While bipolar disorder cannot be cured, treatment aims to stabilize moods and untangle patients from the dramatic ups and downs of mania and depression through the use of medications and therapy.
Medications, called mood stabilizers, which are generally the first and most important step in therapy, are used to treat bipolar disorder by stabilizing moods and untangling patients from the dramatic ups and downs of mania and depression. Although there is no cure for bipolar disorder, it can be treated effectively.
Treatment options for bipolar disorder may include:
Medications
The types of medications generally used to treat bipolar disorder include mood stabilizers, atypical antipsychotics and antidepressants.
Mood stabilizers:
- The mainstay of long-term preventive treatment of both mania and depression is used to improve symptoms during acute manic, hypomanic and mixed episodes and may reduce the symptoms of depression.
- Lithium was the first mood stabilizer approved by the U.S. Food and Drug Administration (FDA) for treating manic and depressive episodes and remains a widely used medication.
Anticonvulsant drugs:
- Traditionally used to treat epilepsy, anticonvulsant drugs are also approved for use as mood stabilizers.
- Valproic acid was approved for treating mania.
- Lamotrigine has been approved for maintenance treatment and is often effective in treating depressive symptoms.
Atypical antipsychotic medications:
- They are sometimes used to treat symptoms of bipolar disorder, often in combination with other medications.
- Atypical antipsychotic medications include olanzapine, which may be prescribed for severe mania or psychosis.
- Other common drugs are quetiapine, risperidone and ziprasidone.
Antidepressants:
- They may be prescribed to treat symptoms of depression in bipolar disorder.
- Because antidepressants can increase the risk of mania, hypomania or rapid-cycling symptoms, they are typically prescribed in combination with mood stabilizers or antipsychotics.
- Commonly prescribed antidepressants include bupropion and selective serotonin reuptake inhibitors, such as fluoxetine fluvoxamine, paroxetine and sertraline.
Anti-anxiety medications:
- Drugs such as lorazepam and clonazepam are prescribed in some cases for insomnia, agitation or other symptoms, especially during a manic phase.
As with most psychiatric prescriptions, side effects do exist with bipolar medications, but in most cases, they’re mild. Common side effects include:
- Weight changes
- Feeling dull or unfocused
- Drowsiness
- Reduced libido
- Dry mouth
- Shifts in appetite
Some more serious side effects have also been reported including coma and kidney failure, but they’re extremely rare. Doctors prescribe these medications initially at a low dose and gradually increase the dose to find the right balance that works most effectively with the least amount of side effects.
Other treatments
Numerous non-pharmaceutical treatment options may be combined with medications to treat bipolar disorder, including:
- Psychotherapy such as cognitive-behavioral therapy (CBT), family therapy, interpersonal therapy and/or psychoeducation.
- Electroconvulsive therapy (ECT) in cases when medication and psychotherapy do not work.
What is bipolar disorder?
Bipolar disorder is a serious condition that causes major abnormalities in mood, thoughts, energy and behaviors. These types of changes cause noticeable impairments in a patient’s day-to-day life.
Patients with bipolar disorder experience these changes in extreme states called mania and depression (although they may go a while without any symptoms). These intense mood shifts can interfere with personal relationships, harm careers and disrupt their ability to just get through the day. Symptoms depend on mood swings.
During a manic high, patients may feel:
- Very happy, energetic or on edge.
- Like they need very little sleep.
- Overly self-confident.
- Like spending a lot of money or getting involved in dangerous activities.
After a manic episode, patients may return to normal. Their mood may also swing in the opposite direction—feelings of sadness, depression and hopelessness.
During a depressive episode or low, patients may have:
- Trouble thinking and making decisions.
- Feeling unworthiness or helplessness.
- Memory problems.
- Less interest in things that they have enjoyed in the past.
- Thoughts about killing themselves.
Mood swings of bipolar disorder can be mild or extreme, and may come slowly over several days or weeks or suddenly over a few minutes or hours. These mood swings may last for a few hours or several months.
What are the types of bipolar disorder?
According to the National Institute of Mental Health (NIMH), there are three types of bipolar disorder.
- It is defined by manic episodes that last a minimum of seven days or manic symptoms severe enough that patients need immediate hospital care.
- In this instance, depressive episodes may occur as well, typically lasting at least two weeks.
- Episodes of depression, with mixed depressive symptoms and manic symptoms at the same time, are also possible.
- This type of bipolar disorder takes shape as a pattern of depressive episodes and hypomanic episodes but doesn’t include severe manic episodes.
- Patients who have this type of bipolar disorder experience one major depressive episode that lasts at least two weeks.
Cyclothymic disorder:
- It is defined by cyclic periods of hypomanic symptoms and periods of depressive symptoms that last for at least two years (or one year in children and adolescents).
- Symptoms of cyclothymic disorder do not meet the diagnostic requirements for hypomanic and depressive episodes.