Bipolar disorders get a bad rap.

In movies and TV, bipolar characters offer a dramatic case for an exciting, out-of-control life. They stagger between high and low emotions, spend money they don’t have, sleep around, and drink and drug at will. They talk too fast and act impulsively without considering anything or anyone.

Away from the screen, however, bipolar illness can feel very different. People with the disorder often spend far more time either perfectly fine, depressed, or in a mix of depressed and upbeat moods rather than surfing continuous manic highs. And, most importantly, given a correct diagnosis, medication, and therapy, many can achieve stable and fulfilling lives.

Why do these misconceptions arise? Maybe because, unlike other mental illnesses, bipolar disorders have acquired a kind of romantic mystique.  Taken only in their high and low extremities, they have become a stand-in for a heightened, creative life.

After all, many famous writers, artists, and musicians share the diagnosis, ranging from Alvin Ailey to Catherine Zeta-Jones. Not to mention Russell Brand, Kanye West, Carrie Fischer, Kurt Cobain, Lou Reed, Demi Lovato, Mariah Carey, and on and on. But it’s worth noting that while some studies show that those with a genetic tendency toward bipolar disorder may be more creative, that doesn’t apply to everyone. And that, for many people with bipolar disorder, a stable consistent routine often allows creativity to flow.

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What Does It Mean to Be Bipolar?

Once called manic depression, bipolar disorder is a mental health condition characterized by unusual shifts in mood, energy, activity levels, concentration and an inability to carry out daily tasks.  Moods can range from highs (mania or hypomania) where you feel extremely energized, elated or unusually irritable to lows (depression) which can lead to sadness, indifference, or hopelessness.1

Although bipolar disorder is a lifelong condition, it’s possible to manage mood swings and other symptoms by following a treatment plan that, in most cases, includes medications and psychotherapy.

“In general, bipolar disorder is much better controlled if treatment is continuous and tailored to each person since different people respond to treatment in different ways,” says Diana Samuel, MD, assistant professor of clinical psychiatry at the Columbia University Medical Center. “The combination of psychotherapy and medications together tends to be more effective, providing improvement in symptoms sooner.”

Diagnosing Bipolar Disorder

Most bipolar disorder falls into three main categories. They include:

Bipolar I

Characterized by episodes of mania that last at least seven days and may require hospitalization. Depressive episodes that follow can last up to two weeks. If these symptoms happen simultaneously, it’s called a mixed episode.

Bipolar II

Defined by a pattern of depressive and hypomanic episodes. Hypomania is a mood elevation that increases energy, agitation, and pressured speech. The mania is not as intense as bipolar I, but the depressive episodes are severe and may last longer.

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Cyclothymic Disorder (also called Cyclothymia)

Defined by periods of hypomanic and depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.

People can experience symptoms of bipolar disorder that do not match the three categories above, which are referred to as “other specified and unspecified bipolar and related disorders.”2

While these categories may seem easily differentiated, reaching a diagnosis for bipolar disorder can be difficult. People who have bipolar disorder often seek help when they are feeling low, so a careful medical history is essential to ensure that bipolar disorder is not mistaken for major depression.

“More than 50% of folks present with depression as their first episode,” says Trisha Suppes, MD, PhD, professor of psychiatry and behavioral sciences at Stanford University and the director of the Bipolar Disorders and Depression Research Program at the VA Palo Alto Health Care System. “In the early course of the illness, people with bipolar I or II may not have had any hypomanic or manic episodes or experiences.”

In addition, while mania is one of the “most recognized syndromes in psychiatry since it is so distinctive, bipolar II is often characterized by hypomania, which many people may not initially identify as a problem,”’ says Dr. Suppes.  “They may simply feel they are somewhat more energetic or sleeping somewhat less. They could even be just more hyper-productive or hyper-functional. They might not see that as a hypomanic symptom because the state could be mixed—both positive and negative.”

Getting a diagnosis correct is extremely important, however, since it can influence the course of treatment. Giving a patient with bipolar I disorder an antidepressant may trigger a manic episode.

“If you knew someone with bipolar I disorder was depressed, you wouldn’t give them an antidepressant,” Dr. Suppes explains.  “You’d give them a mood stabilizer, whereas with bipolar II, an antidepressant could be the treatment of choice.”

Bipolar Disorder and Related Mental Health Comorbidities

Along with depression, about 92% of people with bipolar disorder may also experience other psychiatric disorders during their lifetimes, which may further complicate a diagnosis.3 These include:

Substance Abuse

Of all psychiatric conditions, bipolar disorder is most likely to co-occur with alcohol or drug abuse.4

“For people with bipolar disorders it’s extremely important not to abuse substances,” Dr. Suppes says. “It can change the course of the illness and is really hard on the brain.”

“Cutting down or eliminating alcohol/drug use can be extremely important since the combination of bipolar disorder and alcohol/drug use each can worsen the severity of the other,” Dr. Samuel adds.

Post-Traumatic Stress Disorder (PTSD)

can develop after experiencing a significant traumatic event. People with depression or bipolar disorder are more likely to develop PTSD―both because having a mood disorder increases the risk of experiencing a traumatic event and because having a mood disorder makes it more likely a person who experiences a traumatic event develops PTSD. 5,6

Anxiety

It is also common for people with bipolar disorder to also have an anxiety disorder.7

Attention-Deficit Hyperactivity Disorder (ADHD)

“Bipolar disorder and ADHD have overlapping symptoms that can make it challenging to differentiate between the two,” Dr. Samuel explains.  “Both bipolar disorder and ADHD can present with difficulties in managing focus and being easily distracted, irritable, and speaking quickly.” Many people with bipolar disorders may also have ADHD.

Eating Disorders

Binge eating or bulimia may also accompany bipolar disorders.

Treating Bipolar Disorders

As stated previously, a combination of medication and therapy usually works best for people living with bipolar disorder.

Medications for Bipolar Disorder

When it comes to bipolar I disorder, “Lithium is still considered the first-line treatment for mood stabilization but in recent years, there have been many medications that can effectively treat bipolar disorder other than lithium,” Dr. Samuel says.

“Mood stabilizers are the most commonly prescribed type of medication for bipolar disorder. Antipsychotic medications and, to a lesser extent, antidepressants may also be indicated. Also, many antipsychotic medications have an indication for mood stabilization,” she said.

Medications may include:

  • Mood stabilizers. Used to control manic or hypomanic episodes, these include lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, others), and lamotrigine (Lamictal)).
  • Antipsychotics. Adding an antipsychotic may help relieve depressive or manic symptoms that persist despite treatment with other drugs. Taking these alone or with a mood stabilizer may help. Such drugs include: olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris).
  • Antidepressants. Employed to manage depression, antidepressants are usually prescribed with a mood stabilizer or antipsychotic, since an antidepressant alone can sometimes trigger a manic episode.
  • Antidepressant-antipsychotic. The medication Symbyax combines the antidepressant fluoxetine and the antipsychotic olanzapine. It works as a depression treatment and a mood stabilizer.
  • Anti-anxiety medications. Benzodiazepines may help with anxiety and improve sleep but are usually used on a short-term.8

In addition, cariprazine (Vraylar), has been recently been approved by the FDA for patients with both manic and depressive episodes in bipolar I disorder.9

“It’s very important that patients be absolutely honest with themselves and their doctor about which meds work and which don’t,” Dr. Suppes says. “Also, if they’re having side effects that are not tolerable. It doesn’t matter what they are. There’s a lot of different drug choices and if you work with your doctor, my hope is you’ll find a combination that you are comfortable taking in an ongoing way.”

Finding the right medications for you can sometimes be a trial-and-error affair that takes patience since some medications require weeks or months to reach their full effect. Health providers usually change only a single medication at a time to make it easier to identify which medications work to relieve symptoms with the fewest bothersome side effects. And even if you’ve arrived at the perfect mix, aging and changing symptoms may send require adjustments.

Never make changes on your own or stop taking your medications. If you stop your medication, you may experience withdrawal effects, or your symptoms may worsen or return. You may become very depressed, feel suicidal, or go into a manic or hypomanic episode. If you think you need to make a change, call your doctor.

Psychotherapy

Several types of therapy may be helpful in treating bipolar issues. These include: 10

  • Interpersonal and social rhythm therapy (IPSRT). IPSRT focuses on stabilizing daily rhythms, since following a consistent routine in sleeping, eating, and exercising may help you to manage your moods.
  • Cognitive behavioral therapy (CBT). By identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones, CBT can help identify what triggers your bipolar episodes. You also learn effective strategies to manage stress and to cope with upsetting situations.
  • Dialectical Behavior Therapy: Including both individual and group therapy, DBT teaches mindfulness and acceptance skills such as “the ability to experience moment-to-moment thoughts, emotions and their accompanying physical sensations from an observer’s stance, without negative judgment.”
  • Psychoeducation. Learning about bipolar disorder can help you and your loved ones understand the condition. Knowing what’s going on can help you get the best support, identify issues, make a plan to prevent relapse, and stick with treatment.
  • Family-focused therapy. Family support and communication can help you stick with your treatment plan and help you and your loved ones recognize and manage warning signs of mood swings.

Additional Bipolar Treatment Options

Depending on your needs, other treatments may be added to your depression therapy.

In electroconvulsive therapy (ECT), electrical currents are passed through the brain to trigger a brief seizure in the hopes of creating changes in brain chemistry that will reverse symptoms of certain mental illnesses. ECT may be an option for bipolar treatments in cases where medications don’t work, antidepressants may not be indicated (such as pregnancy), or where the is a high risk of suicide.

Transcranial magnetic stimulation (TMS) is being investigated as an option for those who haven’t responded to antidepressants.

In addition, studies are underway to examine if ketamine might be considered as an option in treating depression in people with bipolar disorder if they are on a mood stabilizer and/or antipsychotic in conjunction with receiving intranasal or intravenous ketamine. 11

Alternative Treatments for Bipolar Disorder

“Treatment for bipolar disorder most often requires a multiprong approach,” Dr. Samuel says.  long with taking your medications and attending regular therapy sessions, things like establishing a healthy sleep schedule and cutting down or eliminating drug and/or alcohol use can help.

Some people treat their symptoms with herbs (St. John’s Wart), dietary supplements (vitamin D), hormones (DHEA), and/or omega-3 fatty acids but research is inconclusive. However, A large meta-analysis conducted in 2013 found that some evidence is emerging in support of complementary-alternative treatments (CAM) for people who do not respond well to traditional medications or have intolerable side effects. If you are thinking of going the natural route, it’s important to speak with your doctor as bipolar disorder is a progressive illness and symptoms can worsen if they aren’t properly treated. 12

Lifestyle changes like adding regular aerobic exercise may lessen depression and anxiety in some people. Anaerobic exercise—such as weightlifting, yoga, and Pilates—might also help reduce stress, which can trigger mood swings.

Tracking your moods, treatments, sleep patterns, and life events can help you and your health care providers treat your bipolar disorder over time. Smartphone apps that collect self-reports, self-ratings and activity data, can easily be shared with therapists and health care providers.

Bipolar Treatment Resources

For Immediate Help

If you are in crisis: Call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), available 24 hours a day, 7 days a week. The service is available to everyone. All calls are confidential. Contact social media outlets directly if you are concerned about a friend’s social media updates or dial 911 in an emergency.

FAQS

What is the best treatment for bipolar?

The best treatment for bipolar disorders is a combination of medications and psychotherapy tailored to the individual. While bipolar disease cannot be cured, a consistent treatment plan can help you live an active, healthy life.

Can bipolar be treated naturally/without drugs?

While living a healthy lifestyle that includes exercise and a regular sleep schedule can help people with bipolar disease regulate their moods, medications are usually required to stabilize moods and prevent depression.

How successful is bipolar treatment?

Bipolar treatment is usually successful, allowing many people to live active and health lives. A certain percentage of people, however, may have a very difficult time stabilizing their disease and may require quite a few medications.

What is the first line of treatment for bipolar?

The first line of treatment is lithium but in recent years there have been many medications that can effectively treat bipolar disorder other than lithium.

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Last Updated: Mar 2, 2021