The first order of business in treating bipolar disorder is to treat the brain. Such treatment usually requires medication and may also include other biological methods that specifically target brain function, such as light therapy. Following are some common biological treatment options for bipolar.
Getting the right meds for your condition
The first, fastest, and generally most effective treatment for mania or depression is medication, which treats acute (severe, short-term) symptoms and is used as a prophylaxis (preventive) to avoid further cycles. The medication choices are based on where someone is in the cycle of the disorder:
Acute mania: Lithium and valproate (Depakote) have historically been the mainstays of treatment for an acute manic episode. However, antipsychotics, such as olanzapine (Zyprexa), risperidone (Risperdal), or asenapine (Saphris) are increasingly used as first choices when someone is suffering with acute mania. Doctors usually try to use just one medication, but sometimes a combination of lithium or valproate with an antipsychotic is needed.
Acute bipolar depression: For a long time the medical community thought that depression in bipolar disorder was the same thing as unipolar depression, but research has increasingly shown that they're not so similar. Treatment with antidepressant monotherapy (using a medication by itself without any other medications), such as fluoxetine (Prozac) or paroxetine (Paxil), appears to be less effective in bipolar depression and also carries a risk of switching someone from depression to mania.
The research suggests that antidepressants, if used in bipolar disorder, should be prescribed with one of the antimanic agents, such as lithium or valproate, or an antipsychotic. Depression causes some of the most chronic and devastating effects in bipolar disorder, but it's still one of the hardest parts to treat.
Currently, three medications are specifically approved to treat bipolar depression: Symbyax (a combination of the antipsychotic olanzapine and the antidepressant fluoxetine) and two additional antipsychotics — quetiapine (Seroquel) and lurasidone (Latuda). Lithium is well established as a booster agent in unipolar depression (to increase the effectiveness of an antidepressant), but not enough studies have been done to clearly show whether it's useful in bipolar depression. Importantly, though, it remains the only medication to clearly reduce the risk of suicide in bipolar disorder.
Maintenance treatment: After an acute episode is resolved, medication is often part of the plan to help reduce the likelihood of having another mood episode of either the depressive or manic type. Lithium is the gold standard for maintenance care in bipolar disorder. The benefits of valproate for this purpose aren't as clear-cut, but it has been used in this way for a long time. Lamotrigine (Lamictal) is a medication that's approved for the maintenance treatment of bipolar disorder, but it's not helpful in acute mania. Lamotrigine may have some benefits in acute depressive episodes, but the data so far has been inconsistent.
These general treatment guidelines apply primarily to bipolar I. The treatment guidelines for bipolar II are much less clear. Although antidepressants may play a larger role in bipolar II than in bipolar I, the risk of switching to a manic or hypomanic episode while taking antidepressants still seems to be present.
Other categories of medications may be used to treat associated problems of bipolar disorder, including sedatives, such as lorazepam (Ativan) for agitation or anxiety, and sleep medications, such as zolpidem (Ambien) for severe insomnia.
The goal of medication treatment is to get maximum benefit while taking the fewest medications. Unfortunately, because bipolar disorder presents with completely opposite symptoms (manic and depressive) in the same person at different times, most people require more than one medication.
Prescription medication isn't designed to cure bipolar or to solve all your problems. It's prescribed to treat the biological side of the disorder in your brain so the rest of your being can function without the interference of mania or depression. When your brain is functioning more normally, you may be able to make adjustments to your lifestyle and attitudes that accelerate your recovery, improve your life, and offer added protection against new episodes.
Few people like taking medicine, especially to treat a chronic or long-term condition such as diabetes or bipolar disorder. Taking medication regularly is a hassle, some medications have undesirable side effects, and people don't want to think of themselves as needing a pill to function normally. Even people without bipolar have a tough time sticking with their treatment plans; just think of how many times people stop taking their antibiotics as soon as they start feeling better, even though the doctor and pharmacist made a point of telling them to take it until the bottle's empty. Coming to terms with medication is a big first step toward recovery.
Exploring other biological treatment options
Although medication is typically the most effective approach for treating bipolar disorder, other treatments demonstrate varying degrees of effectiveness in alleviating mood symptoms. These treatments fall into two categories:
Vitamins and supplements: Omega-3 fatty acids (fish oil), folic acid, and N-acetyl cysteine (NAC)
Brain stimulation: Light therapy, electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), and deep brain stimulation (DBS)