Treating Bipolar Disorder

Bipolar disorder is typically a lifelong illness with episodes 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.

Anti-Convulsants

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

• Carbamazepine (Atretol, Tegretol, Epitol)
• Divalproex Sodium (Depakote, Epival)
• Gabapentin (Neurontin)
• Lamotrigine (Lamictal)
• Oxcarbazepine (Trielptal)
• Topiramate (Topamax)
• Valproic Acid (Depakene)

Antipsychotics

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

• Chlorpromazine (Thorazine)
• Haloperidol (Haldol)
• Fluphenazine (Prolixin, Permitil)

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)
• Lumateperone (Caplyta)
• Clozapine (Clozaril)
• Lurasidone( Latuda)
• Olanzapine (Zyprexa)
• Quetiapine (Seroquel)
• Brexpiprazole (Rexulti)
• Risperidone (Risperdal)
• Cariprazine (Vraylar)
• Ziprasidone (Geodon)

Antidepressants

Selective serotonin reuptake inhibitors (SSRIs) are antidepressants that are commonly prescribed for major depressive disorder but can also be prescribed for bipolar depression. SSRIs include:

• Citalopram (Celexa)
• Fluoxetine (Prozac, Sarafem)
• Fluvoxamine (Luvox)
• Escitalopram (Lexapro, Cipralex)
• Paroxetine (Paxil)
• Sertraline (Zoloft)

The serotonin-norepinephrine reuptake inhibitors (SNRIs) include:

• Desvenlafaxine (Pristiq, Desfax)
• Duloxetine (Cymbalta)
• Levomilnacipran (Fetzima )
• Venlafaxine (Effexor)

Tricyclic antidepressants are an older class of antidepressants that, while effective for some people, 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 (MAOIs) are an older class of antidepressants. They work by preventing the breakdown of monoamines in the brain, like dopamine, norepinephrine, and serotonin. Examples include:

• Selegiline (Emsam)
• Isocarboxazid (Marplan)
• Moclobemide (Manerix)
• Phenelzine (Nardil)
• Tranylcypromine (Parnate)

There are also antidepressants that do not necessarily fit into the above categories, like mirtazapine (Remeron), trazodone (Oleptro, Desyrel), vilazodone (Viibryd), vortioxetine (Trintellix), 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)
• Vortioxetine (Trintellix)
• Vilazodone (Viibryd)

Other Medications

There are a number of other medications used for the treatment of 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), which 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.

Psychological Therapies

Many symptoms of bipolar disorder impact emotional well-being, so psychotherapy can often be helpful. Therapy sessions should take place with trained mental health professionals who can help identify when your moods are changing, triggers that lead to depressive or manic episodes, and skills to cope with bipolar disorder. Therapy 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 therapy (CBT), dialectical behavioral therapy (DBT), interpersonal and social rhythm therapy (IPSRT), 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. Studies have shown it may alleviate mild to moderate depression.

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

Evidence regarding the benefits of omega-3 fatty acids or acupuncture, on the other hand, is inconsistent. There is not currently much data available 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.

Lifestyle Changes

Your doctor and therapist will likely talk to you about strategies to manage your lifestyle, including:

• Avoiding drugs and alcohol, which can intensify the problems associated with bipolar disorder
• Developing healthy coping skills and helpful outlets for your stress
• Focusing on good nutrition
• Getting adequate sleep and regular exercise
• Seeking support from trusted friends and family or join a support group for individuals with bipolar disorder

Finding Treatment

Treatment for bipolar disorder can be initiated once you have recieved a proper diagnosis. Your physician will likely refer you to a psychiatrist or other mental health professional. Be sure to speak openly with your physician and mental health professional about your symptoms, behaviors, moods, and anything else you notice in your daily life.

Bipolar Disorder Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

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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 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.