How To Treat Bipolar Disorder: Four Steps To Promoting Long-Term Recovery

Occasional mood swings can be an expected part of daily life. Depending on the day, your personality, or how much you’ve slept, you may be tired and “down” one day and excited and “upbeat” the next. However, if your moods and emotions fluctuate on a consistent long-term basis, seem excessive and unpredictable, and affect your ability to function, you may be experiencing a mental health condition like bipolar disorder. 

Previously called manic depression, bipolar disorder is a mental illness characterized by extreme mood swings and significant shifts in energy, activity levels, and concentration. Left untreated, this condition may prevent you from fully engaging in daily tasks and relationships. However, psychologists have deepened their understanding of the symptoms and treatment of bipolar disorder, which is divided into three types. Many people living with symptoms of this mental health condition ask, How do you treat bipolar disorder?

To understand the treatment options for bipolar disorder, looking at the three main types of this condition can be helpful. Note that the information below does not replace a medical diagnosis or treatment plan. You can work with your doctor or therapist to determine the underlying cause of your mood swings, confirm the diagnosis, and create a personalized treatment plan.

The three types of bipolar disorder

While bipolar disorder is divided into three subtypes, all diagnoses involve significant changes in mood, energy, and activity levels. Individuals diagnosed with this condition may also experience periods of more neutral moods. With proactive treatment, this condition is often treatable. Below are further explanations of the three most common subtypes of bipolar disorder that can be diagnosed. 

Bipolar I disorder

According to the American Psychiatric Association (APA), bipolar I disorder is diagnosed when someone experiences at least one manic episode, a period of an elevated, expansive, or irritable mood. During a manic episode, a person may experience increased activity, energy, talkativeness, racing thoughts, self-esteem, and other intense emotions. They may also experience paranoia, psychosis, and severe delusions. 

People with bipolar I disorder may experience depressive or hypomanic episodes. Hypomanic episodes involve less severe manic symptoms that last four days or less, whereas manic episodes last at least a week. During hypomanic periods, people may be more energized. However, the shift may not be as severe as mania and is not associated with severe delusions, psychosis, or paranoia like mania can be. Some people who experience mania may be hospitalized for a manic episode due to the severity of this symptom. 

Bipolar II disorder

A person diagnosed with bipolar II disorder must have at least one major depressive episode and one hypomanic episode. Unlike bipolar I disorder, people diagnosed with bipolar II disorder have not experienced a full manic episode.

People commonly receive this diagnosis after their first depressive episode since hypomanic episodes may not affect daily functioning and can be pleasurable, as they tend to increase energy levels and perceived productivity. However, note that hypomania is still a serious symptom and can negatively impact one’s life—it is not “fun,” “quirky,” or “cool.” Bipolar II disorder can be as serious as bipolar I disorder and often requires treatment. 

The depressive symptoms of bipolar II disorder are often worse than those of bipolar I disorder. These symptoms may lead to severe, prolonged depressed moods, a lack of ability to care for oneself, and suicidal thoughts. 

If you are experiencing suicidal thoughts or urges, call the 988 Suicide & Crisis Lifeline at 988 or text 988 to talk to a crisis provider over SMS. They are available 24/7 to offer support. 988 also offers an online chat for those with an internet connection.

Cyclothymic disorder

Cyclothymic disorder is a milder form of bipolar disorder. According to the APA, this disorder is defined by mood swings, hypomania, and depressive symptoms that occur over at least two years. Among people with this subtype of bipolar disorder, also called cyclothymia, the hypomanic and depressive symptoms do not meet the diagnostic criteria for a major depressive or hypomanic episode.

How do you treat bipolar disorder? Four common steps

Because bipolar disorder typically persists for the duration of an individual’s adult life, long-term treatment is usually necessary. If you suspect that you are experiencing bipolar disorder, it can be essential to meet with a licensed physician for a thorough examination and diagnosis. 

In addition to gathering your medical history, a doctor may perform a physical exam and request blood tests to rule out other conditions that could be causing your symptoms. Your doctor may also order a mental health evaluation to confirm the diagnosis of bipolar disorder or other health conditions using the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). 

With a complete diagnosis, your provider may craft a treatment plan tailored to your needs, symptoms, and goals. Treatment for bipolar disorder can vary depending on the mood episodes an individual experiences, as well as the pattern of their symptoms. For example, the treatment plan for someone who experiences rapid cycling, in which four or more mood episodes occur during a one-year period, may involve a mood stabilizer, antipsychotic, and psychotherapy. While doctors commonly suggest the following four steps, consult your physician before introducing treatments or lifestyle changes.

Make healthy lifestyle changes

A balanced diet and regular exercise may help you manage the symptoms of health conditions, including bipolar disorder and related disorders. For people with this condition, it can be important to eat regular meals to avoid sudden drops in blood sugar, which can negatively affect your mood. Incorporate fresh fruits, vegetables, whole grains, and other wholesome foods that stabilize your blood sugar and energy levels.

Some research suggests that omega-3 fatty acids play a role in managing the symptoms of major depression, schizophrenia, obsessive-compulsive disorder (OCD), bipolar disorder, and other mood disorders. To increase your daily dose of omega-3, focus on eating more fish, walnuts, and seeds, and ask your doctor about omega-3 supplements. 

Beyond your plate, you can make efforts to stay active and find a type of exercise you enjoy and can commit to consistently. Other self-management strategies—like getting plenty of sleep and practicing stress-management techniques—may also be incorporated into a lifelong treatment plan for bipolar disorder. In cases of bipolar disorder, regular exercise may improve mood and reduce the number of mood swings you experience. 

Consider medication

Depending on the severity of your symptoms, your doctor may prescribe medications. For clients with bipolar disorder, medications called mood stabilizers may be used to reduce mood swings and improve emotional well-being. Lithium is a commonly prescribed mood stabilizer that is considered most effective for symptoms of a manic or hypomanic episode, though it can also alleviate depression. Valproic acid, an anticonvulsant, is another widely utilized mood-stabilizing medication. Other medications frequently used during treatment for bipolar mania include carbamazepine, lamotrigine, and divalproex sodium. Side effects of these prescription drugs can include weight gain, gastrointestinal distress, and fatigue.

Certain medications are used to control symptoms of psychosis that may arise during a manic or depressive episode. Medications prescribed for psychotic symptoms include quetiapine, risperidone, and clozapine. Antidepressants may also be prescribed in some cases. However, because antidepressants can cause or exacerbate manic symptoms, they are often used alongside other drugs (e.g., mood stabilizers) or avoided altogether.  

Only certain mental health professionals prescribe medication, including psychiatrists, psychologists, and psychiatric nurse practitioners. In addition, consult a physician before starting, changing, or stopping any medication for bipolar disorder.

In some cases, complementary therapies, such as electroconvulsive therapy (ECT), are recommended when people with bipolar disorder do not respond to medication or psychotherapy. ECT is delivered in several rounds and involves applying a brief electrical current to a person’s scalp while under anesthesia. This treatment results in a short, controlled seizure, which is believed to remodel the brain signaling pathways and improve the emotional symptoms of bipolar disorder. Other treatments that involve brain stimulation, including transcranial magnetic stimulation and magnetic seizure therapy, have also been used to treat bipolar disorder. 

Practice self-care strategies

Regardless of your diagnosis, self-care can be essential to lifelong mental health. If you’re living with bipolar disorder, your self-care routine may include activities or rituals that stabilize your mood, help you manage stress, and bring you peace and calm.

Some common self-care activities include: 

• Going on a walk with a friend

• Meditation or yoga

• Deep breathing exercises

• Reading a book

• Listening to music

• Calling a loved one

• Scheduling coffee with a co-worker

Self-care can include both solitary activities and social outings with acquaintances and loved ones. When you live with bipolar disorder, it may help to balance solitary time with social support and prioritize spending time with people who know and care about you. 

In addition to casual check-ins with friends, consider joining a bipolar disorder support group, which you may be able to find in your local community or online. 

Schedule therapy 

For some people with bipolar disorder, talk therapy is a foundational tool. A licensed therapist can help them learn more about their diagnosis, develop coping skills, adhere to a medication schedule, and identify any emotional or physical factors that may worsen mood swings and other symptoms. Common therapeutic modalities for bipolar disorder include cognitive behavioral therapy, interpersonal and social rhythm therapy, and family-focused therapy.  

In a digital era, more people may use online therapy through platforms like BetterHelp, which can offer more flexibility than traditional modes of therapy. Using an online platform, you can match with a licensed therapist within 48 hours and schedule your first session. Some BetterHelp therapists specialize in working with people with bipolar disorder and related conditions, and they’ll listen to your concerns with compassion and expertise. 

Several studies show that online therapy can be as effective as face-to-face sessions. One 2019 study found that an online, mindfulness-based psychotherapy was effective for treating people with “late stage” bipolar disorder who have experienced numerous bipolar disorder episodes. Participants in the online program reported significant increases in their quality of life, which can be a crucial concern among people with severe bipolar disorder. The researchers concluded that online mindfulness therapy is an effective, feasible, and hopeful treatment option.