Bipolar Disorder Treatment: Medications, Therapy and More

Treatment for bipolar disorder generally occurs when a person is in either a major depressive episode or a degree of a manic episode. This acute episode is the focus of initial treatment. Depending on the severity, bipolar treatment options may include hospitalization, particularly if harm to the patient or those around him or her is a concern. The goal of acute bipolar disorder treatment is to rapidly stabilize the condition enough to get the patient out of danger and move forward into a long-term bipolar treatment plan. Typically this means treating the episode with the appropriate bipolar medication and scheduling follow-up sessions with a psychiatrist, psychotherapist and/or case manager.

Medication Treatment of Bipolar Disorder

Both acute manic or depressive episodes, as well as long-term bipolar treatment, typically require the use of medications. Medications for bipolar disorder vary depending on the phase of the illness: acute mania, acute depression or long-term treatment.¹ Medication selection is also based on specific symptoms and severity. Common medications used in the treatment of bipolar disorder include:

• Antipsychotics such as haloperidol (Haldol), ziprasidone (Geodon), quetiapine (Seroquel) and risperidone (Risperdal)
• Lithium
• Anticonvulsants (often called mood stabilizers) like Valproate (Depakote) and lamotrigine (Lamictal)
• Benzodiazepines such as clonazepam (Klonopin) and lorazepam (Ativan)

Antidepressants may be prescribed, but only with additional mood stabilizing medication. Most doctors agree, antidepressants should be used with caution in the treatment of bipolar disorder due to the possibility of inducing mania or rapid-cycling.

(Get comprehensive information on Bipolar Disorder Medications.)

Therapy Treatment for Bipolar Disorder

Therapy can be a valuable component of bipolar disorder treatment. There are several types of useful therapy including psychotherapy. Psychotherapy may be held individually or in a group. Psychotherapeutic bipolar disorder treatment focuses on several aspects of the illness:

• Education about bipolar disorder
• Support
• Increasing life and stress-coping skills
• Identifying and working through psychological issues that may contribute to the symptoms of bipolar

Continued follow-up with a medical professional is crucial to the success of bipolar treatment. The therapist can be a constant touchstone with the patient and keep them on-track and following their treatment plan. Other available types of therapy for the treatment of bipolar disorder include:

• Cognitive-behavioral therapy – focuses on challenging the thoughts and beliefs that are part of bipolar disorder
• Family therapy – includes family and friends of the patient
• Social rhythm therapy – aims to create solid, predictable routines in a patient's life, enhancing mood stability
• Self-help groups – offer ongoing support, may be community or faith-based

(Find out more about Types of Bipolar Disorder Therapy and How Bipolar Therapy Helps.)

Electroconvulsive Therapy as a Bipolar Treatment

Electroconvulsive therapy (ECT), once known as shock therapy, is considered safe and has shown to be extremely effective in treating bipolar episodes. While the treatment is still considered controversial by some, about 100,000 patients receive ECT per year in the US.²

ECT is indicated for the treatment of bipolar mania, mixed-moods, depression and may be useful for those with rapid-cycling or psychotic features. In acute mania, one study showed more than 78% of 400 people showed significant, clinical improvement. Most patients who have not responded to medication positively respond to ECT.³

ECT is generally used as a short-term bipolar disorder treatment (8-12 sessions) to stabilize the patient. After ECT, treatment is maintained with medication, although some patients use periodic ECT maintenance treatments long-term. Memory problems, which are typically transient, should always be considered when undergoing ECT.

Neurostimulation Bipolar Disorder Treatments

Other bipolar therapies that act directly on the brain are known as Neurostimulation treatments. These treatments are new but are showing promising results in some areas. Neurostimulation techniques are never considered first choice bipolar disorder treatments and, by many healthcare professionals, are still considered experimental. Neurostimulation bipolar treatments include:

• Vagus nerve stimulation (VNS) – an electrostimulation device is implanted in the chest that delivers an electrical current to the left vagus nerve. VNS is FDA-approved for use in treatment-refractory major depressive disorder (treatment-resistant depression) and has been studied in refractory bipolar depression as well.⁴
• Repetitive transcranial magnetic stimulation (rTMS) – an electromagnet is held near the head, generating an electric current across the skull no more than five centimeters into the brain. This device is FDA-approved for the treatment of major depressive disorder.⁵
• Deep brain stimulation (DBS) – involves implantation of a neurostimulation device into the brain. DBS is currently approved by the FDA for the treatment of Parkinson's disease but research on depression and obsessive-convulsive disorder is ongoing.⁶

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