Treating Bipolar Disorder

Medications, Therapy, and More

man talking to doctor
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Bipolar disorder is typically a lifelong illness with episodes (especially if untreated) that are highly variable and unique to each individual. Treatment is complex and often involves more than one medication over time. Talk therapy, complementary medicine, and lifestyle modifications can also help, but psychiatric medications are the mainstay of treatment.

Prescription Medications

Medications can help a person with bipolar illness manage their symptoms and function well in everyday life. A person who has bipolar disorder tends to experience extreme highs (mania) and extreme lows (depression). Certain medications help stabilize your mood so you don't experience severe highs and lows.

Since drug therapy is an important component of treatment for bipolar disorder, it's important to educate yourself about the various medication options. A psychiatrist will choose which medications are likely to work best for your symptoms. At times, your medications may need to be adjusted or changed.

If you have bipolar disorder and you're unhappy with the medication that you're currently on—perhaps you feel like it's not working well enough or maybe you're experiencing a side effect that you simply can't stand—remember that it's never a good idea to stop taking a medication cold turkey or change the dose of a medication without first talking to your doctor.

If you need to switch medications, your physician or psychiatrist will advise you on how to do so safely.

Anti-Convulsants

Anticonvulsants, also known as anti-seizure medications, are sometimes used as mood stabilizers in bipolar disorder. 

Antipsychotics

First generation antipsychotics, also known as typical antipsychotics, include:

  • Chlorpromazine (Thorazine)
  • Haloperidol (Haldol)
  • Fluphenazine (prolixin, permitil)
  • Flupenthixol (Fluanxol)
  • Zuclopenthixol (Opixol)

Atypical antipsychotics have fewer extrapyramidal side effects when compared to typical antipsychotics. But some, especially clozapine and olanzapine, carry a high risk of metabolic syndrome. Atypical antipsychotics include:

  • Aripiprazole (Abilify)
  • Clozapine (Clozaril)
  • Olanzapine (Zyprexa)
  • Risperidone (Risperdal)
  • Ziprasidone (Geodon)
  • Quetiapine (Seroquel)

Antidepressants

Selective serotonin reuptake inhibitors, or SSRIs, are antidepressants that are commonly prescribed for major depressive disorder but can also be prescribed for a bipolar depression. The SSRIs include:

The serotonin-norepinephrine reuptake inhibitors (SNRIs) include:

Tricyclic antidepressants are an older class of antidepressants that while effective for some people do carry a large side effect profile including heart arrhythmias and anticholinergic side effects like dry mouth, sedation, and constipation.

 

  • Amitriptyline (Amitrip, Elevil, Endep, Levate, Amitril, Enovil)
  • Amoxapine (Asendin)
  • Clomipramine (Anafril)
  • Desipramine (Norpramin, Pertofrane)
  • Doxepin (Sinequan)
  • Imipramine (Tofranil)
  • Nortriptyline (Aventyl, Pamelor)

Monoamine oxidase inhibitors are an older class of antidepressant. They work by preventing the breakdown of monoamines in the brain, like dopamine, norepinephrine, and serotonin. Examples include:

  • Phenelzine (Nardil)
  • Moclobemide (Manerix)
  • Tranylcypromine (Parnate)

There are also antidepressants that do not necessarily fit into the above categories, like Mirtazapine (Remeron), Trazodone (Oleptro, Desyrel), and Bupropion (Wellbutrin).

Benzodiazepines

Benzodiazepines depress a person's central nervous system and are used to treat anxiety, insomnia, and seizures. Benzodiazepines have different half-lives, meaning some are short-acting, intermediate-acting, or long-acting. They include:

  • Alprazolam (Xanax, Novo-alprazol, Nu-alpraz)
  • Clonazepam (Klonopin, Rivotril)
  • Chlordiazepoxide (Librium, Libritabs)
  • Diazepam (Valium)
  • Flurazepam (Dalmane)
  • Lorazepam (Ativan)
  • Oxazepam (Serax)
  • Temazepam (Restoril)
  • Triazolam (Halcion)

Other Medications

There are a number of other medications used in people with bipolar disorder. Some are used quite commonly but do not necessarily fit into one of the common categories of psychiatric medication.

One example is Lithium (Lithane, Lithobid, Lithonate, Eskalith, Cibalith-S, Duralith)—it is an element and was the first treatment for bipolar disorder. Although it requires careful monitoring, it is still commonly and effectively used as a first line mood stabilizer.

On the other hand, Verapamil (Calan, Isoptin), is a blood pressure medication that has been tried experimentally in the treatment of mania.

Combination Medications

Sometimes your doctor will prescribe a single medication that combines two drugs. This may provide increased convenience, but less flexibility in adjusting the individual dosages. Three examples include:

  • Triavil (Amitriptyline/perphenazine)
  • Limbitrol (Amitriptyline/chlordiazepoxide)
  • Symbyax (Fluoxetine/olanzapine)

Psychological Therapies

Many symptoms of bipolar disorder impact emotional well-being, so psychotherapy can often be helpful. Sessions should take place with trained mental health professionals—they can help identify when your moods are changing, triggers that lead to depressive or manic episodes, and skills to cope with bipolar disorder. They can also increase medication compliance, help you connect with others in the bipolar disorder community, and reduce any negative behaviors that affect your quality of life.

There are several types of psychotherapy (talk therapy) that might be considered such as cognitive behavioral therapydialectical behavioral therapy, and family treatment. Involving loved ones in your treatment can help members of your family gain a better understanding of bipolar disorder and it can assist them in supporting your treatment.

Complementary Treatments

It's important to talk to your doctor before trying any alternative treatments. Herbal supplements, like  St. John's Wort, could interfere with your medication or it may even trigger a manic episode but studies have shown it may alleviate mild to moderate depression.

Another complementary treatment for aspects of bipolar disorder is phototherapy, also known as light box therapy. It is often used to treat seasonal depression.

Evidence regarding the benefits of omega-3 fatty acids or acupuncture is inconsistent. There is not much data available clearly supporting the effectiveness of other alternative interventions in bipolar disorder (e.g., aromatherapy, massage therapy, yoga) although they may be beneficial in terms of general self-care.

Before starting any type of alternative treatment, talk to your physician or psychiatrist.

Lifestyle Changes

Your doctor and therapist will likely talk to you about strategies to manage your lifestyle. Adequate sleep, exercise, and good nutrition can be key components to managing your symptoms.

It's also important to manage your stress level. Developing healthy coping skills and helpful outlets for your stress can be key to regulating your mood.

It may also be important to avoid drugs and alcohol. Mood altering substances tend to intensify the problems associated with bipolar disorder. 

Support can also be helpful in managing your symptoms. If you lack natural resources, like supportive friends and a family, joining a support group for individuals with bipolar disorder may be especially important. 

Finding Treatment

Treatment for bipolor disorder can be initiatied once a proper diagnosis is made. Your physician will likely refer you to a psychiatrist or other mental health professional.

Bipolar disorder is best managed by a team of professionals. When those professionals work together to manage your symptoms, you'll likely be able to experience remission. With the right treatment plan, many people go for years and even decades being symptom-free.

Remission is about gaining stability and keeping your bipolar disorder under control, and that's what most people who have bipolar disorder are hoping for—a productive and harmonious life. Achieving stability usually requires medication as part of the treatment plan.

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