Treatment for Bipolar Disorder: What Are the Options?

Many people with bipolar disorder don’t recognize the extreme changes in their moods and the effect those changes have on their lives and their loved ones’ lives. As a result, too many people with the condition don’t get the necessary treatment that could improve their quality of life.

If you think you may have bipolar disorder, talk to your doctor or a trusted friend or family member. Another person may be able to assist you in taking the first steps toward bipolar disorder treatment. Most people with the condition can lead fulfilling, successful lives if they continue with their treatment and regularly see their doctor.

Hospitalization may be required in some cases of bipolar disorder, but the condition can usually be treated successfully outside the hospital setting, ideally by seeing a psychiatrist.

If you’ve been diagnosed with bipolar disorder, you’ll most likely need to start taking medication immediately to balance your moods, according to Mayo Clinic.

Once your mood swings and other symptoms are stabilized, you’ll work with your doctor to develop a maintenance treatment plan to manage your condition over the long term.

Your doctor may prescribe one or more types of medications to treat bipolar disorder, according to Mayo Clinic:

• Mood stabilizers
• Antipsychotics
• Antidepressants
• Antianxiety medications

This will be based on your specific symptoms, Mayo Clinic experts note.

Many people with bipolar disorder will need mood stabilizing medication to manage their manic or hypomanic episodes, as well as depressive episodes. According to Mayo Clinic, your doctor may prescribe one of the following:

• divalproex sodium (Depakote)
• lamotrigine (Lamictal)
• lithium (Lithobid)
• carbamazepine (Tegretol, Equetro)

A doctor may also prescribe an antipsychotic drug to manage episodes of depression or mania that persist despite treatment with other medications, according to Mayo Clinic. Antipsychotics can be used as bipolar disorder treatment on their own or combined with a mood stabilizer, especially in more severe cases when an individual is experiencing delusions or hallucinations. Drugs in this class include:

• aripiprazole (Abilify)
• lumateperone (Caplyta)
• ziprasidone (Geodon)
• lurasidone (Latuda)
• olanzapine and samidorphan (Lybalvi)
• risperidone (Risperdal)
• asenapine (Saphris)
• quetiapine (Seroquel)
• cariprazine (Vraylar)
• olanzapine (Zyprexa)

Occasionally, an antidepressant may also be prescribed along with a mood stabilizer or an antipsychotic, according to Mayo Clinic. This is usually done to help manage a severe, acute episode of major depression.

However, evolving research has called into question whether adding an antidepressant is effective for treating and preventing bipolar depression, because it has a low potential benefit but a high risk of triggering mania.

A study published in 2021 in The Journal of Clinical Psychiatry demonstrated that citalopram — a medication used to treat depression — was no better than placebo for treating bipolar depression acutely or for managing it over time. Furthermore, maintenance therapy with this medication was found to raise the risk of mania over time.

Finally, in severe cases of bipolar disorder, your doctor may recommend a benzodiazepine — or another type of antianxiety medication — to help manage symptoms of restlessness, irritability, and sleep in the short term. Benzodiazepines are only recommended for short-term treatment, according to Mayo Clinic, whereas mood stabilizers and the other medicines listed are given for longer periods of time.

Finding the right bipolar disorder treatment can be a trial-and-error process, but you and your doctor should be able to find a combination that works well for you. Always tell your doctor about any symptoms you’re having, as well as any medication side effects you’re experiencing.

One of the challenges of medication for bipolar disorder is the potential for a wide variety of side effects, some of which may be serious.

Some of the most common side effects of bipolar medications, according to Mental Health America, are:

• Acne
• Blurry vision
• Dizziness
• Dry mouth
• Fatigue or drowsiness
• Feeling more thirsty than usual
• Frequent urination
  
• Nausea
• Skin rash
• Twitching of the face, hands, or other muscles
• Weight gain

If you experience side effects from your medication, tell your doctor — and don’t stop taking your medication unless your doctor advises you to. If you suddenly stop taking a drug, you may experience a “rebound,” or a worsening of your symptoms, according to the National Institute of Mental Health (NIMH).

In addition to their potential side effects, many drugs used to treat bipolar disorder can interact negatively with birth control pills or may have health implications during pregnancy. If you are using birth control, are pregnant, or are planning to become pregnant, talk to your doctor before starting any medication for bipolar disorder. Certain bipolar disorder medications may raise the risk of birth defects, according to the Depression and Bipolar Support Alliance (DBSA).

In addition to prescribing medication, your doctor will most likely recommend that you undergo psychotherapy (aka talk therapy) or some other form of counseling, according to the Mayo Clinic. This may include treatment for drug or alcohol use if you are dealing with addiction in addition to bipolar disorder.

There are many different types of psychotherapy. Cognitive behavioral therapy (CBT) is a commonly used form, Mayo Clinic experts say. In CBT, a mental health professional (a psychiatrist, psychologist, or social worker) will work with you to identify triggers for your bipolar episodes and develop healthy and effective strategies to manage stress and your bipolar symptoms.

Interpersonal and social rhythm therapy (IPSRT) is another common and effective form of therapy for people with bipolar disorder, according to the Mayo Clinic. IPSRT helps people learn ways to stabilize their daily rhythms, including mealtimes, sleeping, and waking. Establishing a daily routine for meals, exercise, and sleep can help keep your mood stable.

Your doctor may also recommend educational and support programs for you and your family. They may help you better understand the disease and its symptoms, as well as how to manage it, according to the Mayo Clinic.

When a child is diagnosed with bipolar disorder, teachers, school administrators, and other support staff are often engaged in treatment to make sure the child is doing well and has access to services they need.

If your condition doesn’t respond well to treatment with bipolar disorder medications, your doctor may recommend other treatments.

For example, if you have bipolar depression that doesn’t improve with medication, your doctor may recommend electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS), according to the National Alliance on Mental Illness (NAMI).

These interventions may have some benefit for bipolar depression, say Mayo Clinic experts. However, the potential benefits need to be weighed against the potential increased risk of mania.

Both of these approaches typically involve multiple treatments.

Electroconvulsive Therapy

ECT can be used to treat both manic and depressive episodes.

During an ECT procedure, you’re placed under anesthesia, and your brain is treated with small electrical currents. This causes a short, controlled seizure designed to affect the levels of certain neurotransmitters (chemicals that affect the brain), NAMI experts explain. People usually wake up approximately 5 to 10 minutes after the procedure is over.

ECT is much safer today than it was several decades ago, and it’s also very effective. Approximately 70 to 90 percent of ECT recipients say it improved their depression, say NAMI experts.

The potential side effects of ECT, according to NAMI, are:

• Headaches
• Nausea
• Short-term memory loss and confusion, which may happen during or after treatment. Confusion is usually temporary and clears up quickly, and memory loss typically goes away completely within a couple of months, according to the Cleveland Clinic.
• Sore muscles

Transcranial Magnetic Stimulation

TMS is primarily used to treat depressive episodes. During a TMS session, small, painless, magnetic pulses are applied to the brain to stimulate nerve cells that control mood regulation, according to NAMI. This noninvasive procedure typically lasts 40 to 60 minutes per session.

Approximately 30 to 64 percent of TMS recipients say their depression improved afterward, say NAMI experts.

Its potential side effects, which are uncommon and typically mild, are:

• Facial twitching
• Headache
• Scalp pain

Seizure is the most serious potential side effect of TMS, but it’s very rare, affecting about 0.03 percent of people who try it, according to NAMI.

Several complementary and integrative therapies have been suggested for managing bipolar symptoms, but there’s limited scientific evidence to support their effectiveness for this purpose. Most of these approaches involve taking herbal or dietary supplements.

Some common supplements include amino acids like S-adenosyl-L-methionine (SAMe) and Saint-John’s-wort, according to the National Center for Complementary and Integrative Health. Note that neither of these substances should be taken without the supervision of your doctor because of potential side effects that could arise. Among people with bipolar disorder, SAMe may worsen symptoms of mania, and Saint-John’s-wort may exacerbate symptoms of psychosis.

Light therapy has been used to help people with depression, particularly those with seasonal affective disorder. A study published in 2017 in the American Journal of Psychiatry showed that exposure to midday bright light could be an effective therapy for people with bipolar I or bipolar II disorder who take medication to manage manic episodes.

Some people believe that the traditional Chinese medicine practice of acupuncture may help manage depressive symptoms, according to the Cochrane Database of Systematic Reviews. But researchers don’t yet know how effective this approach is for bipolar disorder.

Talk to your doctor before starting any complementary or integrative therapies for bipolar disorder to make sure they won’t negatively interact with any prescription medications you’re taking. Most important, don’t stop taking prescribed bipolar disorder medications even if you’re feeling better. It could cause your symptoms to worsen.

If you’ve been diagnosed with bipolar disorder, it’s important to learn about the condition and its treatment so that you can work with your doctor to find the best course of treatment for you.

Be sure to surround yourself with supportive, caring friends and family who will help you cope with your condition and won’t encourage negative or destructive behaviors.

Learning about the disorder can also help you educate your family and friends about your struggles so that they can better support you, according to the Mayo Clinic. Many sources of support are available for people with bipolar disorder and their families.

As you and your doctor work to refine your treatment to minimize bipolar symptoms and medication side effects, try to be patient and stay motivated toward achieving your recovery goals. There are many combinations of treatments, and one of them will most likely work for you.

In addition, try to find healthy ways to channel your energy and manage or reduce stress. For example, it helps to quit drinking alcohol or using drugs, Mayo Clinic experts advise. These substances can worsen the risk-taking behaviors associated with episodes of mania or hypomania as well as make episodes of depression more severe.

It also helps to exercise regularly, because physical activity can reduce stress, stabilize your mood, and signal your brain to release chemicals called endorphins that make you feel good. Getting enough exercise can also help improve your sleep, which may help stabilize your mood.

Talk to your doctor before starting exercise. They can help you develop an exercise plan that’s beneficial for you. Even just taking a short walk a couple of days each week can help you feel better, according to the DBSA.

Consider taking on hobbies that help you relax, or explore certain relaxation techniques — such as yoga or meditation — that are designed to reduce stress, Mayo Clinic experts suggest.

In some cases, mood episodes are intense enough to warrant emergency inpatient care in a hospital setting. Hospitalization is not a punishment; rather, it’s a safe place to allow severe symptoms to pass and to potentially find a new treatment or combination of treatments that are beneficial for you or a loved one with bipolar disorder, say experts at the DBSA.

Signs that someone with bipolar disorder may need to be hospitalized, according to the Mayo Clinic and DBSA, are:

• They’re behaving in a way that’s extremely impulsive, risky, or dangerous to themselves or others around them.
• They can’t stop using alcohol or drugs in dangerous ways.
• They’re experiencing psychosis, or a detachment from reality. This can mean having hallucinations (seeing or hearing things that aren’t there) or delusions (persistent false beliefs despite evidence against those beliefs).
• They feel too depressed or exhausted to get out of bed or take care of themselves or their family.
• They haven’t slept or eaten for several days.
• Their symptoms are still impeding their ability to function, despite outpatient treatment with medication and psychotherapy.
• They need to make a significant change to their treatment and require close supervision from their doctor.
• They’re having thoughts of self-harm or suicide.

If you think you may hurt yourself or attempt suicide — or if you think a loved one may imminently harm themself or others — seek emergency medical help immediately by dialing 911.