Treatment for Bipolar Disorder: Medications and Remedies

Bipolar disorder is a mental illness characterized by episodes of mania and depression.

Mania is when a person feels elated, energized, and may have difficulty sitting still or acting rationally. A depressive episode is when a person feels a sense of sadness and/or hopelessness.

Bipolar disorder is a lifelong condition, but it can be treated with psychotherapy and medication. (Learn More)

In combination with medication, talk therapy (psychotherapy) can be an effective way to control bipolar symptoms. You can learn strategies to manage stress and avoid triggering manic or depressive episodes as frequently. A psychiatrist or similar professional can also help you and your family understand your condition better, so it induces less anxiety and those close to you can help you more effectively. (Learn More)

There a few types of medications that can be used to manage bipolar symptoms, including mood stabilizers, antipsychotics, and antidepressants. Mood stabilizers and antipsychotics are used to control mania, with mood stabilizers generally considered the better first-choice medication.

The effectiveness of antidepressants when treating bipolar disorder is hotly debated, but in theory, they are meant to control depressive episodes. They can trigger manic episodes, so they must be used with either mood stabilizers or antipsychotics. (Learn More)

Any medication used to treat bipolar disorder has risks and downsides. You should always talk to your doctor about the nature of any medication you will be taking.

Learn about any drugs it may interact poorly with, and be honest about any medical conditions you have or any drugs you already use, including alcohol. Ask about what to expect in terms of side effects and what should be considered a sign of danger or warrant medical attention. (Learn More)

As a general rule, avoid alternative medicine when treating your bipolar disorder. These medications and supplements are not usually recommended by doctors because they tend to be understudied, under regulated, and sometimes even dangerous.

If you are going to take an alternative treatment for bipolar disorder, first consult your doctor. Do not stop your current treatment without consent from your doctor. (Learn More)

black and white face

Bipolar Disorder Overview

Bipolar disorder, sometimes called manic depression, is a mental illness characterized by unusual shifts in mood, energy, activity levels, and productivity. There are several variations of the disorder, and some people deal with more severe episodes than others.

People with bipolar disorder struggle with manic episodes (where they feel elated, energized, and often have trouble sitting still or thinking rationally) as well as depressive episodes (where they feel sad and hopeless).

The same person may experience episodes of different severities. They will also have lulls between episodes where they have balanced levels of energy and stabilized moods, much like most people do.

Bipolar disorder is a lifelong illness that can strain work, social relationships, and general quality of life. However, with psychotherapy and medication, its symptoms can be managed, allowing a person to gain more control over the disorder.

If you believe you have bipolar disorder, talk to a licensed psychiatrist for their input and to learn what treatments will work best for you. Based on their assessment, a treatment plan can be laid out to give you the best chance of controlling your symptoms.

How Psychotherapy Can Help

While it will need to be used in conjunction with medication, psychotherapy can be an effective way to help with bipolar symptoms. There are a few types of psychotherapy that are notably useful for treating bipolar disorder.

  • Interpersonal and social rhythm therapy (IPSRT): IPSRT is about helping a person establish a routine. People with bipolar disorder often benefit from having a controlled routine, so IPSRT helps them learn to sleep, eat, exercise, and participate in other activities at consistent times.
  • Cognitive behavioral therapy (CBT). CBT is what many think of when they hear the word therapy. The patient works with a mental health professional to identify unhealthy, negative beliefs and behaviors that are affecting their health. They then learn strategies to subvert these beliefs and behaviors. Patients learn how to manage stress and potentially what can trigger bipolar episodes.
  • Psychoeducation. A professional explains the nature of a mental illness to a patient and, if they allow, their family. This can help everyone understand what to expect, reduce anxiety in the patient, and help their family have empathy for the person suffering from bipolar disorder.
  • Family-focused therapy. This therapy focuses on the family unit, helping to build a strong support network, improve communication, and repair damaged relationships.

Medications to Treat Bipolar Disorder

Properly controlling bipolar symptoms usually involves medication, even though psychotherapy can be an incredibly valuable addition to the overall treatment plan.

While other medications are occasionally used, such as benzodiazepines, there are three primary categories of drugs used to treat bipolar disorder. A fourth category is more or less just a combination of two of the prior three.

  • Mood stabilizers: Usually the first-choice treatment option, mood stabilizers help to control a patient’s manic episodes.
    One of the most common mood stabilizer is lithium. Others include valproic acid, divalproex sodium, carbamazepine, and lamotrigine.
  • Antipsychotics: Prescribed alone or in conjunction with a mood stabilizer, antipsychotics are used to control manic episodes if mood stabilizers prove ineffective on their own. While effective, there is a greater chance of serious side effects with antipsychotics.
    Commonly prescribed antipsychotics include olanzapine, risperidone, and quetiapine.
  • Antidepressants: Whether antidepressants are effective in treating bipolar depression is highly debated, and more studies are needed. Effective or not, many doctors prescribe antidepressants for bipolar depressive episodes.
    Antidepressants can trigger manic episodes, so they usually are prescribed with mood stabilizers or antipsychotics.
  • Antidepressant-antipsychotic: Symbyax is a medication that combines an antipsychotic with an antidepressant. This essentially negates some of the negatives that come from antidepressants’ ability to trigger a manic episode in people with bipolar disorder.

woman taking pill

Risks and Downsides of Medications

The medications used to treat bipolar disorder can have a number of negative side effects.

  • Mood stabilizers: Mood stabilizers can cause itchiness, extreme thirst, increased urination, hand tremors, nausea, vomiting, slurred speech, irregular heartbeat, blackouts, vision issues, hallucinations, loss of coordination, and swelling. They can trigger some serious problems, including liver damage, so regular checkups with a doctor are important to ensure safety.
  • Antipsychotics: Antipsychotics can cause sleepiness, faintness, agitation, weight gain, nausea, dry mouth, constipation, vomiting, blurred vision, reduced blood pressure, tics or tremors, seizures, and a lower white blood cell count. Typical antipsychotics are more dangerous than newer atypical antipsychotics.
  • Antidepressants: Common side effects associated with antidepressants include nausea and vomiting, weight gain, diarrhea, drowsiness, and sexual problems.
    They can cause sudden mood shifts and suicidal thoughts in some users, especially younger people. If you experience such a mood shift or any suicidal thoughts, contact your doctor immediately.

Always be honest with your doctor when being prescribed medication. Your doctor needs to know about any medical conditions you have and any drugs you use, including recreational or illicit drugs.

Be Wary of Alternative Medicine

Some people choose to use alternative medicine and herbal supplements to treat their bipolar disorder. Never stop your physician-prescribed treatment plan, even if you are going to take an alternative or supplemental treatment.

Most alternative medicine that is used to treat bipolar disorder has little or no research done on its effectiveness. In many cases, the medicine will be ineffective, and in some cases, it may even prove dangerous.

If you are considering taking any kind of medication or supplement to help with bipolar disorder, discuss it with your doctor first.

References

Bipolar Disorder. The National Institute of Mental Health (NIMH).

Medications for Bipolar Disorder. (April 2018). WebMD.

Bipolar Disorder. (January 2018). Mayo Clinic.

Bipolar Medications: Everything You Need to Know. (February 2019). MedicalNewsToday.

Antidepressants in Bipolar Depression: An Enduring Controversy. (August 29, 2018). International Journal of Bipolar Disorders.

Mental Health Medications. (October 2016). The National Institute of Mental Health (NIMH).

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