Bipolar Disorder Therapy And Treatment Options For Mental Health

Bipolar disorder (previously known as “manic depression”) is estimated to impact approximately 4% of US adults. This mental illness typically involves periods of extreme highs (called manic or hypomanic episodes) and, in some cases, extreme lows (called depressive episodes). These mood shifts can make it difficult to function and fulfill daily responsibilities. 

Although bipolar disorder (BD) is a lifelong condition, effective management strategies are available, often including medication, therapy with an in-person or online therapist, and positive lifestyle changes.

What is bipolar disorder?

Bipolar disorder is a mental health condition in the category of affective disorders, which cause persistent disturbances to a person’s emotional state. An individual with bipolar disorder may experience unusual shifts in mood, activity levels, concentration, or energy, often beginning in early adulthood and persisting throughout their life.

One way these shifts may manifest is through intense mood swings, such as extreme periods of feeling up (i.e., elated and energized) and then, in some cases, feeling down (i.e., sad and hopeless). These periods are known as mood episodes of mania and depression, respectively, which may be triggered by factors like lack of sleep and stressful life events. 

Types of bipolar disorder

There are three main types of bipolar disorder, each of which can cause disruptions to one’s life and daily functioning:

• Bipolar I disorder. To be diagnosed with bipolar I disorder, a person must experience at least one manic episode that lasts seven days or longer or severe manic symptoms that require immediate medical attention. A person with this subtype may experience depressive episodes as well, though they’re not required for diagnosis. 
• Bipolar II disorder: A person with bipolar II disorder will usually experience a pattern of hypomanic episodes and depressive episodes. They do not experience full manic episodes. 
• Cyclothymic disorder: This type of bipolar disorder involves hypomanic and depressive symptoms that are not severe or long-lasting enough to qualify as a true hypomanic episode or a depressive episode.

Possible symptoms of bipolar disorder episodes

In order to understand the symptoms of bipolar disorder, it may help to review terminology related to mood episodes, which are a key feature of each type. Manic episodes, hypomanic episodes, depressive episodes, mixed features, and/or psychosis may affect a person with this type of illness.

Manic episodes

A manic episode is “a period characterized by elevated, expansive, or irritable mood.” Examples of symptoms that may occur during a manic episode include:

• Increased talkativeness
• Racing thoughts
• A decreased need for sleep
• Inflated self-esteem
• An increased likelihood of engaging in risky behaviors

Acute mania symptoms must last at least a week in order to qualify as a full manic episode.

Hypomanic episodes

Hypomanic episodes can produce the same types of symptoms as manic episodes, but they’re less severe and last for a shorter duration—though they can still be serious and disruptive to daily life. To meet the criteria for a hypomanic episode, symptoms must last four consecutive days. 

Depressive episodes

Depressive episodes are periods during which a person with bipolar disorder experiences symptoms associated with depression, like:

• Low mood
• Fatigue
• A sense of worthlessness or hopelessness
• Trouble concentrating or remembering things
• Loss of interest in activities once enjoyed
• Thoughts of self-harm or suicide

Episodes with mixed features

“Mixed features” is a clinical term that refers to the experience of symptoms related to both manic and depressive episodes at the same time. A person may be experiencing mixed features if they’re in a manic or depressive episode and also have at least three core symptoms associated with the opposite type of mood episode.

Psychosis

Finally, it may also be possible for a person to experience psychosis as a result of bipolar disorder. Psychosis refers to a loss of touch with reality and may manifest as hallucinations and/or delusions in individuals with BD. General psychiatry research suggests that around half of individuals with BD will experience psychotic symptoms in their lifetime, which may require stabilization at an in-person treatment setting such as a hospital.

What causes bipolar disorder?

Several factors may increase an individual’s chance of developing bipolar disorder. Still, just because someone has one or more of these contributing factors does not mean they will necessarily develop the condition. Some of these risk factors include: 

• Genetics, especially a family history of BD
• Substance misuse
• A history of high-stress situations or trauma
• Already living with other mental health conditions

An article published in the Journal of Biological Psychiatry suggests that differences in brain structure may also play a role in the development of bipolar disorder.

Addressing symptoms: acute treatment vs. long-term management

Acute treatment for bipolar disorder symptoms

For someone experiencing acute symptoms like severe mania, psychosis, self-harm, or suicidal behaviour associated with a depressive episode, acute treatment is often required for stabilization. This process may involve inpatient care like hospitalization, while it may be possible to address other serious but less acute symptoms with outpatient care and management. If you experience warning signs of severe symptoms, seeking immediate in-person medical care can be important.

Long-term management of bipolar disorder symptoms

After a good response to the stabilization of acute symptoms, relapse-prevention planning is common. It’s a form of long-term management of bipolar disorder and often involves:

• Monitoring your daily moods
• Watching for any symptoms that may indicate an impending mood episode
• Making an action plan ahead of time for when you start noticing mood episode symptoms
• Outlining daily self-care activities that may help prevent a relapse

In addition to creating and following this type of plan, a person with bipolar disorder may work closely with their psychiatrist or doctor over time to follow a treatment regimen that works for them. Talk therapy, medication, and self-care are usually part of long-term clinical psychopharmacology strategies for symptom management. Keep in mind that the most effective treatment plan is often one that’s re-evaluated and adjusted with a medical professional as needed over time.

Medication for long-term bipolar disorder treatment

The American Psychiatric Association identifies medication as a cornerstone of bipolar disorder treatment. Mood stabilizers are usually the first-line agent for this condition. However, different classes of medications (such as atypical antipsychotics, antidepressants, anti-anxiety medications, and other agents) may also be prescribed in some cases depending on the person's symptoms, symptom severity, and whether they are experiencing any comorbid mental disorders. 

To avoid potentially dangerous complications associated with interactions of pharmacological agents, always consult with your doctor or psychiatrist before starting, stopping, or changing any prescription medication, over-the-counter medication, or supplement. A qualified healthcare professional may:

• Discuss with you the efficacy, potential side effects (e.g., weight gain, headaches, etc.), and treatment duration of a specific medication
• Closely monitor how you respond to a new medication to potentially reduce the risk of tardive dyskinesia or other complications, especially at high doses
• Stress the importance of medication for safety and effective symptom management

Practical tips to improve medication adherence

Medication adherence may help improve outcomes in individuals with bipolar disorder. According to a multiple treatments meta-analysis, non-adherence may put patients at increased risk of “exacerbations of psychosis and relapse resulting in hospital visits and admission.” Tools and strategies that may help improve medication adherence include:

• Therapy interventions (such as cognitive behavioral therapy or motivational interviewing)
• Psychoeducation (through therapy, books, or different classes)
• Family-based interventions
• Reminders and routines

Therapy options for long-term bipolar disorder treatment

Talk therapy is usually another core part of bipolar disorder treatment over the longer term. According to the American Journal of Psychiatry, talk therapy approaches for this condition tend to involve psychoeducation, skills training, and other components. Ongoing adjunctive psychotherapy for bipolar disorder may be performed by a psychiatrist, psychiatric nurse practitioner, therapist, counselor, or social worker and can often be done online or in person. 

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) is designed to help people with mental health challenges modify negative thoughts and behaviors and shape them into more productive ones. Cognitive behavioral therapy for bipolar disorder often involves educating the individual about their condition and helping them identify cognitive distortions that may exacerbate their symptoms.

Dialectical behavior therapy

Dialectical behavior therapy (DBT) is a type of CBT intended to help individuals learn to manage strong emotions using mindfulness and interpersonal skills. A 2023 systematic review suggests that DBT may help decrease both depressive and manic symptoms and improve emotional regulation in individuals with bipolar disorder.

Interpersonal and social rhythm therapy 

Interpersonal and social rhythm therapy (IPSRT) is another one of the possible psychosocial interventions for bipolar disorder. It focuses on “on the bidirectional relationship between mood and life events,” with an emphasis on techniques for improving social support and interpersonal relationships. This type of therapy consists of three stages that are intended to take place over 20 weeks: 

1. The initial stage, which involves the provider learning more about the client's current state, prior episodes, and key symptoms. The client may also identify an interpersonal problem area that they want to work on improving.
2. The intermediate stage, which involves the client tracking their daily rhythms and learning to regulate them in order to reduce functional impairment and address the interpersonal problem area they chose. This phase may also focus on building confidence and learning to effectively manage changes to routine. 
3. The final stage, which involves wrapping up the treatment and working on relapse-prevention planning.

Family-focused therapy

Family-focused therapy (FFT) can be provided to children and adults with bipolar disorder as well as their immediate family. Treatment involves 21 sessions spread over nine months. Unlike some other therapy techniques, FFT doesn’t usually focus on addressing manic or depressive symptoms. Instead, this type of therapy aims to educate family members on coping responses, communication, and problem-solving skills. 

For example, FFT may help individuals and their family members better understand mood changes, which may help them recognize early warning signs of a manic, hypomanic, or depressive episode. Recognizing the early signs may increase the likelihood of getting help early on and preventing a full-blown episode. 

Group therapy

Group therapy for bipolar disorder is usually facilitated by a trained mental health professional and may involve teaching positive strategies for managing and preventing symptoms. This type of therapy often uses similar approaches to individual treatment, like CBT or DBT, but in a group setting where individuals can benefit from sharing experiences and insights with others. 

Consult a professional for bipolar therapy and treatment options

The BetterHelp platform is not intended to provide any information regarding which medication or medical treatment may be appropriate for you. The content provides generalized information that is not specific to one individual. You should not take any action without consulting a qualified medical professional.

Supplemental treatment options for bipolar disorder

Again, medication and therapy may be considered the core components of treatment for bipolar disorder. However, a healthcare provider may recommend other approaches in addition to these.  

Lifestyle changes

The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends several lifestyle changes to help individuals living with bipolar disorder manage their symptoms, including: 

• Get enough sleep each night
• Eat nutrient-dense meals as often as possible
• Consult your doctor before you take any medications, whether prescribed or over-the-counter
• Take medications as prescribed and directed by your healthcare provider
• Avoid alcohol and substance use and seek help if you’re experiencing challenges with substance use
• Keep a mood journal to track feelings and symptoms
• Exercise regularly to help improve your mood
• Maintain a supportive network of family and friends
• Implement stress management techniques to help prevent future episodes of mania or depression
• Recognize early warning signs of relapse and follow a relapse-prevention plan

An in-person or online therapist can support you in planning healthy routines that may help preserve your mental well-being.

Alternative treatments

Clinical psychiatry researchers continue to explore the possibility of using complementary and alternative medicine approaches to help individuals manage bipolar disorder symptoms. Some examples include:

• Electroconvulsive therapy (ECT), which an Indian Journal of Psychiatry study suggests may promote a positive response in some patients. It involves the individual being put under anesthesia and receiving brief electrical currents to their scalp to cause short, controlled seizures. These seizures may modify brain pathways and improve symptoms in those living with bipolar disorder. 
• Light therapy, where bright lights or tinted glasses are used to help a person regulate their circadian rhythm to potentially reduce symptoms
• Relaxation techniques such as mindfulness meditation, yoga, or acupuncture, which may help reduce stress and potentially decrease the likelihood of mood episodes

Challenges of bipolar disorder treatment

In some cases, challenges may arise throughout the course of bipolar disorder treatment. Becoming aware of these may help individuals and their families prepare for the journey toward finding a treatment plan that works for them.

Misdiagnosis

A healthcare professional will usually make a BD diagnosis based on a physical exam, medical testing to rule out possible illnesses, and a mental health evaluation. While the diagnostic process for bipolar disorder is usually comprehensive, it is possible for people with bipolar disorder to be misdiagnosed. For example, an individual might experience more depressive episodes than they do manic episodes and may only seek help when experiencing a depressive episode. As a result, they may be misdiagnosed with major depression, which could delay the start of appropriate treatment.

Trial and error in finding the right bipolar disorder treatment approach

Each individual is different, and the way they respond to various treatments can be different too. That’s why mental health professionals may need to use a trial-and-error approach to figuring out the best treatment plan for each individual. For example, some BD medications may not meaningfully improve a given person’s symptoms, leading their doctor to prescribe a different dosage or another medication altogether. This process may take time.

The need for ongoing monitoring and adjustment

Bipolar disorder is a lifelong condition, and a person’s symptoms and life circumstances may evolve somewhat over time. That’s why ongoing monitoring of one’s treatment plan can be important. If a medication starts producing undesirable side effects, for example, a person’s doctor may need to adjust the dosage or type. Keeping up with long-term monitoring and adjustment can be key for individuals living with BD.

Resources for individuals with bipolar disorder and their families

In addition to working with a healthcare provider on a tailored treatment plan, there are other avenues of support for individuals with bipolar disorder and their families. You can find more information through resources like:

• The World Health Organization (WHO)
• The National Alliance on Mental Illness (NAMI)
• The International Bipolar Foundation (IBPF)
• Mental Health America (MHA)

If you get stuck on “verification successful; waiting” or “ray ID” messages when trying to access online resources, consider refreshing the page, trying another browser, or contacting site support.

Online therapy for ongoing support

Ongoing talk therapy treatment is often a part of the long-term management of bipolar disorder, but commuting to and from in-person appointments is not always possible. Whether an individual has a busy schedule or few providers in their area, they might find the option of attending therapy online to be more convenient.

With an online platform like BetterHelp, you can get matched with a therapist according to your needs and preferences, making the process of finding a therapist simpler. Then, you can meet with your provider virtually via phone call, video call, or live chat from your smartphone, computer, or tablet. The convenience of this format might make it easier to adhere to long-term psychotherapy treatment, and virtual therapy also tends to be more affordable than in-person care without insurance.

Can online therapy help with bipolar disorder symptoms?

It can be important to talk to your doctor or psychiatrist about their treatment recommendations, but online therapy may be an effective component of the treatment plan for some individuals with bipolar disorder. For example, a 2023 study suggests that online CBT may be effective in addressing symptoms of depressive episodes in individuals with bipolar disorder.