These include Valium (diazepam), Ativan (lorazepam), and Klonopin (clonazepam). Their main purpose is to relieve anxiety and promote sleep, but they can be very effective in quickly bringing down a person from a manic state or as an additional medication in the “drug cocktail”. Their main drawback is they can be habit forming, with severe withdrawal symptoms, as well as having a depressive effect, so they are typically prescribed short-term or on an as-needed basis.

Pregnancy and breastfeeding

In general, antidepressants are considered safe through all phases of pregnancy and breastfeeding. However, check with your doctor or psychiatrist. As for mood stabilizers, lithium runs an outside risk of heart defect in the first trimester, while the risk of spina bifida is too great to be taking Depakote or Tegretol (and possibly the other mood stabilizers) during the first trimester. Of the antipsychotics, Haldol, the most studied, can be used safely during pregnancy. Frederick Goodwin MD, author of the definitive book on bipolar disorder, stated at a 2001 conference that because of the risk of postpartum mania, it is critical for expectant mothers to get back on their medications well before giving birth. Alternatives to medications include omega-3 and light therapy; and, as a last option, ECT. Drugs to avoid while breastfeeding: Lithium, Lamictal, antipsychotics.


Alcohol should not be consumed if you’re expecting your medications to work. If you find it hard to quit, bring this up with your psychiatrist. Caffeine and nicotine are other drugs you should seriously consider eliminating or cutting back on.

Which Medications are Right for Me?

Every individual is unique and no two cases of bipolar disorder are the same, so what works for one person in your support group may not work for you and vice versa. The American Psychiatric Association and other organizations implicitly recognize this in their treatment guidelines, which set out a number of first options for medications treatment, graduating to a stepped series of different options should those first options fail.

As a general rule, finding the right combination of medications takes time. Patience and persistence are required. You may have to persevere through a number of trials before you and your psychiatrist, as a team effort, hit upon a satisfactory solution.

This can be discouraging if you believe you can let your medications do all the work. Smart lifestyle choices and various coping techniques can make a substantial difference. Medication treatment can also be combined with talking therapy to great effect.

What Are My Choices in Psychotherapy?

Cognitive Therapy

Cognitive therapy – also called cognitive behavioral therapy – works to change erroneous thoughts (such as “My life will never be better.”) into more positive ones (such as, “Let’s find a solution.”) Once one is thinking and behaving in a positive way – such as working toward a solution rather than anticipating another day of unhappiness – one actually begins feeling better. The therapy applies equally well to depression and mania. The therapy typically lasts 10 to 20 sessions, involving active participation and homework. Various studies have found cognitive therapy to be as effective as antidepressant treatment. One major study found that a type of cognitive therapy combined with an antidepressant produced better results that either therapy or antidepressant treatment alone. Learn more about cognitive therapy.

Behavioral therapy and interpersonal therapy

These are also short-term, manual-based therapies that focus on coping skills. By changing destructive behaviors and dealing better with people, one can successfully negotiate the stressful situations that can trigger a mood episode. Learn more about behavioral therapy or interpersonal therapy now.

What about other types of talking therapy?

Before you engage in therapy that involves working on painful issues or suppressed memories, it’s important that your mood is stabilized. Otherwise these therapies may cause your condition to deteriorate. However, if your boss is making you unhappy and your family is causing you stress, simply taking medications only invites another episode. These situations represent very dangerous triggers that need to be addressed. Long-term talking therapy that can help you resolve these issues may literally save your life.

What about ECT?

Electroconvulsive therapy, also known as shock treatment, has been used successfully to treat both depression and mania. However, because of risk of short-term memory loss – and in rare cases long-term memory loss – it is regarded as a treatment of last resort, except if the patient’s condition puts him/her in a life-threatening situation where achieving a quick response is vital. Patients are typically given a course of several or more ECTs spaced over several weeks. Treatment involves being given anesthesia and muscle relaxants. Electrodes are placed to one side or both sides of the skull and a current is switched on.

The treatment is controversial, though much of the opposition comes from groups opposed to all forms of psychiatry. Unfortunately, the psychiatric profession has been less than candid over the memory loss element, and neglects to mention that relapses are common, which necessitates additional periodic “booster” treatments.

Keep in mind that the middle of a raging depression is not the time to be making decisions about ECT. People with their bipolar in remission should do their research and make their decision accordingly, while they have their wits about them. You can state your wishes in the form of a psychiatric advance directive.