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Your top 10 questions about treatment for bipolar disorder
A mental-illness diagnosis can be scary, but you don’t have to let it overrun your life. We asked the experts about medication, therapy and other treatment strategies for living with bipolar.
People with bipolar disorder experience changes in mood, activity and energy levels. They might also find it difficult to think clearly. The National Alliance on Mental Illness says that life with untreated bipolar disorder can seem “like riding a rollercoaster that feels never-ending.”
That might sound terrifying, but don’t panic. With proper treatment, you can flatten the track and restore some normalcy to your life.
If you have been diagnosed with bipolar disorder, it means you have experienced at least 1 episode of mania. This is a highly energized state, where you feel less need for sleep and you may feel especially good or “on top of the world.” You could also be irritable, and you might catch yourself making poor decisions. Some patients with bipolar experience only a mild form of mania, called hypomania.
Depending on the type of bipolar disorder you have, you might also experience periods of depression. That’s why bipolar disorder used to be called manic-depressive illness or manic depression.
Without treatment, bipolar disorder will often get worse. But it doesn’t have to. “With the proper treatment, many people live full, productive lives with bipolar disorder,” says Holly A. Swartz, MD. She’s a professor of psychiatry at the University of Pittsburgh School of Medicine. Dr. Swartz is also the editor in chief of the American Journal of Psychotherapy. (If paying for medication is getting in the way of your treatment, Optum Perks can help. Get our discount card now.)
If you’ve just been diagnosed with bipolar disorder, you likely have questions. We have answers. Here’s what you need to know.
1. What are the most common medications used for bipolar disorder?
Medications called mood stabilizers are used to treat bipolar disorder. They work by helping to balance the highs and lows of the disease. The most common mood stabilizer is lithium (Eskalith®, Lithobid®), which has the added benefit of being able to reduce suicidal thoughts.
Doctors aren’t exactly sure how lithium helps bipolar disorder, Dr. Swartz says. But it may affect the messages sent from cell to cell in the brain. Lithium is usually taken 1 to 3 times a day.
Other medications that act as mood stabilizers include (click each drug name to access coupons instantly):
These are all anticonvulsant medications, meaning they are also used to treat seizure disorders. Valproic acid and carbamazepine both help prevent mania and depression. Lamotrigine, on the other hand, is more effective at preventing depressive episodes than mania, Dr. Swartz says.
Atypical antipsychotics are another class of medications for bipolar disorder. Examples include:
Antipsychotics can help people sleep, especially during manic episodes, says Aarti Mehta, MD, a psychiatrist in Chicago and diplomate of the American Board of Psychiatry and Neurology.
2. How quickly do bipolar medications take effect?
That depends on which phase of the illness a patient is in, says Dr. Swartz. Medication tends to work quicker on people in a manic or “up” episode. In that case, “we may see the effect of mood stabilizers or antipsychotics within 1 to 2 weeks.” For people in a depressive phase, it may take a little longer. Maybe a month or more, says Dr. Swartz.
She also points out that if a person is experiencing mania, it’s considered a psychiatric emergency. An individual with bipolar disorder will usually need to be cared for in a hospital or carefully monitored by a doctor.
As the medication takes effect, bipolar disorder will generally become easier to manage. “People usually say, ‘I’m still having ups and downs, but they’re not as high and low as before,’” Dr. Mehta says. “And then the highs and lows become further and further apart.”
3. Are there side effects to bipolar medication?
There can be. But the side effects vary from 1 medication to another. Lithium, for instance, may cause a metallic taste in the mouth and possibly worsening acne in patients with bipolar disorder who already had the skin condition.
More critically, lithium can affect your kidneys and thyroid. Therefore, lithium requires regular blood tests to make sure your medication levels are correct and to monitor your kidney function and thyroid function.
Lithium is also very sensitive to water intake. “If you get dehydrated, your lithium level goes up,” says Dr. Mehta. “But drink too much water and your lithium level goes down.” Your doctor can help you determine the right amount of water to drink.
The potential side effects of antipsychotics differ from those of lithium. Antipsychotics can cause weight gain, increase cholesterol levels and make you more likely to develop diabetes. Doctors avoid the worst problems by starting patients with bipolar disorder at a very low dose. But you may still experience other side effects. Some people “may feel foggy, disconnected, or have trouble with word-finding,” says Dr. Mehta.
4. Can women who are pregnant or plan to become pregnant take these medications?
This is an important question, considering that half of all patients with bipolar disorder are women. Dr. Mehta says lithium and lamotrigine can be used during pregnancy. But your doctor will need to monitor your blood levels more frequently than before pregnancy. In high doses, lithium and lamotrigine may cause birth defects in a developing fetus.
Your doctor will talk with you about possible risks to the fetus. These need to be considered alongside the risks to you if you stop taking your medication. Overall, Dr. Mehta says, the risks are relatively low, and the benefit of medication “can be so great for some patients with bipolar disorder that it may be worth that risk.”
Atypical antipsychotics should not be used in pregnancy, because of their tendency to cause birth defects. Certain anticonvulsant medications should also not be taken by pregnant women because of the potential risks the fetus.
5. Are most bipolar medications affordable?
Lithium is very inexpensive, usually pennies per pill. Generic lamotrigine and some generic atypical antipsychotics are also relatively affordable, perhaps $15 to $30 per month, Dr. Swartz says.
The newer antipsychotics are much more expensive. They are not available generically, and they tend to cost hundreds of dollars per month unless covered by insurance.
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6. Is medication always required?
With mania, yes, medication is almost always needed. It may also be needed with hypomania. For the depression related to bipolar disorder, doctors usually recommend a combination of medication and therapy.
We have answers to all your depression questions, too. Click this link to learn more.
7. How can a therapist help?
Talk therapy, sometimes called psychotherapy, can teach coping strategies and offer patients a chance to discuss their concerns. It can help you recognize the signs and symptoms of an impending manic or depressive episode. Therapy can also help you understand your relationships with friends and family.
The following types of therapy may be particularly helpful with bipolar disorder:
- Cognitive behavioral therapy (CBT)
With CBT, the focus is on changing negative or harmful thought patterns and behaviors. You may also learn strategies for getting the proper amount of sleep. Too much sleep can trigger depressive episodes, but too little can trigger mania. CBT can also help with stress management. That’s important, as stress can trigger bipolar disorder, Dr. Mehta says.
- Interpersonal and social rhythms therapy (IPSRT)
The goal with this therapy is to help you develop healthy daily routines, such as waking up, going to bed, and eating at the same times every day. The more regular your schedule, the more likely it is that you will be able to successfully manage bipolar disorder, Dr. Swartz says.
In addition to therapy, you may also want to try a support group. The Depression and Bipolar Support Alliance can help connect you with people near you.
8. What is ECT?
ECT stands for electroconvulsive therapy. It is a serious medical procedure that can be highly effective in people who have suicidal thoughts, especially when medication isn’t working.
With ECT, an electric current passes through the brain, leading to a seizure. It’s not painful since the patient is under anesthesia. “The shock to your system resets the way the [brain cells] are firing,” Dr. Mehta explains. “It is very effective. You could feel improvements after 1 treatment.”
The average person may need 6 to 12 treatments over the course of a few weeks. But some people may only need 1, while others require “booster” treatments every few years.
9. What else can I do to help improve my symptoms?
Exercise has been shown to help improve both sleep quality and symptoms of depression. It can also help to keep a log of your sleep and mood when dealing with major life events, such as starting or losing a job, losing a loved one or getting married.
These types of life events are useful information to share with your doctor or therapist. They may be able to identify patterns that you miss. And they can incorporate that information into your treatment plan.
10. Will I have bipolar disorder forever?
Bipolar disorder is a lifelong condition. But Dr. Swartz says that you can think of it as a manageable chronic illness, similar to diabetes. With treatment, you may have long periods of time with no symptoms.
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Overview of bipolar disorder: National Institute of Mental Health
Lithium background: National Alliance on Mental Illness
Lithium during pregnancy: International Journal of Bipolar Disorder. (2018.) “Lithium during pregnancy and after delivery: a review”
Electroconvulsive therapy (ECT): National Institute of Mental Health