Bipolar Disorder Treatments

Bipolar disorder (BD) is a mental health condition that causes extreme changes in mood, energy, activity levels, concentration, and behavior. [4] These shifts can range from extreme highs (known as mania or hypomania) to extreme lows (known as depression). [4] People with bipolar disorder may also experience periods of stability, during which their mood and behavior are balanced.

Bipolar disorder affects an estimated 3% of adults in the U.S. [4] and can greatly interfere with daily living. Fortunately, there are several treatments available to help manage symptoms. This article explores traditional and alternative therapies to help treat and cope with bipolar disorder.

Bipolar Disorder Classifications

Bipolar disorder is a mental health disorder classified into three types:

Bipolar I Disorder

Individuals with bipolar I experience manic episodes that last at least a week and are present most of the day, almost every day, or are severe enough to require immediate hospitalization. [2] Depressive episodes may also occur, lasting at least two weeks. Some individuals may have mixed episodes involving symptoms of mania (extreme increase in energy or mood) and depression occurring simultaneously or rapidly alternating. The occurrence of manic episodes is a defining feature of bipolar I disorder. Episodes of hypomania (a less extreme form of mania) or depression may occur before or after manic episodes. [4]

Bipolar II Disorder

Bipolar II disorder is characterized by recurrent episodes of depression and hypomania (a less severe form of mania. Symptoms are still elevated but less disruptive compared to manic episodes seen in bipolar I disorder. Hypomanic episodes last at least four days. Individuals with bipolar II do not experience full-blown manic episodes [4]

Cyclothymic Disorder (Cyclothymia)

Cyclothymic disorder is characterized by depressive or hypomanic episodes that do not meet the criteria for full manic or depressive episodes. These mood shifts are less severe and typically last for at least two years in adults (one year in children and adolescents). Cyclothymia symptoms may not cause significant impairment in functioning but can still impact daily life. [4]

It is important to seek treatment as soon as possible if you or someone you know exhibits signs of bipolar disorder. A treatment program can reduce the intensity and frequency of manic and depressive episodes, improve overall functioning, reduce the risk of relapse, and increase the rate of medication response. [10]

Related: Understanding and Managing Types of Bipolar Disorder

Bipolar Disorder Treatments

When it comes to treating bipolar disorder, there are many effective options available. More often than not, mental health professionals will create a treatment plan that includes medication management, psychotherapy, and potential alternative treatments including TMS therapy.

Medications

Psychiatric medications are an essential part of the treatment plan for bipolar disorder, and they can help stabilize mood, prevent or reduce the frequency and severity of episodes, and improve overall functioning. Mood stabilizers and atypical antipsychotics are the two main medications to treat bipolar disorder.

Mood Stabilizers

These medications are the primary treatment for bipolar disorder and effectively control manic and depressive episodes. They work by stabilizing mood and preventing extreme shifts. Some commonly prescribed mood stabilizers include:

• Lithium has been used for decades and is effective in treating acute manic episodes, preventing relapse, and reducing suicide risk. [12]
• Valproic Acid (Sodium Valproate): It effectively treats acute mania and prevents mood episodes. [12]
• Carbamazepine: It is used to treat acute mania and to prevent relapse. [12]
• Lamotrigine: It is primarily used to prevent depressive episodes in bipolar and to prevent depression relapse. [12]

These medications are thought to influence or regulate certain neurotransmitters’ activity, which stabilizes moods.

Atypical Antipsychotics

Atypical antipsychotics are also referred to as second-generation antipsychotics. They are considered “atypical” because they differ from first-generation antipsychotics and have fewer side effects. [14]

Second-generation antipsychotics include:

• Abilify (ariprazole)
• Saphris (asenapine)
• Vraylar (cariprazine)
• Latuda (lurasidone)
• Risperdal (risperidone)
• Zyprexa (olanzapine)
• Symbyax (Fluoxetine/olanzapine)
• Seroquel (quetiapine)
• Geodon (ziprasidone) [10]

These medications are used to treat mania and psychosis and work by blocking specific dopamine and serotonin receptors, which can reduce symptom severity.

Common side effects may include:

• Dry mouth
• Weight gain
• Hyperlipidemia (high cholesterol)
• Blurry vision
• Sexual side effects  [14]

Certain antipsychotic medications can cause considerable weight gain and high cholesterol, which may increase the risk of developing diabetes. More severe side effects occur less often with atypical antipsychotics than typical (first-generation) antipsychotics, but are possible and may include:

• Extrapyramidal side effects (EPS): EPS includes muscle stiffness, tremors, restlessness, difficulty speaking or swallowing.
• QTc prolongation:  Some antipsychotic medications may cause a dangerous condition called QTc prolongation, which can increase the risk of developing potentially life-threatening arrhythmias.
• Myocarditis: Myocarditis is inflammation of the heart muscle. Symptoms include chest pain, shortness of breath, fatigue, and an irregular heart rate, and may range from mild to severe.
• Agranulocytosis: Agranulocytosis is a rare, life-threatening condition when someone has dangerously low amounts of white blood cells.

It is important to work closely with your healthcare provider or clinician. Clinicians decide which antipsychotic medication to try for someone with bipolar disorder by assessing the individual’s medical history, diagnosis, and symptoms and then consider factors such as the side effects of each particular medication, the individual’s response to other drugs, and the cost of the medicine.

If you or a loved one is living with bipolar disorder, call Neuro Wellness Spa today. We offer online psychiatric medication management to support you in a safe and secure environment. Don’t wait; contact us now and take the first step toward improving your mental health.

Spravato for Bipolar Disorder

The Food and Drug Administration (FDA) approved a new nasal spray medication for treatment-resistant depression. Although Spravato hasn’t been approved to treat bipolar disorder, there is some evidence of its potential safety in combination with mood stabilizers in individuals with bipolar disorder without a recent history of manic or hypomanic episodes or for individuals with bipolar disorder in a depressive episode who have shown minimal response to other treatments. [13]

Esketamine targets and increases glutamate, a chemical messenger in the brain. It is administered on an outpatient basis through a nasal spray.

Individuals with bipolar disorder experience 20 times higher rates of death by suicide than the general population [3], so fast treatment options are essential. Spravato provides a rapid and short-term reduction in depressive symptoms, including suicidal thoughts, in individuals with bipolar disorder. [3] Some studies have shown that esketamine may be effective in individuals with bipolar treatment-resistant depression (B-TRD). [9]

Psychotherapy for Bipolar Disorder

Managing bipolar disorder with medication alone is limiting at times. While symptoms can be managed effectively, medications fail to address the effects that mental health conditions can have on your life, relationships, and overall quality of life. Psychotherapy for bipolar disorder has proven to be an effective method for treating and managing symptoms as well as the underlying causes and broader effects on your quality of life.

Our integrative brief psychotherapy program at Neuro Wellness Spa utilizes a wide range of effective modalities and types of therapy that are commonly used to treat and manage bipolar disorder.

Psychoeducation:

Psychoeducation aims to help individuals with bipolar disorder develop compelling reasons to seek, adhere to, and continue treatment. [11] Psychoeducation is often structured to empower people to understand their condition better, detect and manage their symptoms, handle stressful situations, and promote medication adherence. [11]

One analysis that examined 14 randomized controlled trials (RCTs) showed that psychoeducation was linked to significant improvements in social and occupational performance, significant reductions in the number of manic relapses, and a longer amount of time from the first manic relapse. [11]

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy (CBT) helps individuals identify and change negative thoughts, feelings, beliefs, and behaviors that contribute to and exacerbate symptoms of Bipolar Disorder. [11]

CBT incorporates psychoeducation and tools like thought logs, mood diaries, and activity plans. In CBT, the clinician aids the patient in establishing a connection between mood and thoughts, identifying and monitoring symptoms and prodromes, developing behavioral coping mechanisms for symptoms, learning the fundamentals of CBT, enhancing sleep and activity patterns, enhancing medication adherence, and resolving psychosocial issues. [11]

According to research, CBT and psychoeducation resulted in significantly fewer days of depression and a smaller increase in antidepressant dosage over a year. [11]

Family-Focused Therapy

Family-focused therapy (FFT) is a type of therapy that is designed to help people with bipolar disorder and their families cope with the illness. It focuses on better understanding the condition, improving communication between family members, and learning how to manage stress and emotions.

FFT is designed to help families work together to provide support and assistance while promoting healthy coping skills and emphasizing the importance of adhering to medication treatment plans. It can also help reduce the risk of relapse and help people with bipolar disorder develop better problem-solving skills and coping strategies. Studies have demonstrated that FFT is an effective treatment that reduces illness burden and improves social functioning for both the individual with bipolar disorder and their family.[11]

Interpersonal and Social Rhythm Therapy

Interpersonal and Social Rhythm Therapy (IPSRT) encourages people with bipolar disorder to maintain regular sleep patterns and manage their daily routines and activities. It emphasizes the importance of managing stress, developing healthy relationships, and establishing regular routines and social activities. [11]

It can also help people recognize early warning signs of relapse and develop prevention strategies. By helping people to manage their daily routines and activities, IPSRT can help to reduce the severity of symptoms in people with bipolar disorder and help them to lead more fulfilling lives. [11[

Therapy is often combined with other treatments, such as medication, to treat bipolar disorder. Your clinician can help guide you in which treatment may work best for your unique needs and can help answer any questions or concerns.

Related: Practical Benefits of Therapy: How Therapy Can Transform Your Life

TMS Therapy for Bipolar Disorder

Transcranial magnetic stimulation (TMS therapy) is a non-invasive medical treatment that uses magnetic fields to stimulate targeted areas in the brain. TMS is considered safe and effective, with few side effects. The FDA has approved TMS for treating Major depressive disorder (MDD), obsessive-compulsive disorder (OCD), migraines, and smoking cessation. [6]

During the TMS treatment, a magnetic coil is applied to the patient’s scalp, and magnetic pulses are sent to targeted areas of the brain. The process is painless, and patients can return to their daily activities after treatment.

While TMS is primarily FDA-approved for the treatment of major depressive disorder (MDD), there have been several off-label uses explored, including the following: [7]

Anxiety disorders: TMS has been studied as a potential treatment for generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and panic disorder. Research is ongoing to determine its efficacy in these conditions.

Bipolar disorder: TMS has been explored as a potential treatment for bipolar disorder, particularly for the depressive episodes associated with the condition. Research is ongoing.

Schizophrenia: TMS has been investigated as an adjunctive treatment for schizophrenia, particularly for managing auditory hallucinations. Initial studies show promise, but additional research is needed 

Chronic pain: TMS has been studied as a potential treatment for chronic pain conditions, including fibromyalgia, neuropathic pain, and migraines. However, the evidence is still limited, and further research is necessary to determine its efficacy.

Parkinson’s Disease: There is evidence that TMS can improve reaction times in patients with Parkinson’s disease (PD), which suggests that TMS could be used to treat this condition.

Stroke rehabilitation: TMS has been explored as a tool for stroke rehabilitation to improve motor function and facilitate recovery. It has been investigated for hemiparesis and aphasia following a stroke. [7]

Side effects are usually mild, including headaches and scalp discomfort. If you are considering TMS therapy, you should discuss the potential risks and benefits with your healthcare provider.

If you have been diagnosed with bipolar disorder, call Neuro Wellness Spa today to discuss whether Transcranial Magnetic Stimulation (TMS) may be the right treatment option. We have conducted over 91,000 TMS sessions with a 75% response rate, making us one of the most experienced practitioners of TMS therapy. TMS is a safe, non-invasive treatment effective in treating depression and other mental health issues. Call Neuro Wellness Spa today to learn more.

Lifestyle Changes

The National Institute of Mental Health (NIMH) offers the following lifestyle change tips for coping with bipolar disorder:

• Work with your health provider or clinician to create a treatment plan that will work best for you and that you can stick to.
• Follow the treatment plan as directed and reach out and work with your health provider if you have any concerns or if the plan needs to be adjusted.
• Work to develop daily routines, such as eating, sleeping, and exercising at specific times.
• Engage in regular exercise and make sure it is an activity that raises your heart rate, like jogging, swimming, or bicycling. This type of exercise helps promote and improve sleep and supports your brain and body’s health.
• Keep a journal to track your feelings, activities, and general health and well-being to help better understand your mood fluctuations.
• Ask close family and friends for their support in sticking to your treatment schedule.
• Be patient with yourself, as it takes time to get better. [4]

Alternative Therapies

Many alternative therapies are being investigated as possible treatments for bipolar disorder. Two that show some promise include omega-3 fatty acids and probiotics. [10]

Omega-3 Fatty Acids:

Some evidence supports the use of Omega-3 fatty acids for use in several mental health disorders, including unipolar and bipolar depression, schizophrenia, anxiety disorders, OCD, and attention deficit hyperactivity disorder (ADHD), [5] and shows that omega-3s may improve depressive symptoms, but not manic symptoms [5] and may be considered along with other forms of treatment.

Probiotics:

While research is ongoing, some studies suggest a connection between the gut microbiome and some neuropsychiatric disorders, such as bipolar disorder, autism, anxiety, unipolar depression, schizophrenia, Alzheimer’s disease, and Parkinson’s disease. [1,8]

This preliminary evidence suggests that probiotics may improve symptoms of bipolar disorder, particularly mania, with few side effects. [1] Research has shown that probiotics positively impact the gut microbiome, which, in turn, enhances mood and reduces anxiety.

It is important to note that probiotics should not replace traditional medical treatments and should always be taken in consultation with a doctor.

Key Takeaways

• Treatment of bipolar disorder often involves a combination of medication, psychotherapy, and lifestyle changes. Traditional, alternative, and newer treatments such as Spravato and TMS are all possibilities worth exploring.
• All medications have the potential for side effects, and the choice of medication depends on the individual’s symptoms, medical history, and response to treatment.
• Working closely with a qualified healthcare professional to develop an individualized treatment plan that you stick to is crucial.
• Remember that there is no one-size-fits-all approach to treating bipolar disorder and just because one option has not worked, it doesn’t mean another one won’t.

Supporting and Treating Bipolar Disorder

If you or someone you know is struggling with bipolar disorder, don’t wait to get help. Contact Neuro Wellness Spa today for personalized treatment options and a caring team of professionals dedicated to helping you take control of your mental health. We offer comprehensive mental health treatment utilizing in-person and online psychiatry for medication management when necessary, talk therapy utilizing effective modalities for treating and managing bipolar disorder, and alternative treatments like TMS therapy which stimulates specific areas of the brain that have been impacted by bipolar disorder.

Don’t let the negative effects of mental health disorders such as bipolar disorder get in the way of living the life you deserve. Our passionate team of clinicians including psychiatrists, nurse practitioners, and therapists is always available to walk you through your treatment options. Call us today to schedule an assessment and start your journey toward mental well being.

References 

1. Ahmed, N., Husain, MM. (2023). Can probiotics reduce bipolar symptoms: A systematic review. https://doi.org/10.1016/j.pmip.2022.100098
2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
3. Baldessarini, R. J., Vázquez, G. H., & Tondo, L. (2020). Bipolar depression: a major unsolved challenge. International journal of bipolar disorders, 8(1), https://doi.org/10.1186/s40345-019-0160-1
4. (n.d.). Bipolar Disorder. National Insititute of Mental Health. https://www.nimh.nih.gov/health/topics/bipolar-disorder
5. Bozzatello, P., Brignolo, E., De Grandi, E., & Bellino, S. (2016). Supplementation with Omega-3 Fatty Acids in Psychiatric Disorders: A Review of Literature Data. Journal of clinical medicine, 5(8), 67. https://doi.org/10.3390/jcm5080067
6. Cohen, S. L., Bikson, M., Badran, B. W., & George, M. S. (2022). A visual and narrative timeline of US FDA milestones for Transcranial Magnetic Stimulation (TMS) devices. Brain stimulation, 15(1), 73–75. https://doi.org/10.1016/j.brs.2021.11.010
7. (n.d.). About TMS Therapy. Clinical TMS Society. https://www.clinicaltmssociety.org/patients
8. Lucidi, L., Pettorruso, M., Vellante, F., Di Carlo, F., Ceci, F., Santovito, M. C., Di Muzio, I., Fornaro, M., Ventriglio, A., Tomasetti, C., Valchera, A., Gentile, A., Kim, Y. K., Martinotti, G., Fraticelli, S., Di Giannantonio, M., & De Berardis, D. (2021). Gut Microbiota and Bipolar Disorder: An Overview on a Novel Biomarker for Diagnosis and Treatment. International journal of molecular sciences, 22(7), 3723. https://doi.org/10.3390/ijms22073723
9. Martinotti, G., Dell’Osso, B., Di Lorenzo, G., Maina, G., Bertolino, A., Clerici, M., Barlati, S., Rosso, G., Di Nicola, M., Marcatili, M., d’Andrea, G., Cavallotto, C., Chiappini, S., De Filippis, S., Nicolò, G., De Fazio, P., Andriola, I., Zanardi, R., Nucifora, D., Di Mauro, S., … REAL-ESK Study Group (2023). Treating bipolar depression with esketamine: Safety and effectiveness data from a naturalistic multicentric study on esketamine in bipolar versus unipolar treatment-resistant depression. Bipolar disorders, 25(3), 233–244. https://doi.org/10.1111/bdi.13296
10. Marzani, G., & Price Neff, A. (2021). Bipolar Disorders: Evaluation and Treatment. American family physician, 103(4), 227–239.
11. Novick, D. M., & Swartz, H. A. (2019). Evidence-Based Psychotherapies for Bipolar Disorder. Focus (American Psychiatric Publishing), 17(3), 238–248. https://doi.org/10.1176/appi.focus.20190004
12. Shah, N., Grover, S., & Rao, G. P. (2017). Clinical Practice Guidelines for Management of Bipolar Disorder. Indian journal of psychiatry, 59(Suppl 1), S51–S66. https://doi.org/10.4103/0019-5545.196974
13. Skriptshak, C., & Reich, A. (2021). Intranasal esketamine use in bipolar disorder: A case report. The mental health clinician, 11(4), 259–262. https://doi.org/10.9740/mhc.2021.07.259
14. Willner K, Vasan S, Abdijadid S. Atypical Antipsychotic Agents. [Updated 2022 Nov 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448156/