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How Is Bipolar Disorder Treated?

Posted on July 01, 2021
Medically reviewed by
Paul Ballas, D.O.
Article written by
Brooke Dulka, Ph.D.

  • Bipolar disorder is a chronic condition that requires long-term medication maintenance.
  • Mood stabilizers, antipsychotics, and antidepressants are the primary drugs used to treat bipolar disorder.
  • Psychotherapy approaches are also important in the treatment of bipolar disorder.

Bipolar disorder is a chronic mental health illness characterized by extreme emotional states. People with bipolar disorder swing from the lows of depression to the highs of mania. Without effective treatment, bipolar disorder can be a debilitating condition associated with significant disability and reduced quality of life.

Medication for Bipolar Disorder

Long-term medication use is generally recommended for bipolar disorder. Even if a person with bipolar disorder is experiencing a stable period of mood, it is still important to continue to take medication to prevent or reduce the effects of another mood swing to a manic or depressed state.

Treating bipolar disorder can be a difficult process. It is important to find the medication (or medication combination) that works best for the child or adult with bipolar disorder. Medications are also often combined with psychotherapy.

It is normal for people with bipolar disorder to take a combination of medications to treat the condition. According to one study of individuals with bipolar disorder:

  • 42 percent take one medication.
  • 42 percent take two medications.
  • 16 percent take three or more medications,

Several types of drugs are used to treat bipolar disorder. These drugs include mood stabilizers, antidepressants, and antipsychotics. Each of these drugs is used to control a different aspect of bipolar disorder.

Reducing Mood Swings: Mood Stabilizers

Mood stabilizers are a first-line treatment against bipolar disorder. They are used, as the name suggests, to stabilize mood and reduce mood swings. Most of these drugs (except lithium) are used at different dosages as anticonvulsants or antiepileptic drugs to control seizures. As an anticonsulvant stops seizure-related brain activity, these drugs keep the brain from becoming too overactive when used as mood stabilizers.

Some examples of mood stabilizers commonly used in the treatment of bipolar disorder include:

  • Lithium
  • Lamictal (lamotrigine)
  • Depakote (divalproex sodium)
  • Tegretol (carbamazepine)

Side effects are one of the most common reasons people with bipolar disorder stop taking their medications. Potential side effects of mood stabilizers vary greatly from person to person. Some people do not notice side effects.

Side effects of mood stabilizers can include:

  • Drowsiness
  • Dizziness
  • Nausea
  • Blurred vision
  • Vomiting
  • Headaches
  • Rash
  • Muscle tremor
  • Weight gain
  • Bruising or bleeding
  • Liver problems

Although primarily used for their mood stabilizing properties, some of these drugs may also be prescribed to help with symptoms of depression (Lamictal) or mania (lithium).

Treating Depressive Episodes: Antidepressants

Although mood stabilizers can help with the symptoms of depression, sometimes additional medications are needed to control depressive episodes.

Antidepressants prescribed to treat bipolar disorder are typically of the selective serotonin reuptake inhibitor (SSRI) class, particularly for bipolar disorder type 2. Serotonin is a brain chemical that plays an important role in mood. An SSRI is a drug that keeps serotonin molecules active and increases overall serotonin signaling. Increasing serotonin can improve emotion regulation.

Some examples of common SSRIs include:

While antidepressants are helpful for some people, there is also some controversy among experts and clinicians about how efficient they really are. Some researchers theorize the medications may cause more mood swings or manic episodes. Antidepressant use also needs to be monitored closely in younger people because of the medication’s potential to cause suicidal behaviors.

Potential side effects of antidepressant use may include:

  • Nausea
  • Changes in appetite
  • Weight gain
  • Fatigue
  • Drowsiness
  • Insomnia
  • Dry mouth
  • Dizziness
  • Constipation
  • Agitation or restlessness
  • Anxiety
  • Reduced sex drive

Treating Manic Episodes: Antipsychotics

Antipsychotics are another class of medications prescribed to treat bipolar disorder. These drugs are primarily used to treat the manic side of bipolar disorder. This is particularly important in cases of bipolar disorder type 1, where psychosis may occur.

In recent years, second generation “atypical” antipsychotics are the preferred category of antipsychotics to use. Older “typical” antipsychotics such as Haldol (haloperidol) have riskier side effects.

Examples of atypical antipsychotics used for bipolar manic symptoms are:

Atypical antipsychotic drugs can be quite effective against fighting symptoms of bipolar disorder. Each person responds differently to different drugs, and some drugs work better for specific groups. For instance, Latuda is an atypical antipsychotic that is approved to treat bipolar disorder in children and adolescents, as well as adults.

There are also side effects associated with antipsychotic use. Common side effects of antipsychotics include:

  • Drowsiness
  • Dizziness
  • Dry mouth
  • Blurred vision
  • Constipation
  • Restlessness
  • Weight gain
  • Nausea and vomiting
  • Seizures
  • Low blood pressure
  • Uncontrollable movements, such as tics and tremors

Other Medications Used To Treat Bipolar Disorder

For some individuals, different pharmaceutical approaches that don’t fall into the categories mentioned above may be necessary. Medications that fall outside these categories may be used to treat symptoms of bipolar disorder other than depression and mania. For example, Lunesta (eszopiclone) is a nonbenzodiazepine hypnotic sedative used to treat insomnia, but it is also used sometimes in bipolar disorder to treat sleep-related symptoms.

Psychotherapy Approaches in Bipolar Disorder

Although medications are an important component of bipolar disorder treatment, so are nonpharmaceutical methods, such as psychotherapy or counseling. One form of psychotherapy scientifically shown to be a useful adjunctive treatment for bipolar disorder is cognitive behavioral therapy (CBT). CBT approaches, which emphasize skills such as mindfulness and problem-solving, are particularly useful for adolescents with bipolar disorder.

What Is the Prognosis for Bipolar Disorder?

It can be tempting for a person, when they find themselves in a state of stability, to discontinue medication use. However, bipolar disorder is a chronic disease, and long-term medication maintenance is necessary. Bipolar disorder doesn’t go away, and its symptoms do not tend to get better. Symptoms can be managed using prescription medication and psychotherapeutic strategies.

Discontinuing a treatment without the supervision of a doctor can have devastating consequences. However, it is important to be aware of unwanted side effects of medication, and discuss these with your doctor. You and your doctor can work together to find the prescriptions that work best for you.

Talk With Others Who Understand

MyDepressionTeam is the social network for people with depression and their loved ones. On MyDepressionTeam, more than 13,000 members diagnosed with bipolar disorder come together to ask questions, give advice, and share their stories with others who understand life with depression and bipolar disorder.

Have you found a treatment plan to effectively manage your bipolar disorder? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. Bipolar Disorder — The Lancet
  2. Functioning and Disability in Bipolar Disorder: An Extensive Review — Psychotherapy and Psychosomatics
  3. Treatment of Bipolar Disorder — The Lancet
  4. Evolving Trends in the Long-term Treatment of Bipolar Disorder — The World Journal of Biological Psychiatry
  5. Lamotrigine and Antiepileptic Drugs as Mood Stabilizers in Bipolar Disorder — Acta Psychiatrica Scandinavica
  6. Bipolar Disorder and Mechanisms of Action of Mood Stabilizers — Brain Research Reviews
  7. The Prevalence and Management of Side Effects of Lithium and Anticonvulsants as Mood Stabilizers in Bipolar Disorder From a Clinical Perspective — International Clinical Psychopharmacology
  8. Antidepressants in Bipolar Disorder — Psychiatry
  9. SSRIs as Mood Stabilizers for Bipolar II Disorder? A Proof of Concept Study — Journal of Affective Disorders
  10. Antidepressants in Bipolar Depression: An Enduring Controversy — International Journal of Bipolar Disorders
  11. Do Antidepressants Increase the Risk of Mania and Bipolar Disorder in People With Depression? A Retrospective Electronic Case Register Cohort Study — BMJ Open
  12. Antidepressants and Suicidal Behavior in Bipolar Disorder — Bipolar Disorders
  13. Antidepressants: Get Tips to Cope With Side Effects — Mayo Clinic
  14. A Placebo-Controlled, Double-Blind Study of the Efficacy and Safety of Aripiprazole in Patients With Acute Bipolar Mania — American Journal of Psychiatry
  15. Antipsychotic Agents in the Treatment of Bipolar Mania — Bipolar Disorders
  16. Efficacy and Safety of Lurasidone in Children and Adolescents With Bipolar I Depression: A Double-Blind, Placebo-Controlled Study — Journal of the American Academy of Child & Adolescent Psychiatry
  17. Lurasidone Monotherapy in the Treatment of Bipolar I Depression: A Randomized, Double-Blind, Placebo-Controlled Study — The American Journal of Psychiatry
  18. Mental Health Medications — National Institute of Mental Health
  19. Efficacy and Safety of Nonbenzodiazepine Hypnotics for Chronic Insomnia in Patients With Bipolar Disorder — Journal of Affective Disorders
  20. The Efficacy of Cognitive-Behavioral Therapy in Bipolar Disorder: A Quantitative Meta-Analysis — The Journal of Clinical Psychiatry
  21. Cognitive-Behavioral Therapy for Bipolar Disorders in Adolescents: A Pilot Study — Bipolar Disorders
Paul Ballas, D.O. is an attending psychiatrist at Friends Hospital in Philadelphia, Pennsylvania. Review provided by VeriMed Healthcare Network. Learn more about him here.
Brooke Dulka, Ph.D. is a freelance writer at MyHealthTeams. Learn more about her here.

A MyDepressionTeam Member said:

There are a number of Medications for Depression
Zoloft is one of the few out there
I take Citalopram 20 .mg tablets ; 1 @bedtime. If you're already on a Depression Medication , see about adding
read more

posted 4 days ago

hug

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