Bipolar Disorder Therapies: What May Be Most Helpful

Having bipolar disorder is more than simply being “moody” – it is a serious mental health condition that can significantly impact a person’s ability to function in daily life. The symptoms of bipolar disorder can be difficult to cope with, but therapeutic treatments can help. If you are concerned that you or a loved one may be experiencing bipolar disorder, it might be beneficial to learn more about it. In this article, we’ll explore what bipolar disorder is, including its symptoms and potential treatment options. 

What is bipolar disorder?

Bipolar disorder (sometimes shortened to BPD or BD) is a mood disorder characterized by mood swings and symptoms associated with manic and depressive episodes. It has overlapping symptoms with other mood disorders, such as depression and anxiety. What sets bipolar disorder apart is the extremity of the shifts between mania and depression, as well as the severity of the symptoms, some of which may require hospitalization. 

In addition to causing significant changes in cognition, behavior, and mood, bipolar disorder can occur alongside several other mental health conditions. Anxiety disorders (e.g., panic disorder and social anxiety disorder) and behavioral disorders (e.g., ADHD and oppositional defiant disorder) are commonly comorbid with bipolar disorder. Additionally, according to clinical practice guidelines provided by the VA and DoD, approximately one-third of individuals living with bipolar disorder experience comorbid substance use disorder.

Symptoms of bipolar disorder

The symptoms of bipolar disorder can vary from person to person. They can also shift depending on whether an individual is experiencing a manic or depressive episode. Consider the following symptoms, which can be common in those living with bipolar disorder. 

Manic symptoms 

When people with bipolar disorder experience episodes of mania, they are often in a highly elevated state. They may believe they are capable of anything, experience extreme euphoria, and even enter a state of psychosis where they are disconnected from reality. Despite the positive feelings mania often brings, manic episodes can be more dangerous than depressive episodes, because the impulsivity and lack of control associated with mania can cause serious harm. People who experience severe mania may need to be hospitalized until the manic episode ends. 

Some variants of bipolar disorder involve a state of hypomania, which is a less intense form of mania that typically still allows the person experiencing the hypomanic episode to function as usual. Manic or hypomanic episodes can involve the following symptoms:

• Euphoria

• Difficulty focusing

• A sense of accomplishment or power

• Rapid, illogical speech that jumps from subject to subject without any clear connection

• Bursts of energy

• Overanalyzing and racing thoughts

• Irresponsible substance use

• Increased physical activity

• Lack of ability to feel tired

It should be noted that while substance use is a symptom, consuming drugs and alcohol can further destabilize a person’s mood and become a feedback loop in which symptoms of mania or hypomania are heightened by the substance use.

Depressive symptoms

In contrast to mania, depressive episodes can look a lot like major depressive disorder. As with symptoms of a manic episode, depressive symptoms can be extreme. Some symptoms of bipolar depression can seriously inhibit functioning. A depressive episode may include:

• Significant and impairing levels of fatigue and sluggishness

• Feelings of sadness, hopelessness, and despair

• Reduced motivation

• Chronic pain, such as headaches, migraines, sore muscles, and body aches without a clear medical cause

• Lack of interest in hobbies and activities that used to bring joy

• Difficulty in taking care of oneself or performing basic activities associated with daily functioning, such as taking a shower

• Abandonment of goals and ambitions

• Isolation and withdrawal from friends and family members

• Suicidal thoughts and behaviors

Manic depressive symptoms

Some symptoms can occur in states of mania, hypomania, and depression. The following symptoms may be indications that a person is experiencing bipolar disorder and not another mood disorder:

• Mood swings: As the most common and differentiating symptom of BPD, mood swings involve shifts between positive and negative mood states over short or long periods of time (i.e., episodes of mania or depression can last days to months).

• Loss of appetite or increase in appetite, with subsequent significant weight changes

• Agitation and irritability

• Lack of interest in or an inability to follow through on commitments

• Inability to maintain a regular schedule

How is bipolar disorder diagnosed?

Prior to receiving care for bipolar disorder, an individual will typically need a diagnosis. The Diagnostic and Statistical Manual of Mental Disorders (DSM-V), published by the American Psychiatric Association, outlines the diagnostic criteria for bipolar disorder. Though other diagnoses may be provided, the primary conditions listed under “Bipolar and Related Disorders” in the DSM-V are bipolar I disorder, bipolar II disorder, and cyclothymic disorder. 

To be diagnosed with bipolar I, an individual must have experienced at least one manic episode. While episodes of mania may precede or follow depressive episodes, the presence of depression is not required for a diagnosis. For a person to be diagnosed with bipolar II, they must have experienced at least one episode of major depression and one episode of hypomania, which is a less severe form of mania. Cyclothymic disorder may be diagnosed when an individual experiences periods of depressive and hypomanic symptoms that do not meet the diagnostic criteria for a depressive, manic, or hypomanic episode. 

Individuals seeking care will typically need to be evaluated by mental health professionals (e.g., psychiatrists, psychologists, psychiatric nurse practitioners) before a diagnosis can be provided, and bipolar treatment can begin. A provider may conduct a series of assessments to rule out certain medical or mental health conditions and identify possible symptoms of bipolar disorder. These may include blood tests and a physical exam, as well as questionnaires that evaluate the frequency and severity of potential bipolar depression and mania symptoms. Additionally, the provider may conduct an interview in which they ask more questions about the person’s symptoms, medical history, use of certain medications, and lifestyle (e.g., sleep patterns, alcohol use). 

If an individual’s symptoms fulfill the criteria for one of the above-mentioned types of bipolar disorder, a diagnosis may be provided. The professional can then help the patient develop a treatment plan or refer them to other providers for care. Because the symptoms of bipolar disorder can persist throughout adulthood, lifelong treatment is often necessary. If you believe you’re living with bipolar disorder, consider reaching out to a mental health professional. Alternatively, your primary care provider may be able to help you find a doctor or other professional who specializes in bipolar disorder or related mental health conditions.

Standard methods of treating bipolar disorder

Certain psychotherapeutic modalities (e.g., cognitive behavioral therapy) and lifestyle changes (e.g., exercise) have been shown to reduce symptoms of bipolar disorder. Bipolar disorder can also be treated with brain stimulation therapies, such as electroconvulsive therapy (ECT).

The Depression and Bipolar Support Alliance note that medication has different effects on different individuals, and a person may need to try several different kinds of medication before they find one to effectively treat bipolar disorder. Often, a combination of prescription drugs will be used during acute episodes of mania or depression. Always consult with a healthcare provider prior to starting or stopping any medication. A medical or mental health professional can discuss the side effects, benefits, and treatment duration of different medications.

Valproic acid, carbamazepine, and lithium are mood stabilizers that are often prescribed to manage bipolar disorder symptoms. Many experts recommend the use of mood stabilizers for long-term treatment as they can help reduce the risk of episode recurrence. Antipsychotics may also be utilized to help control symptoms of psychosis, which can arise during manic or depressive episodes. Antidepressants are also utilized in some cases, though certain medications used to treat depression (e.g., SSRIs) have been shown to exacerbate or cause mania. 

Brain stimulation therapies are other treatments that can improve symptoms of mania and depression. These modalities work by activating certain brain regions through electrical currents. Electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS), two of the most widely studied brain stimulation therapies, have shown promise as alternative or complementary methods of treatment for bipolar disorder. Research suggests that electroconvulsive therapy can alleviate symptoms of bipolar disorder that are resistant to treatments like mood stabilizers. It is important to note, however, that electroconvulsive therapy can trigger a manic episode. Researchers in one study found that 25% of participants switched from depression to mania due to ECT.  

Additionally, lifestyle changes can help people with bipolar disorder manage their symptoms. According to the Substance Abuse and Mental Health Services Administration, these changes include getting regular exercise, maintaining a consistent sleep schedule, eating a balanced diet, journaling, and practicing stress-management techniques. Individuals with bipolar disorder may also benefit from support groups, where they can connect with people experiencing similar challenges.

Therapies used to treat bipolar disorder

Psychotherapies, also called talk therapies or talking therapies, are primary methods of treatment for bipolar disorder. Several therapeutic methods, in conjunction with medication, have also been found to have a significant impact on reducing bipolar disorder symptoms.  

Cognitive behavioral therapy

Used to treat several different mental health conditions, cognitive behavioral therapy (CBT) focuses on the connections between participants’ thoughts, feelings, and actions. A primary goal of cognitive behavioral therapy is to help clients identify and replace negative thought patterns that may be contributing to their symptoms. For example, people with bipolar disorder may develop unhelpful beliefs about their self-worth that worsen feelings of depression. Through cognitive behavioral therapy, they can learn to recognize and reframe those negative thoughts, potentially reducing maladaptive feelings and behaviors. Research suggests that cognitive behavioral therapy can help people with bipolar disorder regulate their mood, understand their symptoms, and address comorbid mental disorders.  

Interpersonal and social rhythm therapy

Interpersonal and social rhythm therapy (IPSRT) is one of the most widely used methods for treating bipolar disorder. Research has demonstrated that having a daily routine can be an effective method for preventing manic and depressive episodes and can help address some of the most concerning symptoms of these episodes if they do arise. IPSRT’s focus is the creation of such a daily routine: going to bed at roughly the same time every night, setting your alarm clock for the same time every morning, and eating meals at around the same time every day.

With IPSRT, individuals record the effects that any changes to their routine have on their moods, identifying important aspects of the routine to focus on, as well as possible triggers that may result in bipolar episodes. The “interpersonal” component of IPSRT focuses on issues the client is experiencing in their interpersonal relationships, such as difficulty making and keeping friends or frequent arguments with family members. The client and therapist work together to identify solutions to interpersonal problems and implement those solutions in their daily lives. 

It can be important for people with bipolar disorder to take a mood stabilizer or other medication when prescribed. IPSRT also teaches techniques to promote adherence with certain bipolar disorder medications. Additionally, IPSRT helps individuals manage their stress levels, which could increase their likelihood of staying on a regular medication schedule. 

Family-focused therapy

Family-focused therapy involves the person with bipolar disorder and their parents, spouse, children, or other family members (typically people the person lives with or is close to). The client and their family members meet with a mental health professional for around 12 sessions, depending on each family’s specific needs. 

The first few sessions focus on educating everyone about bipolar disorder. They often learn what it means to have the condition, its symptoms, its potential causes, how to recognize early warning signs of a bipolar episode, how to manage episodes as a family while they are occurring, the importance of recognizing triggers and preventing future episodes, and more. Once everyone has a solid understanding of BPD, the therapist, client, and family work together on problem-solving and effective communication with the goal of increasing trust and building the sense that everyone in the family is on the same team. 

Family-focused therapy can be an effective form of bipolar disorder treatment because it emphasizes the family support system, which can help with medication adherence to other aspects of a client’s treatment plan. 

Online therapy can help people with bipolar disorder

Bipolar disorder can be highly disruptive to day-to-day functioning, but a combination of therapy and medication treatment can help with alleviating symptoms. Many people with bipolar disorder experience depressive episodes that last longer or occur more often than manic episodes. If you are having difficulties with fatigue or motivation due to a depressive episode, you may want to consider online therapy, which can be sought from the convenience of your home. BetterHelp is an online therapy platform that can connect you with a licensed therapist according to your needs. Since those with bipolar disorder often experience episodes of depression, online therapy may be useful for continuing to seek mental health support even when symptoms make it difficult to leave the house. 

The efficacy of online therapy for bipolar disorder

Research demonstrates that online therapy for bipolar disorder may be just as effective as traditional in-person therapy. One study found that internet-based therapy was able to reduce symptoms of mental health conditions, including bipolar disorder, and that seeking therapy online was more financially feasible for patients. Online therapy, in conjunction with medication management, can be a helpful way to find relief for people living with bipolar disorder.