While a combo of medication and therapy can help you manage bipolar disorder, treatment doesn’t end there.
Living well with bipolar disorder involves managing the symptoms and mood episodes you experience. This means finding a treatment plan that works for you.
It’s not always easy or simple, though — finding a treatment team and coping strategies can be a process. Mood episodes can often make it harder to manage your daily life, too.
Bipolar disorder treatment can involve medications, psychotherapy, and lifestyle or self-care changes. Usually, it’s a combination of things.
But because no two experiences are alike, your path to addressing your symptoms may depend on your own personal needs and goals.
It can sometimes be tricky to get a bipolar disorder diagnosis. But working closely with a mental health professional who provides screening and testing can be a good place to start.
Types of bipolar disorder
Overall, it’s estimated that about 4.4% of U.S. adults have bipolar disorder at some point in their lives.
There are different types of bipolar disorder you can be diagnosed with, including:
- Bipolar I. This diagnosis involves having episodes of mania. You may or may not also have depressive episodes.
- Bipolar II. This type of bipolar disorder means you experience at least one episode of depression and one of hypomania (a milder form of mania).
- Cyclothymic disorder. Also called cyclothymia, this involves symptoms of depression and hypomania that continue for at least 2 years. These symptoms don’t meet the criteria for a full mood episode.
Your symptoms may line up more closely with one diagnosis in particular. If they don’t quite align with any of those descriptions, you may be diagnosed with something else like bipolar disorder with mixed features.
Getting a bipolar disorder diagnosis
Mental health professionals typically follow criteria in the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) to help diagnose bipolar disorder. The DSM-5 gives healthcare providers a guide to diagnosing the type of mental health condition you have, and suggest treatments that fit the diagnosis.
Your doctor may ask several questions to find the right diagnosis:
- Have you experienced very high energy or irritable moods?
- Do you feel depressed — sad, empty, or hopeless — for long periods of time?
- During “high” mood episodes, do you also feel you have higher self-esteem, impulsivity, or talkativeness? Do you have racing thoughts, difficulty focusing, or less need for sleep?
- Have you been in the hospital because of a mood episode?
- Have you recently lost or gained a significant amount of weight?
- Have you recently experienced changes to your sleep?
- Do you go through periods where it’s harder to think, make decisions, or concentrate?
- Have you had thoughts about death or suicide?
- Do you have any other medical or mental health conditions? Are you taking any medications?
If you receive a bipolar disorder diagnosis, you’ll want to know the many treatment approaches out there. These involve medications, therapies, and more.
Medication can help reduce bipolar disorder symptoms, keep them from returning, and support you in pursuing additional mental health goals.
There are many medication options to choose from for bipolar disorder. But it can take some time to find the right med or combo for you.
Your doctor may consider many factors as they decide what medication to prescribe, such as:
- the kind of episode you’re experiencing
- the severity of your symptoms
- how quickly you need the medication to work
- whether you have any other conditions
- medications you’ve taken in the past
- how safe and tolerable the medication is
- your treatment preferences
Clinicians tend to think of medications as first-line, second-line, and third-line treatments. These categories help them rank treatments based on their safety and how well they’ve been proven to work.
Medications for bipolar disorder come in different categories based on how they work:
- mood stabilizers
One of the most common types of meds for bipolar disorder are mood stabilizers. These work by helping regulate mood and reduce symptoms of mood episodes.
Lithium is one of the most commonly prescribed mood stabilizers. It’s typically recommended as a first-line treatment for bipolar disorder.
Lithium is often used for bipolar I disorder, since it may help with severe mood episodes.
Your doctor will likely prescribe a mood stabilizer if you experience episodes of mania or hypomania. In some cases, you might take both a mood stabilizer and atypical antipsychotic.
Atypical antipsychotics are also called second generation antipsychotics. These antipsychotics are more often prescribed than first generation (or typical) antipsychotics since they tend to have fewer side effects.
Second generation antipsychotics work by helping regulate levels of neurotransmitters — especially dopamine — in the brain. Antipsychotic medications block some dopamine receptors, which may help regulate extreme moods and thoughts.
Atypical antipsychotics may help if you experience manic episodes. They’re used fairly often for bipolar disorder, though researchers are still discovering how effective they are for the condition.
Some common second generation antipsychotics include:
- lurasidone (Latuda)
- quetiapine (Seroquel)
- asenapine (Saphris)
- aripiprazole (Abilify)
- paliperidone (Invega)
- risperidone (Risperdal)
- cariprazine (Vraylar)
Some antipsychotics can cause drowsiness and other side effects. Find out how to deal with drowsiness caused by these meds.
Anticonvulsant medications work by reducing electrical activity in the brain. They’re typically prescribed for treating epilepsy and seizures, but sometimes prescribed for bipolar disorder.
While other medication types can help ease symptoms during mood episodes, anticonvulsants may work to prevent them. Your doctor might prescribe an anticonvulsant to make your mood episodes less frequent.
Lamictal (lamotrigine) is one common anticonvulsant used for managing bipolar disorder.
Antidepressants are medications that can help relieve symptoms of depression and other mental health conditions — but doctors are cautious about prescribing these for bipolar disorder.
Depending on your symptoms, antidepressants may reduce symptoms, but they could also make certain symptoms worse.
For some people, antidepressants can trigger mania. If you have bipolar I disorder, an antidepressant may intensify your symptoms rather than bring relief.
If you experience more depressive episodes, your doctor may prescribe an antidepressant such as:
When it comes to discussing medication options with your doctor, there can be a lot to consider. What will work best for your symptoms? What about side effects?
Here are some tips based on common questions people have about bipolar disorder medications:
Work with a doctor you trust
To get started on a medication, you’ll need to get a prescription from a healthcare provider that can prescribe meds.
Whenever possible, it can help to work with a doctor you trust. They should be open to your questions, concerns, and feedback.
If you’re seeing someone new after your diagnosis, learn how to find the right mental health professional.
Ask about potential side effects
Your treatment team will likely work with you to find a medication with as few side effects as possible, but it often takes some trial and error.
It’s not uncommon to try a few medications before finding one that works for you. During this process it can be helpful to know about potential side effects. This way, if you experience them, you can figure out how much impact they’re having.
If you do experience side effects, be sure to let your prescriber know, especially if it’s severe.
Some medications can also have interactions — for instance, certain meds can make birth control less effective. Others can cause complications during pregnancy. If you’re pregnant or planning to be, let your care team know.
Know your options
While there are many treatment options out there, finding what works for you isn’t always easy. What works for one person may not always work for someone else.
But just because one medication doesn’t work for you or causes unwanted side effects, doesn’t mean another medication won’t be able to help.
It can sometimes happen that the first medication a doctor prescribes might not work as planned. It may not help with the symptoms you’re experiencing, or it might cause new symptoms or side effects.
If the med you’re on doesn’t seem to be working, let your doctor know. If a first-line medication isn’t doing the trick, your doctor may prescribe a different medication or a combination of treatments.
Stopping a medication suddenly can cause unwanted symptoms. It may also increase risk of hospitalization or suicide.
So if you have any doubts or concerns about a medication you’re taking, talk with your treatment team before making changes. Even if you do end up deciding to stop, they can help you avoid discontinuation symptoms.
It can also be tempting to stop taking a medication once it starts working. But research has found that
When you find a med that works, you may need to continue taking it to keep your condition managed.
Staying in touch with your care team about tracking your treatments can help. These appointments and check-ins can help ensure that the medication is still working as it should and that it’s not affecting your health in any unintended ways.
Keep communication open
Good communication with your treatment team will help pave the way to better treatments. Keep communication open by:
- asking them to explain potential medication side effects
- reaching out when you have questions or concerns about a med your doctor suggests
- bringing up any treatments you’ve found out about while researching
- asking about medication interactions you should know about (not just with other meds, but with foods and supplements, too)
When it comes to your needs, you are the expert. If you feel like your current treatment isn’t working, advocate for yourself. A good care provider will listen to your concerns and take them seriously.
Psychotherapy — aka talk therapy — helps a lot of people manage bipolar disorder. In fact, a combo of medication and therapy is usually recommended for the best treatment results.
If you’re thinking about starting therapy, there are several options for bipolar disorder that you can pursue.
Research has shown that psychoeducation is effective for managing long-term symptoms of bipolar disorder. It’s typically recommended as a first-line treatment, especially when you’re first diagnosed.
Some goals of psychoeducation include learning to:
- identify mood episodes
- navigate stress
- solve problems
- develop healthy habits
Psychoeducation can take place in one-on-one sessions or in groups. Your therapist may guide you in creating personalized coping strategies to help prevent and manage symptoms.
Cognitive behavioral therapy (CBT)
CBT is probably one of the most well-known types of talk therapy. Its goal is to help people manage coping strategies and thought processes.
CBT techniques can help you rethink the way you think (seriously), so you can recognize thoughts that serve you well and let go of negative or destructive thinking.
Research supports CBT for bipolar disorder.
CBT can help you:
- address impulsivity
- stay grounded during mania
- practice self-care and self-compassion during depression
- take action when your motivation and energy are low
CBT can also include psychoeducation to help you learn more about bipolar disorder and develop skills and tools to manage it.
Family focused therapy (FFT)
FFT is a form of family therapy used to strengthen communication between you and the people close to you.
During FFT, your therapist may help your family understand how your condition works and how they can be part of your support network.
When used alongside medication,
Interpersonal and social rhythm therapy (IPSRT)
The goal of IPSRT is to help people manage mood changes and symptoms.
This type of therapy focuses on helping people identify triggers of mood episodes. In therapy, you may practice setting and keeping daily routines and consistent sleep cycles.
Research indicates that IPSRT may help people with bipolar disorder to reduce their mania and depression symptoms. One study even suggests it could improve how people respond to mood stabilizers, making them more effective.
Dialectical behavioral therapy (DBT)
DBT can help you:
- manage strong emotions
- even out mood symptoms
- increase emotional resilience
- decrease emotional reactivity
DBT may involve one-on-one therapy, group skills training, coaching between sessions, and working with a consultation team.
If you’re looking for more ways to manage everyday symptoms, there’s a lot you can do.
Keep track of your well-being
It may help to jot down notes on your mood, sleep, and causes of stress. Keeping a log of how you feel can help you determine how well your treatments are working.
Tracking your moods can also help you identify any symptom triggers, as well as signs you’re about to have a mood episode.
Identifying mood episodes early may help you feel more in control and centered while it’s happening.
Stay on top of medication
Make it easy to take your medication by setting up a routine.
- use a pillbox
- set reminders on your phone
- connect taking medication to another ritual such as brushing your teeth or making coffee
Establish a daily routine
Consider creating a calming morning or evening routine.
Since lack of sleep can trigger mania, you can try sleeping and waking up around the same time every day. In general, this is a good step for better sleep hygiene.
Create a safety plan
Have a safety plan ready for a crisis situation.
Collect a list of support resources, coping strategies, and people you can reach out to if you feel like you’re a danger to yourself or others.
If you’re experiencing suicidal thoughts, help is always available. The National Suicide Prevention Lifeline is available 24 hours a day at 800-273-8255. You can also call or visit your nearest emergency room or psychiatric care center to speak with a mental health professional.
Join a support group
Join an in-person or online support group. Not everyone will get what you’re going through, but other people with bipolar disorder will.
Find a support group through:
Participate in a stress-relieving activity
Find healthy ways to manage stress. This might be anything from meditating to gardening to swimming to taking walks.
If you want to pursue medication or therapy, you can always bring this up with a primary care doctor. They may be able to refer you to a specialist who can help.
You can also search online for a mental health professional who specializes in helping people manage bipolar disorder. If you plan on using insurance, you’ll want to make sure they accept your plan.
There’s no secret formula to managing bipolar disorder. Instead, there are many treatment paths that depend on your goals.
Whether you want to manage symptoms, learn coping skills, gain a sense of relief, or improve your relationships, there’s plenty of hope ahead.