What is the treatment for bipolar disorder?

In order to ensure that the affected person receives the best treatment, it is advised that the opinion and diagnosis of a doctor or medical professional who specialises in mental health conditions – often known as a psychiatrist is sought.

Bipolar disorder, being a lifelong condition, needs treatment that is able to manage the symptoms thereof.

These treatments may include:

Medications

Medications are often given immediately to help balance mood swings and improve the person’s everyday life.

Continuous treatment

Being a lifelong condition, a bipolar sufferer will need to continuously take medications, even when having a ‘happy’ period. This is known as maintenance treatment. If this is not done, the risk of a relapse of symptoms or developing severe depression or mania increases.

Hospitalisation

One may need to be hospitalised if experiencing suicidal thoughts, wanting to inflict self-harm or psychosis. This helps the sufferer to stay in a stable environment, be under constant monitoring where they will also be kept safe and calm.

Day treatment program

Some bipolar patients may be put on a day treatment program that provides counselling and support in order to control and deal with their symptoms. This is known as outpatient care in which patients are treated under a physician’s supervision and monitoring.

Treatment for substance abuse

Those having issues with drug or alcohol addiction may need to treat these through a clinic or rehabilitation centre in order to help manage bipolar disorder. Once the sufferer begins to deal with these addictions, it will be easier to combat bipolar symptoms as they will not be heightened or triggered through drug or alcohol use.

Support groups

A mental health professional may also recommend that a bipolar patient joins a support group. This helps the person to not feel alone in the condition, to know what to expect and how to deal with certain symptoms.

Bipolar medications explained

We touched on medications earlier in saying that they are often administered right away in order to help the patient to get bipolar related mood swings under control and bring about some kind of normalcy to the sufferer’s life. However, in order to fully cover this section in-depth, we will look at the specific medications used, their side effects and what they are used for.

Mood stabilisers

These are able to control hypomanic and manic episodes. Some examples include:

• Lithobid (lithium)
• Depakene (valproic acid)
• Depakote (divalproex sodium)
• Carbamazepine (Tegretol, Equetro and others)
• Lamictal (lamotrigine)

Antipsychotics

For those who experience symptoms of mania or depression that are persistent, regardless of the treatment and other medications, doctors may prescribe an antipsychotic drug. These include:

• Zyprexa (olanzapine)
• Risperdal (risperidone)
• Seroquel (quetiapine)
• Abilify (aripiprazole)
• Geodon (ziprasidone)
• Latuda (lurasidone)
• Saphris (asenapine)

One of these may be prescribed with a mood stabiliser.

Antidepressants

A doctor may prescribe an antidepressant to help manage episodes of depression. Caution is often taken when these are prescribed as they may trigger additional manic episodes. These are normally given with a mood stabiliser or an antipsychotic.

Antidepressant - antipsychotic

Symbyax is a medication that combines the antipsychotic olanzapine with the antidepressant fluoxetine in order to work as a treatment for depression as well as a mood stabiliser.

Anti-anxiety medication

The medication benzodiazepine is able to help with anxiety and improve sleep. However, these are normally used on a short-term basis.

Getting the right medication

Finding the right mix of medication that works for the affected person is often a process of trial and error. The upside is that if one of the medications does not work, then there are a number of others to try. This is a process that requires patience and weeks or even months to wait for the medication to be in full effect. A doctor is likely to only change one medication at a time to relieve some of the symptoms and side effects associated with the currently administered meds. If the patient’s symptoms change, the previously prescribed medication may also need to be adjusted.

Side effects

Side effects that are mild can often be improved through adjusting medication or dosages in finding the right ones that work for the patient. If medication side effects become bothersome, then it is advisable to speak to a healthcare professional about an adjustment.

As with most other prescribed medications, patients should never adjust their own medication or stop taking it. This can result in more side effects such as withdrawal or a severe relapse.

Pregnancy and medications

Some medications for bipolar disorder are known to result in birth defects and are able to be passed through a mother’s milk ducts when breastfeeding her baby. Some of these include valproic acid as well as Divalproex – both of which should not be used when one is pregnant or breastfeeding.

It is also likely that contraceptive pills used for birth control lose their efficiency when taken with bipolar medications.

If the patient is a female who suffers from bipolar disorder, it is advisable to discuss options of treatment with regard to pregnancy with their doctor, and specifically disclose if they are pregnant, think they might be or would like to be in the near future. And if they do not want to get pregnant, they will have to explore other options of contraception.

Psychotherapy

This is an important part of the treatment for bipolar disorder. There are several types of therapy, and it can be provided in family, group or individual settings. The types of therapy include:

• IPSRT (interpersonal and social rhythm therapy) – This type of therapy focuses on stabilising daily rhythms, such as waking up, sleeping and meal times. It creates a consistent routine in order to help with the management of moods. This helps to create an environment of stability.
• CBT (cognitive behavioural therapy) – This type of therapy focuses on identifying negative and unhealthy behaviours in order to replace them with healthier and more positive ones. This treatment allows the person with bipolar disorder to learn what triggers bring about these episodes and assists in creating strategies that will enable them to manage stress and deal with situations that are upsetting.
• Psychoeducation – This type of therapy educates the patient, their family and loved ones to understand bipolar disorder more effectively in order to be able to identify what the issues are, put preventative measures in place and give support in dealing with the condition in helping the sufferer’s family to understand what they are going through.
• Family-focused therapy – This type of therapy involves the patient’s family in order to help them to stick to a treatment plan and allow loved ones to be able to recognise potential triggers and mood swings. Relationships can often take a toll in the life of a bipolar person, specifically if they or their loved ones do not know they have the condition. Loved ones may think the person is simply acting out, depressed or stressed without knowing that they have a serious mental condition. This can result in them distancing themselves from the sufferer’s behaviour due to the fact that they don’t understand the associated mood swings and other symptoms. In order to prevent this, it is best for a bipolar sufferer to be correctly diagnosed, and then to have assistance in educating and involving their loved ones in their treatment and recovery.

Other options of treatment

Other options of treatment are dependent on the patient’s needs. These treatments are known to include ECT, which is the abbreviation for electroconvulsive therapy. In this type of therapy, electric currents pass through the brain in order to trigger a small and brief seizure. This creates a change in the chemistry of the brain and is sometimes able to reverse the symptoms of a number of mental disorders, bipolar disorder being one of them. This is often the solution when other means of treatment are not effective and the patient is not able to take antidepressants due to health reasons, it is also a viable option if he/she has suicidal thoughts.  

Treatment in teenagers and children

Treatments for younger people are decided for the specific case at the time, including what the symptoms are, the possible side effects of the medication and the individual patient. Treatment is generally known to include:

• Psychotherapy – This kind of therapy when used in the initial stages of bipolar disorder can often stop the symptoms returning. This helps young adults and children to create a routine and manage the disorder in order to bring stability to their daily lives. It also helps to develop skills to cope with stressors, improve learning difficulties, aid in resolving social issues, and help in strengthening communication and relationships. It is also able to help to treat in drug and alcohol abuse in teenagers. This treatment involves going to daily or weekly sessions with a psychologist or psychiatrist.
• Medications – Teens and children who have bipolar disorder are normally given the same medication as adults. However, there is a lack of research done on the side effects of said medication in children and teens, so safety is assumed based on research done in adults.
• Support – This involves doctors or psychiatrists working with teachers, parents and friends in order to encourage the support of loved ones, identify triggers and stressors and provide the much-needed care.
• Psychoeducation - This is a form of treatment that includes learning about the symptoms of bipolar and how they are different from a child’s normal behaviour that is part of their personality development and how to detect and differentiate between the two types of behaviours.

Alternative medicine

Research is lacking in the field of alternative medicine, sometimes referred to as integrative medicine and the use of it with bipolar disorder. If the sufferer does, however, decide to choose to go the non-traditional route of treatment, there are some precautions that should be taken into consideration:

• Do not stop taking the medication the doctor has prescribed as alternative treatment should not be seen as a substitute for regular medication. The patient should also still attend all of their therapy sessions and not skip any.
• It is best to be honest with health professionals and tell them what exactly the patient’s alternative treatments are or what they would like to try.
• Always beware of what potential danger there is in taking alternative treatments as they are often not regulated in the way that prescription medication is.