Editor’s Note: From medication to psychotherapy to lifestyle management, there are many options to help people manage the symptoms of bipolar disorder. In this section, we’ll explore the more common treatments by looking at guidelines from the National Institute of Mental Health. We’ll then provide first-person accounts of how treatments have affected individuals living with bipolar disorder.

As a reminder, nothing in this book is intended as medical advice. You should consult with your own medical experts for your specific situation.

A diagnosis of bipolar disorder is a life-changing event, but it also offers a path forward. According to the National Institutes of Mental Health, “Proper diagnosis and treatment can help people with bipolar disorder lead healthy and active lives.” There are a wide variety of treatment options available to manage the symptoms of bipolar disorder. These include medications, psychotherapy, alternative therapies such as ECT, and lifestyle management.  The information provided below is taken from the National Institutes of Mental Health’s  “Bipolar Disorder” website. A more comprehensive systematic review of the most current treatments can be found in the article “Treatment of Bipolar Disorder for Adults: A Systematic Review.”

Medications

Medications generally used to treat bipolar disorder include mood stabilizers and second-generation (“atypical”) antipsychotics. Treatment plans may also include medications that target sleep or anxiety. Health care providers often prescribe antidepressant medication to treat depressive episodes in bipolar disorder, combining the antidepressant with a mood stabilizer to prevent triggering a manic episode.

Living with bipolar disorder can be challenging, but there are ways to help make it easier for yourself, a friend, or a loved one.

People taking medication should:

• Talk with their health care provider to understand the risks and benefits of the medication.
• Tell their health care provider about any prescription drugs, over-the-counter medications, or supplements they are already taking.
• Report any concerns about side effects to a health care provider right away. The health care provider may need to change the dose or try a different medication.
• Remember that medication for bipolar disorder must be taken consistently, as prescribed, even when one is feeling well.

Avoid stopping a medication without talking to a health care provider first. Suddenly stopping a medication may lead to a “rebound” or worsening of bipolar disorder symptoms. For basic information about medications, visit NIMH’s Mental Health Medications webpage. For the most up-to-date information on medications, side effects, and warnings, visit the U.S. Food and Drug Administration (FDA) Medication Guides website.

Psychotherapy

Psychotherapy, also called “talk therapy,” can be an effective part of the treatment plan for people with bipolar disorder. Psychotherapy is a term for a variety of treatment techniques that aim to help a person identify and change troubling emotions, thoughts, and behaviors. It can provide support, education, and guidance to people with bipolar disorder and their families. Treatment may include therapies such as cognitive-behavioral therapy (CBT) and psychoeducation, which are used to treat a variety of conditions.

Treatment may also include newer therapies designed specifically for the treatment of bipolar disorder, including interpersonal and social rhythm therapy (IPSRT) and family-focused therapy. Determining whether intensive psychotherapeutic intervention at the earliest stages of bipolar disorder can prevent or limit its full-blown onset is an important area of ongoing research.

Other Treatment Options

Some people may find other treatments helpful in managing their bipolar symptoms, including:

Electroconvulsive Therapy (ECT): ECT is a brain stimulation procedure that can help people get relief from severe symptoms of bipolar disorder. With modern ECT, a person usually goes through a series of treatment sessions over several weeks. ECT is delivered under general anesthesia and is safe. It can be effective in treating severe depressive and manic episodes, which occur most often when medication and psychotherapy are not effective or are not safe for a particular patient. ECT can also be effective when a rapid response is needed, as in the case of suicide risk or catatonia (a state of unresponsiveness).

More research is needed to determine the effects of other treatments, including:

Transcranial magnetic stimulation (TMS): TMS is a newer approach to brain stimulation that uses magnetic waves. It is delivered to an awake patient most days for 1 month. Research shows that TMS is helpful for many people with various subtypes of depression, but its role in the treatment of bipolar disorder is still under study.

Supplements: Although there are reports that some supplements and herbs may help, not enough research has been conducted to fully understand how these supplements may affect people with bipolar disorder.

It is important for a health care provider to know about all prescription drugs, over-the-counter medications, and supplements a patient is taking. Certain medications and supplements taken together may cause unwanted or dangerous effects.

Lifestyle Management

Regular Exercise: Regular aerobic exercise, such as jogging, brisk walking, swimming, or bicycling, helps with depression and anxiety, promotes better sleep, and is healthy for your heart and brain. There is also some evidence that anaerobic exercise such as weightlifting, yoga, and Pilates can be helpful. Check with your health care provider before you start a new exercise regimen.

Keeping a Life Chart: Even with proper treatment, mood changes can occur. Treatment is more effective when a patient and health care provider work together and talk openly about concerns and choices. Keeping a life chart that records daily mood symptoms, treatments, sleep patterns, and life events can help patients and health care providers track and treat bipolar disorder over time. Patients can easily share data collected via smartphone apps—including self-reports, self-ratings, and activity data—with their health care providers and therapists.

Coping with Bipolar Disorder

Living with bipolar disorder can be challenging, but there are ways to help make it easier for yourself, a friend, or a loved one.

• Get treatment and stick with it—recovery takes time and it’s not easy. But treatment is the best way to start feeling better.
• Keep medical and therapy appointments and talk with the provider about treatment options.
• Take all medicines as directed.
• Structure activities: keep a routine for eating and sleeping, and make sure to get enough sleep and exercise.
• Learn to recognize your mood swings and warning signs, such as decreased sleep.
• Ask for help when trying to stick with your treatment.
• Be patient; improvement takes time. Social support helps.
• Avoid misuse of alcohol and drugs.

Remember: Bipolar disorder is a lifelong illness, but long-term, ongoing treatment can help control symptoms and enable you to live a healthy life.

References

Butler, M., Urosevic, S., Desai, P., Sponheim, S.R., Popp, J., Nelson, V.A., Thao, V., Sunderlin, B. (2018, August).  Treatment for bipolar disorder in adults: A systematic review. Comparative Effectiveness Review No. 208. (Prepared by the Minnesota Evidence-based Practice Center under Contract No. 290-2012-00016-I.) AHRQ Publication No. 18-EHC012-EF. Rockville, MD: Agency for Healthcare Research and Quality

Posted final reports are located on the Effective Health Care Program search page. DOI: https://doi.org/10.23970/AHRQEPCCER208.