatment can improve symptoms for patients with few side effects.
Managing Bipolar Disorder
In addition to therapy and medications, patients with bipolar disorder can help themselves feel better and support their own treatment by using self-care and management strategies at home:
- Avoiding drugs and alcohol, which can intensify symptoms and risk-taking behaviors. Someone with bipolar disorder and a substance use disorder should get treatment for both.
- Working on good relationships with family and friends is important for stabilizing mood and having positive social support.
- Establishing a regular routine at home and in other settings, such as school, also helps to stabilize mood.
- Making a mood chart, which keeps a record of mood and symptoms, can be useful for supplementing therapy and identifying factors that trigger depression or mania.
- Making healthy lifestyle choices, such as a healthy diet, plenty of exercise, and getting enough sleep can also support treatment and promote good brain health.
Bipolar disorder is a mental illness that can have a big impact on a person’s life. Depending on the severity and type, it can limit an individual’s ability to go to school, to work, or to have meaningful personal relationships. Getting diagnosed and getting treatment is essential for feeling better and for being able to function again. Treatment with the right medications, effective therapy, and self-care along with good social support can make a world of difference for someone struggling with bipolar disorder.