Bipolar disorder is a long-term condition that requires lifelong treatment, even during periods when you feel better. Bipolar disorder treatment is usually guided by a psychiatrist skilled in treating the condition. But you may have others on your treatment team as well, including psychologists, social workers and psychiatric nurses, because the condition can affect so many areas of your life. Effective and appropriate treatment is vital for reducing the frequency and severity of manic and depressive episodes and allowing you to live a more balanced and enjoyable life. Maintenance treatment — continued treatment during periods of remission — also is important. People who skip maintenance treatment are at high risk of a relapse of their symptoms or having minor episodes turn into full-blown mania or depression. If you have problems with alcohol or substance abuse, you must get treatment for those, too, since they can worsen bipolar symptoms. Here are the core treatments for bipolar disorder:
Medications Medications are a vital part of bipolar treatment. Because medications for bipolar disorder can cause serious but rare side effects, you may be reluctant to take medications. But you can work with your psychiatrist and other health care professionals to find a medication regimen that works for you. Medication options include:
- Mood stabilizers. Mood stabilizers are most the commonly prescribed medications for bipolar disorder. These medications help regulate and stabilize mood so that you don't swing between depression and mania. Lithium (Eskalith, Lithobid) has been widely used as a mood stabilizer and is generally the first line of treatment for manic episodes. Your doctor may recommend that you take mood stabilizers for the rest of your life to prevent and treat manic episodes.
- Anti-seizure medications. The medications are used to prevent mood swings, especially in people with rapid cycling bipolar disorder. These medications, such as valproic acid (Depakene), divalproex (Depakote) and lamotrigine (Lamictal), also are widely used as mood regulators. These medications are also known as anticonvulsants.
- Antidepressants. Use of antidepressants in bipolar disorder, although once common, is now controversial. Antidepressants may not be advised at all, depending on your situation. There's limited data indicating that antidepressants are effective for bipolar disorder, and in some cases they can trigger manic episodes. Before taking antidepressants, carefully weigh the pros and cons with your doctor.
- Other medications. Certain atypical antipsychotic medications, such as olanzapine (Zyprexa) and risperidone (Risperdal), may help people who don't gain benefits from anti-seizure medications. And anti-anxiety medications, such as benzodiazepines, may help improve sleep. In addition, one medication, quetiapine (Seroquel), has been approved by the Food and Drug Administration to treat both the manic and depressive episodes of bipolar disorder. Numerous medications are available to treat bipolar disorder. If one doesn't work well for you, there are many others to explore. Your doctor may advise combining certain medications for maximum effect. It can take several weeks after first starting a medication to notice an improvement in your symptoms. Be aware that all medications have side effects and possible health risks. Certain antipsychotic medications, for instance, may increase the risk of diabetes, obesity and high blood pressure. If you take these medications, talk to your doctor about being monitored for health problems. Also, mood-stabilizing medications may harm a developing fetus or nursing infant. So women with bipolar disorder who want to become pregnant or do become pregnant must fully explore with their health care providers their options and the benefits and risks of medications.
Psychotherapy Psychotherapy is another vital part of bipolar disorder treatment. Several types of therapy may be helpful.
- Cognitive behavioral therapy. This is a common form of individual therapy for bipolar disorder. The focus of cognitive behavioral therapy is identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones. In addition, you can learn about bipolar disorder and its treatment and what may trigger your bipolar episodes. You also learn effective strategies to manage stress and to cope with upsetting situations.
- Family therapy. Family therapy involves you and your family members. Family therapy can help identify and reduce stressors within your family. It can help your family improve its communication style and problem-solving skills and resolve conflicts.
- Group therapy. Group therapy provides a forum to communicate with and learn from others in a similar situation. It may also help build better relationship skills.
Electroconvulsive therapy(ECT) Electroconvulsive therapy is geared mainly for people who have episodes of severe depression with suicidal tendencies or for people who haven't seen improvements in their symptoms despite other treatment. Electroconvulsive therapy is a procedure in which electrical currents are passed through your brain to trigger a seizure. Researchers don't fully understand just how ECT works. But it's thought that the seizure causes changes in brain chemistry that may lead to improvements in your mood. Hospitalization In some cases, people with bipolar disorder may benefit from inpatient hospitalization. Hospitalization for psychiatric treatment can help stabilize your mood, whether you're in a full-blown manic episode or a deep depression. Partial hospitalization or day treatment programs also are options to consider.