Managing Bipolar Disorder Effectively

Bipolar disorder is treated with three main classes of medication: mood stabilizers, antipsychotics, and, while their safety and effectiveness for the condition are sometimes controversial, antidepressants.

Typically, treatment entails a combination of at least one mood-stabilizing drug and/or atypical antipsychotic, plus psychotherapy. The most widely used drugs for the treatment of bipolar disorder include lithium carbonate and valproic acid (also known as Depakote or generically as divalproex). Lithium carbonate can be remarkably effective in reducing mania, although doctors still do not know precisely how it works. Lithium may also prevent recurrence of depression, but its value seems greater against mania than depression; therefore, it is often given in conjunction with other medicines known to have greater value for depression symptoms, sometimes including antidepressants.

Valproic acid is a mood stabilizer that is helpful in treating the manic or mixed phases of bipolar disorder, along with carbamazepine (Equetro), another antiepileptic drug. These drugs may be used alone or in combination with lithium to control symptoms. In addition, newer drugs are coming into the picture when traditional medications are insufficient. Lamotrigine, another antiepileptic drug, has been shown to have value for preventing depression and, to a lesser degree, manias or hypomanias.

Other antiepileptic drugs, such as gabapentin, oxcarbazepine, or topiramate, are regarded as experimental treatments that sometimes have value for symptoms of bipolar disorder or other conditions that often occur with it.

Haloperidol or other newer antipsychotic medications, such as olanzapine or risperidone, are often given to patients who fail to respond to lithium or divalproex. They also may be given to treat acute symptoms of mania — particularly psychosis — before lithium or divalproex can take full effect, which may be from one to several weeks. Another antipsychotic, Latuda, is approved for use in bipolar I depression as is the combination of olanzapine plus fluoxetine (called Symbyax). The antipsychotic quetiapine is approved to treat bipolar I or bipolar II depression. Preliminary studies also suggest that the atypical antipsychotic cariprazine (Vraylar) also may have value for treating bipolar depression.

Some of these drugs can potentially become toxic if doses get too high. Therefore, they need to be monitored periodically with blood tests and clinical assessments by the prescriber. Because it is often difficult to predict which patient will react to what drug or what the dosage should ultimately be, the psychiatrist will often need to experiment with several different medications when beginning treatment.

Psychotherapy, or talk therapy, is an important part of treatment for bipolar disorder. During therapy, you can discuss feelings, thoughts, and behaviors that cause you problems. Talk therapy can help you understand and hopefully master any problems that hurt your ability to function well in your life and career. It also helps you stay on your medication. It can help you maintain a positive self-image. The types of psychotherapy used to treat bipolar disorder include:

Behavioral Therapy

This focuses on behaviors that decrease stress.

Cognitive Therapy

This type of approach involves learning to identify and modify the patterns of thinking that accompany mood shifts.

Interpersonal Therapy

This involves relationships and aims to reduce strains that the illness may place upon them.

Social Rhythm Therapy

This helps you develop and maintain a normal sleep schedule and more predictable daily routines.

Support groups also help people with bipolar disorder. You receive encouragement, learn coping skills, and share concerns. You may feel less isolated as a result. Family members and friends may also benefit from a support group. They can gain a better understanding of the illness, share their concerns, and learn how to best support loved ones with bipolar disorder.

Education is another integral part of treatment for you and your family. People with bipolar disorder (and their families) often benefit from learning about the disorder — its symptoms, early signs of an episode, and types of treatment.

Also, taking these steps may help you cope with bipolar disorder:

Establish routines
Regular sleep, eating, and activity appear to help people with bipolar disorder manage their moods.

Identify symptoms
Even though the early warning signs of an approaching episode vary from person to person, together with a psychiatrist you can identify what behavior changes signal the onset of an episode for you. It may be needing less sleep to feel rested, buying things you can’t afford or don’t need, or becoming suddenly involved in religion or new activities and interests.

Adapt
This can help you avoid embarrassing behavior during manic episodes and set realistic goals for treatment. Your doctor can help you prepare for possible future episodes and manage fear about having more. A key part of adapting is to understand the types of stressors that might increase the risk for manic or depressive episodes and the lifestyle changes that can reduce them.

Maintain a regular sleep pattern
Go to bed and wake up around the same times each day. Changes in sleep can disrupt the normal functioning of brain circuits involved in the processing of emotions, potentially triggering mood episodes.

Do not use alcohol or recreational drugs
These substances can trigger or mimic mood episodes. They can also interfere with the effectiveness of medication.