How To Treat Bipolar Disorder

Approximately 2.3 million Americans are currently diagnosed with bipolar disorder.¹ Despite advances in diagnosing the disorder, there is still much that remains unknown about the causes of this mental illness. In addition, there's still a lot of stigma surrounding the disorder, which leads to many feeling ashamed of their diagnosis or attempting to hide it. The truth is, though bipolar disorder is a lifelong illness, it is nothing to be ashamed of, and it's highly treatable.

Originally called "manic depression" and thought to be a psychotic disorder, bipolar disorder was first officially named in the DSM-III. However, there are still plenty of people who believe that those diagnosed with bipolar disorder are "crazy," dangerous, or unpredictable.

To combat this stigma, it's important to understand bipolar disorder, the treatments available, and how it affects those who have this diagnosis.

What are the treatments used for bipolar disorder?

One essential thing to remember about bipolar disorder is that it can be treated, and treatments can effectively relieve symptoms. Those who are diagnosed with bipolar disorder aren't damaged or broken in any way, and with the proper treatment, they can go on to live productive, happy lives. New and more effective treatments are constantly being developed.

Bipolar disorder must be diagnosed by a mental health professional, such as a psychiatrist or psychologist, who will help develop a treatment plan that aims to treat your symptoms.

There are different types of bipolar disorder. Bipolar I usually encompasses longer and more severe periods of mania, with psychotic episodes in many cases (i.e., hallucinations, losing touch with reality).  Bipolar II usually encompasses longer periods of depression and hypomania, which are less severe manic symptoms.

There are a few different types of treatments available, and what works well for one person may not work as well for another. Here are a few of the most popular bipolar disorder treatments:

Mood stabilizers

Because bipolar disorder has characteristic highs and lows in mood, mood stabilizers are one of the most effective treatments. Historically, bipolar disorder has been treated with lithium, and it's still widely used.²

Antidepressants

Periods of depression or low mood are a part of bipolar disorder. If your bipolar disorder features longer periods of depression and shorter periods of mania or hypomania (less severe mania),  you may need antidepressant medication to help manage low moods.

Antipsychotics

Antipsychotics can stabilize both manic and depressive episodes and are usually prescribed when other medications, like antidepressants, don't work. They can be used in conjunction with other mood stabilizers or antidepressants.

Treatment programs

In severe cases of bipolar disorder, the patient may pose a risk to themselves or others. In periods of mania, people may take extreme risks, do drugs, or spend money uncontrollably. In periods of depression, people may turn to self-harm or may even have thoughts of suicide.

Hospitalization is an option in these cases, though both inpatient and outpatient treatment programs are potential options. Outpatient treatment may consist of a day program that provides the support and structure needed for the patient to recover.

Therapy

Therapy can be a part of a long-term treatment plan and can help you learn to manage and recognize your symptoms over time. Cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), and family therapy can benefit those with bipolar disorder. Therapy gives you a safe space to talk about your illness, your symptoms, and anything else that may be on your mind.

Electroconvulsive therapy (ECT)

Some people with bipolar disorder seem to be resistant to treatment. If this is the case, your doctor may recommend ECT. This is not the same as the scary and haphazard "electro-shock" treatments of the past. ECT produces safe and targeted electrical impulses that can stimulate parts of your brain.

Transcranial magnetic stimulation (TMS)

Like ECT, TMS aims to stimulate underactive areas of the brain, which may provide relief for bipolar patients, especially during depressive episodes. And like ECT, TMS is best for patients who haven't responded to medication. TMS uses noninvasive magnets to stimulate various areas of the brain and is also used to treat other mental health conditions. This is a fairly new form of treatment and is still being studied.

Not every patient responds to treatment in the same way, so it's important to talk to your doctor and try a few different treatments. Just because one doesn't work doesn't mean others won't help you.

In many cases, treatments may be combined to increase effectiveness. Therapy and medication can be used in conjunction on a long-term basis to help you stay healthy.

In addition, many people with bipolar disorder can also have a substance use disorder, as drugs can help to mask some of the more distressing symptoms of the disorder.³ It's important to treat drug addiction, too, in order to get the most out of bipolar disorder treatment. 

Can bipolar disorder be cured?

Bipolar disorder is a lifelong, chronic condition. It cannot be cured. It's important for those who have been diagnosed with bipolar disorder to continue their treatment even if they are no longer displaying symptoms. For the most part, people with bipolar disorder will be prescribed medication for the rest of their lives.

With treatment, people with bipolar disorder can be asymptomatic for years. But even so, if you stop taking your medication, symptoms can return quickly, and you may not even notice them coming back. In some cases, even without medication, patients can go for years without symptoms, but typically, over time, bipolar disorder will worsen without treatment.

The good news is that medication, therapy, and other treatments do work in combating bipolar disorder and other mental illnesses. In recent decades, more research has been done into the causes of bipolar disorder, and as we learn more, we can discover more effective treatments.

When we think of how far we have come in the last 50 years in regard to the treatment of mental illness, we can see hope for the future. Medical technology and research continue to improve with each passing year, and we’ll likely see huge changes in the treatment of this disorder in the coming years. We are only beginning to understand the genes that may cause bipolar disorder and how the chemicals in our brains respond to certain treatments.

Many people with bipolar disorder view it as a life sentence, and in a way, it is. However, taking the time to understand your illness is important. Realize that everyone's brain works differently, and you just happen to have bipolar disorder. It doesn't make you less than anyone else. 

Are there natural remedies or lifestyle changes that can help make living with bipolar disorder easier?

Because of its extreme highs and lows, maintaining a healthy routine is especially important for someone with bipolar disorder. This includes avoiding stress, getting plenty of sleep, exercising regularly, and eating regular, nutritious meals. Exercise can help stabilize your mood, alleviate stress, and help you sleep. Getting enough sleep can also help to stabilize mood and reduce irritability. Finally, eating healthy can help provide your brain with the nutrition it needs to function properly.

When you're experiencing mania, you may feel invincible, forgoing sleeping and eating. When you're in the midst of a depressive episode, you may not have the energy for self-care. But learning to maintain a routine with interpersonal and social rhythm therapy (IPSRT) can help in both manic and depressive periods.⁴

Meditation and other mindfulness activities can also help ease negative moods and deal with stress. Practice these techniques daily to help improve your emotional regulation skills.

But there is one key takeaway to remember here. Natural remedies and lifestyle changes alone are not effective at treating bipolar disorder. When used in conjunction with medication and therapy, these remedies can help you find relief from your symptoms and stay asymptomatic longer. They can help you manage your moods better, educate you, and help you advocate for yourself. 

When should you see a doctor for bipolar disorder?

Living with untreated bipolar disorder can be difficult, so it's important to seek treatment as soon as symptoms start to appear. People sometimes seek a diagnosis for years and cycle through manic and depressive phases several times before finding a correct diagnosis. Because depression is a classic symptom of bipolar disorder, many people may be diagnosed with depression before they get a bipolar diagnosis.

If you suspect you have bipolar disorder, it can be really helpful for you to keep a journal of your moods and feelings. This can help you chart your moods as they fluctuate and can help doctors make a diagnosis more quickly. Bipolar diagnoses are usually made in early adulthood but can occasionally appear in childhood or the teenage years.

When you visit your doctor seeking a mental health diagnosis, they will first complete a physical examination to ensure that there aren't any other underlying medical conditions that may be causing your symptoms. They may order a blood test or other lab tests. While you can't diagnose bipolar disorder based on lab work, it can rule out other conditions. If no other cause is found, your doctor will likely recommend that you visit a psychiatrist.

When you visit a psychiatrist for the first time, they will first ask you about your symptoms and complete a thorough evaluation. They will compare your symptoms to those listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and will be able to confirm if you have the disorder. There are four different diagnoses related to bipolar disorder:

Bipolar I

Those with this type of bipolar disorder have experienced at least one episode of mania. The majority of individuals diagnosed with bipolar I have episodes of both depression and mania, though they may cycle through mania and a more normal mood. You don't need to have a period of depression to be diagnosed with bipolar I. To receive a diagnosis, the patient's manic periods must last at least seven days and must be severe enough to affect the person’s ability to function in work or school or interact with other people.

Bipolar II

Those with this type of bipolar disorder experience periods of depression and will swing back and forth between depression and hypomania periods where they may have more energy, feel restless, feel happy or excited, and become more talkative. A full manic episode does not occur among people with a bipolar II diagnosis.

Cyclothymia

This is a form of bipolar disorder characterized by a chronically unstable mood. Patients experience both hypomania symptoms and mild depression symptoms, cycling for two or more years. Patients with cyclothymia sometimes have short-lived periods of normal mood, usually lasting under eight weeks.

Bipolar disorder "unspecified"

These patients don't meet the traditional criteria for the other types of bipolar disorder. However, they still experience periods of abnormally elevated or depressed mood.

In some cases, bipolar disorder can be classified as rapid-cycling, with manic and depressive periods lasting just a few days. In other cases, a depressive period can last for months or years, and a manic period may appear out of nowhere. This is why it can be so difficult to get a bipolar diagnosis. It can be difficult to track your moods over the course of years, and it can be tough to recognize those patterns in your own emotions. 

The lowdown

If you or someone you know has been diagnosed with bipolar disorder, it's natural to feel a little scared. After all, a lot of myths surround this disorder, and many people misunderstand what it really means to have bipolar disorder. They may picture someone who is unpredictable with wild mood swings, but in reality, those with bipolar disorder can function in society. They are our friends, our coworkers, and our neighbors.

Bipolar disorder is highly treatable, with more than two-thirds of patients reporting a reduction in their symptoms after three months of ongoing treatment.⁵ With treatment, patients can have healthy relationships, meaningful employment, and enjoyable life. With a combination of therapy, medication, and innovative new treatments, bipolar symptoms can improve significantly.