Bipolar disorder affects millions worldwide, with recent data from the National Mental Health Survey showing a lifetime prevalence of 0.7% and a consistent treatment gap of 70% in India. If you have bipolar disorder, your mood issues may range from fairly mild to very disruptive. The good news is there are many effective treatments for bipolar disorder. A treatment regimen often includes both therapy and medication. Lifestyle changes and support from loved ones can also help recovery.
Bipolar disorder is characterized by a spectrum of mood states, and alterations in biological rhythms, including sleep phase, structure, and duration are consistently reported throughout all illness states. These disruptions in biological rhythms and sleep are associated with various clinical outcomes, including lower quality of life, increased risk of suicide attempts, impaired cognitive functioning, and higher relapse rates of mood episodes.
Table of Contents
- Psychotherapy for Bipolar Disorder
- Medication for Bipolar Disorder
- Hospitalization for Bipolar Disorder
- Self-Help for Bipolar Disorder
- Supporting Loved Ones with Bipolar Disorder
- Frequently Asked Questions
- Find a Therapist
Psychotherapy for Bipolar Disorder
While bipolar disorder cannot be cured, it can be managed effectively. Psychotherapy can help you understand your condition so you can manage it better. A therapist may also help you develop strategies to reduce emotional distress.
Evidence-Based Therapy Options
According to the 2023 CANMAT/ISBD guidelines, psychotherapy is recommended as an adjunctive treatment to medications for bipolar disorder, with cognitive-behavioral therapy (CBT), family-focused therapy, and interpersonal and social rhythm therapy showing particular efficacy.
Cognitive-Behavioral Therapy (CBT)
Research shows that CBT plus medication is more effective in treating patients with bipolar disorder than medication alone. Treatment durations of 90 minutes or more per session were found to be much more effective than shorter durations, as CBT relies on a strong collaborative relationship between therapists and patients that is strengthened by longer treatment duration.
Dialectical Behavior Therapy (DBT)
DBT, originally developed for borderline personality disorder, may target several common symptoms of bipolar disorder including emotion dysregulation. In a 12-week DBT group skills training program, participants showed skill acquisition in mindfulness, emotion regulation, and distress tolerance, as well as improved psychological well-being and decreased emotion reactivity.
Therapy Goals and Strategies
In therapy, you may work on goals such as:
- Educating yourself about bipolar disorder and letting go of harmful or untrue beliefs
- Spotting signs of oncoming mood episodes and learning how to counteract them
- Improving relationships that may have been affected by bipolar disorder
- Re-entering the workforce at a healthy pace
- Practicing mindfulness and relaxation techniques
Since many people experience gaps between mood episodes, there may be periods when you go to therapy without having any symptoms. That is okay. In fact, you may find it simpler to learn new habits when your mind is in a stable place. By practicing coping skills during rest periods, you can put them to use more easily during mood episodes. A consistent therapy regimen will likely work better than therapy you only use in emergencies.
Medication for Bipolar Disorder
Medication is commonly used in the treatment of bipolar disorder. According to recent guidelines, lithium remains a first-line treatment option, particularly for maintenance therapy. Some regularly prescribed medications include:
Mood Stabilizers
These medications can stabilize your mood to avoid the highs and lows typically associated with bipolar disorder.
Lithium
Lithium is the most commonly used mood stabilizer for bipolar disorder. It has been reported to reduce the risk of life-threatening suicide attempts and death by 60-80%. Research shows lithium reduces manic and depressive symptoms by more than 50% from baseline in around two-thirds of patients. However, lithium has potentially serious side effects and may cause kidney or thyroid issues. People taking this medication are encouraged to have their blood monitored regularly.
Anticonvulsants
These medications are typically used to treat seizures, but they have been found to be effective in mood stabilization as well. However, new regulations state that valproate must NOT be started in new patients (male or female) younger than 55 years, unless two specialists independently consider that there is no other effective treatment. These medications may increase one's risk of suicidal thoughts and behaviors. People taking these medications should be closely monitored for new or worsening signs of depression.
Atypical Antipsychotics
These medications are often used in the treatment of schizophrenia. Yet they have also been found to be effective for treating bipolar disorder (especially manic symptoms). Recent research shows olanzapine plus fluoxetine, quetiapine, olanzapine, lurasidone, lumateperone, cariprazine, and lamotrigine were found to be more efficacious than placebo in adults with acute bipolar depression.
Antidepressants
Antidepressants can be used to treat depressive symptoms of bipolar disorder. However, these medications can also cause a manic or hypomanic episode. For that reason, these medications are typically used in combination with a mood stabilizer.
There are many myths about medication for bipolar disorder. People taking these medications should know that they do NOT change your core personality. They do not cause addiction or create artificial "highs" either.
Some people taking antidepressants or mood stabilizers do report emotional numbing. However, this side effect will likely go away if you switch to a different medication. A mental health professional can help you change medications or alter doses as needed.
Hospitalization for Bipolar Disorder
Recent research shows that approximately 3.06% of outpatients with bipolar disorder experience psychiatric hospitalization over the course of a year. If your bipolar symptoms grow severe enough, you may need hospitalization. Contrary to what popular culture suggests, psychiatric hospitalizations are typically brief. Bipolar disorder affects approximately 2.8% of U.S. adults annually and carries an outsized burden of disability, hospitalization, and suicide risk, with fivefold variation in hospitalization rates across states.
When Hospitalization May Be Necessary
Hospitalization may be necessary if you have the following symptoms:
- Psychotic symptoms such as hallucinations or delusions
- Insomnia that persists for several days
- Extreme fatigue that leaves you unable to perform daily tasks like getting dressed
- Thoughts of hurting yourself or others
In some cases, going to the hospital may save your life. Research shows that bipolar disorder has a high disease burden with the highest mortality risk coming from suicide. Our study underscores the severity of BD-II, with a risk for suicide not dissimilar from BD-I, with factors like greater propensity to depression, comorbidity, and rapid-cycling contributing to significant mortality hazard. Studies suggest that up to 50% of people with the condition attempt suicide at least once, and 15-20% die by suicide.
What to Expect During Hospitalization
During a hospital stay, you can expect to follow a schedule for meals, bedtimes, and so on. Hospital staff may check on you throughout the day to watch for symptoms, especially if you are trying a new medication. You may participate in group therapy or brief, daily check-ups from a clinician. However, intensive individual therapy is usually reserved for after the hospital stay when your mood has stabilized.
After hospitalization, you will likely be referred to outpatient therapy. Like other forms of healthcare, therapy and hospitalization are confidential. Employers and friends have little way of knowing about your treatment unless you share the information yourself. The only people who need to know about the hospital stay are you and your healthcare providers.
Self-Help for Bipolar Disorder
Therapy for bipolar disorder often involves lifestyle changes. Understanding the connections between circadian rhythms, sleep disturbances, and BD pathophysiology can inform treatment and interventions. The identification of circadian clock genes' involvement in mood regulation provides potential targets for therapeutic interventions, and interventions aimed at realigning circadian rhythms could be beneficial in managing BD.
Sleep Hygiene and Circadian Rhythm Regulation
Cognitive-behavioral therapy for insomnia in BD (CBTI-BP) includes behavioral elements such as developing winding down activities in low lighting settings, ensuring regular sleep-wake, exercise, and meal times, and educating patients on the relevance of circadian rhythms in sleep. It also includes cognitive elements such as practicing strategies to decrease anxiety surrounding sleep.
Sleep hygiene habits include:
- Having a set bedtime and wake time
- Keeping your bedroom dark and cool
- Avoiding screen time and bright lights at least 60 to 90 minutes before sleep, instead reading a book in dim light, listening to gentle music or an audiobook, or meditating
- Maintaining regular routines to support your circadian rhythm—the 24-hour cycle that dictates your body's schedule, guiding body temperature, hormonal cycles, hunger, and sleep-wake cycle
Additional Self-Management Strategies
Mood journaling: By writing your symptoms down, you and your therapist can find patterns in your mood changes. With practice, you may be able to recognize an oncoming mood episode and prepare yourself for it.
Building positive, supportive relationships: There may be times when your symptoms affect your ability to function at work or at home. A support network can be invaluable in helping you get through a severe mood episode.
Managing stress effectively: Stress is often a trigger for mood episodes. You may wish to avoid taking on too much responsibility at work or school. If you are constantly pushing your limits, you may not have energy left to cope with symptoms when they come.
Developing a healthy daily routine: Keeping a schedule for meals, sleep, and exercise can help your body know what to expect each day. Based on findings showing circadian phase disturbances directly precede mood symptoms, clinicians may be able to intervene early through lifestyle modification or administration of light therapy or melatonin.
Light therapy considerations: Research shows that midday bright light (45-60 minutes of 7000 lux) can contribute to phase advance of melatonin rhythm and may be particularly helpful for bipolar depression, while morning light can induce mixed states. Patients receiving bright white light therapy demonstrated significantly reduced depression and increased remission rates.
Supporting Loved Ones with Bipolar Disorder
If you have a family member with bipolar disorder, you may feel confused or overwhelmed by your loved one's behavior. While you cannot cure their condition, you can help them manage their symptoms.
Creating a Crisis Plan
One of the most important things you can do with your loved one is to create a crisis plan. A crisis plan is a written agreement of what actions the family will take in an emergency. You and your loved one may discuss how severe their symptoms can get before you take them to the hospital. You might also write a list of preferred treatment centers or medications.
During a mood episode, your loved one may be reluctant to accept treatment. You may find it helpful to have your loved one sign the crisis plan beforehand. The individual may be more willing to accept help if they know they are following their own instructions.
Providing Support During Episodes
Even during milder mood episodes, a loved one may still benefit from your help. During a depressive period, you can support your loved one by making sure they follow a daily routine (even if they would rather sleep all day). You can also remind the person that they are valuable and that they will not feel this bad forever.
During a manic phase, you may need to watch your loved one to make sure they do not take actions they will later regret (such as quitting a job they love). If your loved one insists everything is under control, you may ask them to put the plans off for a week. If their plan truly comes from their heart, they will probably still want to do it even after the mood episode ends.
Remember that you do not have to support your loved one on your own. There are professionals who can take on much of the work. If you and your loved one would like to start bipolar treatment, you can find a therapist here.
Frequently Asked Questions
How effective is lithium compared to other medications?
Lithium has been shown to reduce the risk of life-threatening suicide attempts and death by 60-80%. Meta-analyses have concluded that maintenance lithium treatment significantly reduces the rates of suicide and suicide attempts in patients diagnosed with bipolar disorder. In prevention of manic episodes, lithium showed superiority compared to anticonvulsants with a relative risk of 0.66.
How long do psychiatric hospitalizations typically last?
While specific duration can vary, data from 2016-2018 showed the overall U.S. rate of bipolar hospital stays was about 83.6 per 100,000. Mental disorders were among the top five reasons for hospitalization in younger adults. Most hospitalizations are brief, focusing on stabilization until mood symptoms improve.
What types of therapy work best for bipolar disorder?
According to 2023 treatment guidelines, cognitive-behavioral therapy (CBT), family-focused therapy, and interpersonal and social rhythm therapy have shown particular efficacy as adjunctive treatments. DBT has also shown promise, with studies supporting its feasibility as an adjunct intervention for patients with bipolar disorder.
How important is sleep in managing bipolar disorder?
Sleep and biological rhythms play a critical role in mood regulation. Changes in sleep patterns have been associated with lower quality of life, greater risk of suicide attempts, worse clinical and cognitive functioning, and higher relapse rates. The maintenance of regular sleep-wake cycles is crucial for preserving affective stability.
Can lifestyle changes really help with bipolar disorder?
Yes, research shows that correcting circadian rhythm through lifestyle modification can be beneficial. This includes maintaining regular sleep-wake schedules, meal times, and activity patterns. Light therapy and melatonin administration timed to individual circadian phases can also help manage mood symptoms.
What should family members know about supporting someone with bipolar disorder?
Creating a crisis plan together during stable periods is crucial. This written agreement should outline when to seek help and preferred treatment options. Family members can also help by encouraging routine maintenance during depressive episodes and monitoring for risky behaviors during manic phases. However, professional support remains essential.
Find a Therapist
If you or a loved one would benefit from professional support for bipolar disorder, finding the right therapist is an important first step. Look for mental health professionals who:
- Have experience treating bipolar disorder
- Can provide evidence-based therapies like CBT, DBT, or interpersonal and social rhythm therapy
- Are willing to coordinate with your psychiatrist or prescribing physician
- Understand the importance of sleep and circadian rhythm regulation
Visit the GoodTherapy directory to find qualified therapists in your area who specialize in bipolar disorder treatment. Many therapists offer initial consultations to help determine if they're the right fit for your needs.
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