Treatments

Medication

Medication is the cornerstone of bipolar disorder treatment. Medications are the most effective way to stabilize mood and prevent a recurrence of manic and depressive periods. Just as people with diabetes may need to take insulin for the rest of their lives, people with bipolar disorder need to take mood stabilizing medication for the rest of their lives in order to manage the illness. Many people with bipolar disorder need a combination of medications to achieve remission and remain well.

The first choice of medication for bipolar disorder is usually a mood stabilizer. Mood stabilizers include lithium and a group of medications called anticonvulsants. Anticonvulsants have been found to have mood stabilizing effects.

Increasingly, doctors are turning to atypical antipsychotic medications. These drugs are called “atypical” to distinguish them from older, “first-generation” antipsychotic medications.

Doctors are careful about prescribing antidepressants for bipolar disorder, as there is not much evidence showing them to be effective for bipolar disorder. When doctors do prescribe antidepressants, they usually also prescribe using a mood stabilizer at the same time out of concern that antidepressants may contribute to manic episodes.

Tips to ensure that medication is effective:

• Work closely with your doctor to find the right combination of medications and dosages; if the medication isn’t working or side effects are bothering you, your doctor may be able to make adjustments
• Consider therapy as well as medication; the combination seems to be the most effective approach
• Continue taking medication even once you’re feeling better; medication can’t prevent another cycle if you’re not taking it
• Reinforce your medication with natural mood stabilizers, such as a healthy diet, regular exercise, getting enough sleep, and having a strong support system

Source: National Institute on Mental Health, Helpguide.org

Psychotherapy

Bipolar disorder is a biological illness and responds well to medication to correct chemical imbalances in the brain. Like any other chronic illness, education, lifestyle choices, and healthy habits can make the difference in having a great quality of life. This is where psychotherapy in combination with medication can help.

Types of therapy that have been helpful to those with bipolar disorder include:

Cognitive behavioral therapy
Cognitive behavioral therapy focuses on identifying unhealthy, negative beliefs and behaviors and replacing them with healthy ones. For bipolar disorder in particular, your therapist can help you understand your symptoms, learn what triggers your bipolar episodes, and develop effective strategies for managing those triggers.

Family-focused therapy
The extremes of manic and depressive moods can be very hard on family members. During depressive periods, a loved one may largely withdraw from the family and regular activity. During manic periods, impulsive behavior may cause financial and relationship problems. Family therapy helps family members understand their loved one’s illness and develop coping strategies, including recognizing new manic or depressive episodes early, communication, conflict resolution, and problem solving.

Psychoeducational therapy
Psychoeducational therapy teaches you and your family about bipolar disorder, how to manage it, how to recognize signs of a relapse, and what to do if a relapse is starting. This therapy draws on your own strengths and empowers you to manage your own recovery. The idea is, the better knowledge you have of your illness and your own capabilities, the better you can live with the condition. This therapy works well with children, adults, and families.

Interpersonal and social rhythm therapy
The mood extremes of bipolar disorder can be seen as disruptions in our bodies’ normal rhythms. Interpersonal and social rhythm therapy focuses on helping you identify and maintain rhythms of everyday life. In this therapy you may keep a regular routine for sleeping, eating, and taking medications. Your therapist may help you notice when interpersonal interactions upset your rhythm. By keeping to a regular routine and problem solving around exceptions to your routine, you can better manage your emotional highs and lows.

In any of these approaches, psychotherapy can help you manage bipolar disorder by helping you to do the following:

• Understand your illness
• Define and achieve healthy goals
• Cope with stress
• Make sense of past traumatic experiences
• Sort out your true self from the mood extremes caused by your illness
• Identify triggers that may make your symptoms worse
• Improve relationships with family and friends
• Establish healthy habits and routines
• Develop a plan in case of crisis
• End destructive habits such as drinking, drugs, risky sex, and spending sprees

Sources: National Institute on Mental Health; Healthguide.org; Mayo Clinic; Depression and Bipolar Support Alliance

Other treatments

While many people live with and manage bipolar disorder day in and day out, it is a very serious mental disorder with increased risk of self-harm and suicide. It can also be difficult to diagnose, which means that sometimes people don’t get help until the disease has progressed to a crisis. There may be times when the best approach is hospitalization to ensure your safety while your doctors find a treatment that will stabilize your moods.

Another option for bipolar disorder is electroconvulsive therapy, or ECT. This is one alternative for those who don’t respond to medication. It’s also often used for those who have an increased risk of suicide.

If your doctor recommends ECT, you will be admitted to the hospital for treatment. Once you’re under general anesthesia, electrical currents are applied and travel through the brain to deliberately create a controlled seizure. This seizure causes the brain to alter the balance of neurotransmitters such as serotonin and norepinephrine. The seizure lasts about 30 seconds. Treatments usually require six to 12 applications. Loss of memory of events that occur right around the time of ECT treatment may occur. However, ECT treatment does not impair your ability to make new memories.

Barriers to treatment

Some of the symptoms of bipolar disorder can themselves interfere with getting help and treatment. If your illness is making you think and act more impulsively than you normally would, or you are struggling with apathy from depression, it can be hard to seek help and stick to treatment. It can help to know this and prepare for times when you may not feel like staying with treatment.

Challenges you may experience with treatment:

• Denying or dismissing the diagnosis; a diagnosis of bipolar disorder can be hard to accept
• Resisting mania; you may enjoy the manic periods, and the nature of mania is that you can feel overly confident, powerful and in control, and begin behaving impulsively or recklessly
• Making time for treatment; therapy may involve weekly sessions; you might not always feel like you have the time to get enough sleep and exercise
• Discontinuing treatment when you’re feeling better; it can be very tempting to stop treatment when your mood has stabilized; bipolar disorder is a chronic, recurring illness and continuing treatment is the key to preventing future episodes
• Understanding that treatment is a process and it will take time; symptoms will subside gradually, not suddenly, and it may take some time to find the right medication and dosage that is effective with minimal side effects
• Separating yourself from your illness; therapy can help you learn to distinguish between the real you and the symptoms of your illness; this can be hard to do because bipolar disorder affects your self-perception

Therapy can help you educate yourself about bipolar disorder, learn how it affects you and your loved ones, and gives you a chance to think through the pros and cons of treatment and make choices about how you want to manage your illness and live a full and healthy life.

Source: PsychCentral