Navigating Bipolar Disorder: An Overview Of Bipolar Therapy And Treatment Options

Bipolar disorder (previously known as manic depression) impacts more than 2% of adults in the United States. This mental illness includes periods of extreme highs (called a manic or hypomanic episode) and lows (referred to as bipolar depression), and these mood shifts can make it difficult to function and complete responsibilities day-to-day. Although bipolar and related disorders can make life more challenging, many people can successfully control symptoms with a combination of psychotherapy and medication. Keep reading to learn more about bipolar disorder, including its types, symptoms, and causes. Then, explore some of the most effective treatment options. 

What is bipolar disorder?

Bipolar disorder is a mental health condition in which a person experiences unusual shifts in mood, activity levels, concentration, or energy. People with this disorder go through intense mood swings, experiencing extreme periods of feeling up (i.e., elated and energized) to feeling down (e.g., sad or hopeless). These periods are known as mania and depression, respectively. 

Types of bipolar disorder

There are three types of bipolar disorder that someone might experience. They are:

• Bipolar I disorder: This type consists of manic episodes that last seven days or longer or severe manic symptoms that require immediate medical attention. A person with this subset of the disorder often experiences depression as well.

• Bipolar II disorder: A person experiencing bipolar II disorder will experience a pattern of hypomanic episodes and depressive episodes. 

• Cyclothymic Disorder: This type of bipolar disorder occurs when someone experiences hypomanic and depressive symptoms that are not severe or long-lasting enough to qualify as a hypomanic episode or a depressive episode.

Symptoms

Warning signs and symptoms of bipolar disorder can vary based on whether a person is experiencing a period of mania or depression. Symptoms exhibited during a depressive episode can include:

• Trouble concentrating or remembering things

• Loss of interest in daily activities

• Feeling worthless, sad, or hopeless

Symptoms exhibited during a manic episode may include:

• Feeling extremely happy, energetic, or self-important

• Fast speech

• Irritability

• Making unwise or out-of-character decisions

Consider that each individual may have a unique experience when living with bipolar disorder. They may have different symptoms than those listed above. Moreover, the severity of symptoms can vary from person to person. 

Contributing factors

Several factors can 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 develop the condition. Some of these risk factors include: 

• Genetics

• Brain structure

• Drug or alcohol misuse

• High-stress situations

• Other mental health conditions

Traditional bipolar therapy and treatment options

Bipolar disorder requires lifelong treatment. A comprehensive bipolar treatment plan consists of therapy and medication to help manage disruptive symptoms. With treatment, those with this condition can go on to lead healthy, productive lives. Some forms of treatment could include: 

• Psychotherapy: Although medication is often vital in successfully treating bipolar disorder, psychotherapy can help. Specifically, psychotherapy can assist patients in develop coping skills, like how to successfully adhere to their prescribed medication regimen. This can be accomplished by teaching them more about the condition and how they can adapt their lifestyle to manage it. Psychotherapy can be performed by a psychiatrist and a psychiatric nurse practitioner.

• Cognitive behavioral therapy: CBT is designed to help people with mental health challenges modify negative behaviors and shape them into more productive thoughts and actions. One important aspect of CBT involves educating people about their condition and helping them identify the cognitive distortions that lead to their symptoms. With CBT, those with bipolar disorder can learn to recognize the negative thoughts associated with periods of mania or depression and find ways to change their thinking patterns. Therapists can also use CBT to teach their clients how to manage their sleep, stress, and anxiety.

• Dialectical behavior therapy: Dialectical behavior therapy is designed for individuals who experience intense emotions. Based on CBT, it’s a type of talk therapy that helps people manage and control their emotions. Research has shown that DBT can successfully decrease depressive and manic symptoms as well as improve emotional dysregulation.  

• Interpersonal and social rhythm therapy: IPSRT was created to support people with mood disorders such as bipolar disorder. This type of therapy consists of three different stages. During the initial stage (usually the first few sessions), the therapist learns about the patient’s current state and prior episodes, diving into the behaviors that occur during periods of mania and depression. The therapist and patient may also work together to select an interpersonal problem area that they can then work together to improve. 

During the intermediate stage, the patient may track and control their social rhythm and work with the therapist to learn how to manage changes in their rhythm more effectively. When a patient reaches the final stage, they can consult with their therapist to determine if therapy should be concluded or if sessions should occur less often.

• Family-focused therapy: Family-focused therapy can be provided to children and adults with bipolar disorder as well as their immediate family. Treatment typically takes place during 21 sessions spread over nine months. Unlike other therapy techniques, FFT does not usually help decrease manic or depressive symptoms. The goal of this type of therapy is to educate family members about coping responses, communication, and problem-solving skills. For example, FFT may help the patient and their family members better understand mood changes, which may help them recognize early warning signs of a hypomanic (depressive) episode. Recognizing the early signs of hypomania may increase the likelihood of getting help early on and therefore may prevent a full blown hypomanic episode. 

• Psychodynamic therapy: In psychodynamic therapy, patients dive into the psychological roots of their condition. Studies have shown that this technique can lead to lasting change, even after therapy sessions have ended. 

1. Group therapy: Group therapy for bipolar disorder is usually facilitated by a psychologist or trained peer mental health counselor. The focus of this therapy may depend on the dynamic of the group. Some groups may educate and teach coping skills, while others become a safe harbor for people with bipolar disorder to connect with others experiencing the same struggles. The National Alliance for Mental Illness and Bipolar Support Alliance both offer group therapy. If you don’t have a local in-person group, you can find dozens of online groups to join.

Alternative treatment options

Medicine and talking therapies are two key factors in treating bipolar disorder, but other treatment options may help in managing the condition. These include: 

Lifestyle changes

The Substance Abuse and Mental Health Services Administration recommends several lifestyle changes to help manage symptoms. These include: 

• Follow a consistent sleep schedule to help normalize sleep patterns by going to sleep and waking at the same time each day

• Adopt healthy eating habits to provide your body the nutrition it needs

• Consult your doctor before you take medications, whether prescribed or over the counter

• Avoid alcohol and drug use and seek help if you have a substance use problem

• Keep a mood journal to track how you feel each day and note any triggers or changes in your experience

• Exercise regularly to help improve your mood

• Maintain a supportive network of family and friends

Electroconvulsive therapy

During ECT, patients are put under anesthesia and receive brief electrical currents to their scalp to cause short, controlled seizures. These seizures may help modify brain pathways and improve symptoms in those living with bipolar disorder. 

Complementary and alternative medicine

Research is still looking into the efficacy of complementary and alternative medicine in treating mood disorders. Current studies have shown promising support for light therapy, St. John’s wort, and omega-3 fatty acids. If you’re interested in exploring other treatments or alternative medicine treatments for bipolar disorder, you can speak to your doctor about how to combine these options with more traditional treatments like medication and therapy. 

Challenges of bipolar disorder treatment

Undergoing treatment for bipolar disorder may include a few obstacles along the way. Knowing what to expect can help prepare you for these challenges, so you can navigate them more easily. 

Misdiagnosis

A health care professional will make a 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 comprehensive, it is possible for people with bipolar disorder to be misdiagnosed. This is because people with bipolar disorder can experience up to three times 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 can delay the start of appropriate treatment.

Difficulty in finding the right treatment approach

Mental health professionals use a trial-and-error approach in order to develop the most effective treatment plan for each patient. Certain bipolar disorder medications may exacerbate symptoms or do nothing to improve them. In addition, medicine can take weeks or months to take effect. As a result, it can take six months or longer to settle on a mood-stabilizing medication that meets your specific needs. Moreover, your dosage may need to be adjusted as your symptoms change or you experience physical changes such as weight loss or pregnancy, for example. 

Finding the right psychotherapy approach may also take time. When looking for a therapist, you might want to find a therapist who specializes in bipolar disorder and follows an approach that suits your individual needs.

Importance of ongoing monitoring and adjustment

Bipolar disorder is a lifelong condition, and as such, it can be vital for people with this diagnosis to adhere to their treatment plan. When treatment is followed, individuals can more effectively avoid the extreme mood shifts associated with bipolar disorder. As a result, they may experience fuller and more productive lives. 

Online bipolar disorder treatment

While people with bipolar disorder can benefit from psychotherapy, symptoms can make it difficult to adhere to a therapy plan. During depressive episodes, a person may be unwilling or unable to leave their home to meet with a therapist. During a manic episode, they may not acknowledge that they even have a mood disorder since they feel so great.

Online therapy can mitigate these barriers by making treatment available anywhere at any time. Individuals can participate in a therapy session from their bed or couch, wherever is most comfortable. In addition, with platforms like BetterHelp, they’re able to send a message to their therapist at any time of the day. Online therapy can make it easier and more convenient for those with mood disorders to get the support and care they need without lengthy wait times. 

The efficacy of online therapy for bipolar disorder

Research has shown that online therapy can be effective in reducing symptoms of mood disorders. A study published in 2023 confirmed that those participating in internet-based cognitive behavior therapy saw significant reductions in their symptoms of bipolar disorder. This held true for all participants, whether they were taking medication or not.