Bipolar Disorder Treatment

While there is currently no cure for bipolar disorder, it can be successfully managed with the help of therapy and medication. The key factor that determines whether a person experiences worsening mood episodes over time or has only minor symptoms is whether they receive treatment.

Can bipolar disorder be cured? Unfortunately, like most other chronic mental health disorders, bipolar disorder can’t be completely eradicated or fixed. It is based on inborn differences in brain chemistry and function that can’t be permanently changed. However,bipolar disordercan be successfully managed to the point that people are mostly or completely symptom-free for long periods of time. The key factor that determines whether a person experiences worsening mood episodes over time or has only minor symptoms is whether they receive proper treatment.

Psychotherapy

Therapy for bipolar disorder is an important part of any treatment plan. In therapy, people can process trauma, learn how to recognize the signs of impending mood episodes and gain insight into behavior patterns that either worsen or improve bipolar symptoms.

People with bipolar disorder can benefit from different therapeutic styles, but successful bipolar disorder therapyshould include an educational componentto help people learn:

• How to recognize the warning signs of oncoming mood episodes
• The effects of certain behaviors on bipolar symptoms
• Consequences of discontinuing medication or treatment
• Techniques for managing stress and regulating emotions

Supportive psychotherapy, which focuses on the relationship between a therapist and a client, might be a better option for some. In this style of therapy, clients receive emotional support and are encouraged to continue using successful strategies or behaviors. Supportive psychotherapy promotes acceptance of treatment and increases adherence to medication and treatment plans.

Cognitive Behavioral Therapy

Cognitive behavioral therapy(CBT) helps people identify distorted or irrational thoughts or beliefs that trigger negative emotions and behaviors. They then learn how to challenge and change these ways of thinking. For people with bipolar disorder, CBT functions in a similar way as supportive psychotherapy. Instead of focusing on the origins of their disorder, this therapy tactic helps people manage symptoms and follow through on important behavioral strategies.

Cognitive behavioral therapy for bipolar disorder focuses on the following outcomes:

• Stabilizing daily routines
• Improving symptom recognition
• Increasing problem-solving abilities
• Enhancing interpersonal and communication skills
• Identifying and addressing thoughts that affect mood
• Encouraging early and consistent intervention when mood symptoms arise

Research showsthat people who receive CBT for bipolar disorder have a better quality of life, fewer and less intense mood episodes, improved treatment compliance and fewer hospitalizations.

Group or Family Therapy

Group and family therapy can be important components of treatment for people with bipolar disorder.Group therapyor support groups can help people with bipolar disorder learn effective symptom-management strategies from their peers and reduce feelings of stigma, shame and loneliness. Treatment groups might be the first places that people with bipolar disorder feel understood and not alone.

Both group and family therapy can help people with bipolar disorder improve communication deficits caused by the disorder’s common symptoms. People think and act differently when they are depressed or manic and can alienate others without realizing they are doing so.

In joint therapy sessions, people can learn how others perceive them and how they can be more effective in conversing or interacting with others.Family therapycan help people with bipolar disorder and their loved ones understand one another and practice different communication strategies in real-time.

Medication Options

Medication is an important component of treatment for bipolar disorder. Because it is rooted in biological factors, bipolar disorder nearly always requires medication to treat, even when people participate in other therapies. Many different types of medication can be used, but mood stabilizers are the most common.

Mood Stabilizers

Scientists and mental health professionals do not fully understand howmood stabilizersfor bipolar disorder work, but these medications are effective in reducing the frequency of mood episodes.Lithiumwas one of the first mood stabilizers used to treat bipolar disorder and is still a common option, though it requires more monitoring and management than other bipolar medications.

Anticonvulsants

Other commonly prescribed mood stabilizers include drugs that were originally formulated to treat epilepsy or control seizures. These drugs are generally known asanticonvulsants.

The most commonly prescribed anticonvulsant medications for bipolar disorder are:

• Oxcarbazepine (Trileptal)
• Carbamazepine (Tegretol)
• Valproic acid (Depakote)
• Lamotrigine (Lamictal)
• Gabapentin (Neurontin)
• Topiramate (Topamax)

Researchers believe that these medications work by controlling levels of neurotransmitters in the brain. There are significant differences in how they are formulated that can make some more useful than others for treating certain aspects of bipolar disorder.

Antipsychotics

Sometimes people with bipolar disorder experience psychotic symptoms and need medication to control them. However,antipsychotic medicationshave many uses aside from managing psychotic symptoms. They are frequently prescribed to help people control aggression or anger. Antipsychotics can also be prescribed instead of anticonvulsants to stabilize mood or reduce manic symptoms. Second-generation or atypical antipsychotic medications have been found to work as antidepressants for bipolar disorder. These medications include:

• Aripiprazole (Abilify)
• Risperidone (Risperdal)
• Quetiapine (Seroquel)
• Olanzapine (Zyprexa)
• Lurasidone (Latuda)

Research showsthat Abilify for bipolar disorder is effective in treating and preventing manic and mixed episodes but not as effective in treating bipolar depression.Research supportsthe use of Seroquel for bipolar depression, though it may not be the best option for people with diabetes or other medical conditions. Using Latuda for bipolar depression is as effective as using Seroquel and also comes with fewer risks and side effects.

Antidepressants

Clinicians frequently prescribe antidepressants, including selective serotonin reuptake inhibitors (SSRIs), as bipolar depression medication, though they are usually prescribed in addition to mood stabilizers to avoid triggering manic or hypomanic episodes. Many professionals are not comfortable with the risks and prefer to try anticonvulsant or antipsychotic medications with antidepressant properties first, especially for people with histories of severe mania.

In place of traditional SSRIs, physicians may prescribe Symbyax, a newer drug that combines fluoxetine (Prozac) with olanzapine. Using this medication can prevent some of the negative outcomes that occur when SSRIs are used to treat bipolar depression.Research showsthat using SSRIs like Lexapro for bipolar disorder can help with severe depression but frequently causes adverse effects like mania, psychosis and suicidal ideation.

Anti-Anxiety Medication

Anti-anxiety medicationslike benzodiazepines are sometimes prescribed to people who have bipolar disorder and comorbid anxiety disorders or to address bipolar agitation or insomnia. However, using this type of medication comes with many risks, including triggering depressive symptoms. These medications also have addictive properties and are not recommended for people with substance use disorders. For these reasons, clinicians often try to treat anxiety in people with bipolar disorder in other ways.

Psychiatric Hospitalization

People who experience severe manic or depressive symptoms may require brief inpatient hospitalization for their safety and stabilization before they are able to continue treatment in an outpatient setting. Some people receive treatment in specialized bipolar treatment centers but most inpatient or residential mental health treatment facilities are able to provide tailored treatment for people with bipolar disorder.

People usually enterinpatient treatmentfor bipolar disorder for one of three reasons:

• They are at risk of harming themselves or others
• They are in an environment that is triggering their symptoms
• They have symptoms too severe to be treated in an outpatient setting

People with severe bipolar symptoms may have enough awareness of their condition to seek inpatient treatment voluntarily or may need to be admitted involuntarily through a process of civil commitment. When friends, family members or professionals are concerned, they can reach out to local authorities to have the person with the disorder evaluated for involuntary admission.

Regardless of whether treatment is voluntary or involuntary, inpatient treatment for bipolar disorder has the same goals:

• Starting or resuming medication for bipolar disorder to stabilize brain chemistry
• Participating in individual and group therapy to address immediate symptoms
• Identifying and addressing psychological factors that led to the admission
• Developing a discharge plan with referrals to outpatient treatment providers

For some people with bipolar disorder, hospitalization can become a regular part of their lives. However, following a consistent outpatient treatment plan can help people reduce the number of times they are admitted for inpatient treatment.

Treating Bipolar Disorder and Co-Occurring Disorders

People with bipolar disorder frequently have co-occurring disorders.Research suggeststhat they may be especially prone to obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD) and substance use disorders. The reason PTSD and bipolar disorder commonly occur together is that people with each disorder often have histories of childhood trauma.
Other researchshows that comorbid adult attention-deficit hyperactivity disorder (ADHD) is also common, with up to 21 percent of people with bipolar disorder having comorbid ADHD and almost half of the people with adult ADHD having comorbid bipolar disorder.

Autism and bipolar disorder are common co-occurring disorders for children who havepediatric bipolar disorder. As many as30 percentof children with bipolar disorder also meet the criteria for autism spectrum disorder. These comorbid disorders are associated with more severe symptoms and more intensive treatment like assertive community outreach programs.

Regardless of the type of co-occurring disorder a person with bipolar disorder experiences, the approach to treatment is similar. People with co-occurring conditions require separate services that target different aspects of each condition. The best outcomes occur in integrated treatment programs in which mental health professionals closely coordinate services and communicate regularly with one another. This prevents advancements in treating one condition from causing regression in another.

Bipolar Disorder and Substance Abuse

People with bipolar disorder often use substances to try to change or enhance their moods. Due to the severity and persistence of bipolar symptoms, this can frequently lead to addiction. These co-occurring disorders come with many risks. Havingcomorbid substance use and bipolar disorderincreases the risk of suicide and reckless behavior with severe legal, financial and social consequences.

Bipolar disordercan be overwhelming on its own and even more so when it is combined with a substance use disorder. The key to breaking the cycle of crisis and hospitalization associated with addiction and bipolar disorder is receiving the appropriate type of care.Contact The Recovery Villageto learn about how targeted intensive treatment can change the lives of people with these comorbid disorders.