To diagnose bipolar disorder, your healthcare provider may use many tools, including:
1. A physical exam.
2. A thorough medical history, which will include asking about your symptoms, lifetime history, experiences and family history.
3. Medical tests, such as blood tests, to rule out other conditions that could be causing your symptoms, such as hyperthyroidism.
4. A mental health evaluation. Your healthcare provider may perform the evaluation, or they may refer you to a mental health specialist, such as a psychologist or psychiatrist.
To be diagnosed with bipolar disorder, you must have experienced at least one episode of mania or hypomania. Mental health providers use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose the type of bipolar disorder a person may be experiencing.
To determine what type of bipolar disorder you may have, your mental health provider assesses the pattern of symptoms and how much they affect your life during the most severe episodes. People with bipolar disorder are more likely to also have the following mental health conditions:
1. Anxiety.
2. Attention-deficit /hyperactivity disorder (ADHD).
3. Post-traumatic stress disorder (PTSD).
4. Substance use disorders/dual diagnosis.
Because of this, as well as the fact that memory is often impaired during mania so people can’t remember experiencing it, it can be difficult for healthcare providers to properly diagnose people with bipolar disorder.
People with bipolar disorder who are experiencing a severe manic episode with hallucinations may be incorrectly diagnosed with schizophrenia. Bipolar disorder can also be misdiagnosed as borderline personality disorder (BPD). Because of this, it’s important to be honest and thorough when explaining all of your symptoms and experiences when talking with your healthcare provider. It can also be helpful to include a loved one who may be able to provide additional details about your mental health history in your discussions with your provider.
How is Bipolar Disorder Treated?
Treatment can help many people, including those with the most severe forms of bipolar disorder. An effective treatment plan usually includes a combination of the following therapies:
1. Psychotherapy (talk therapy).
2. Medications.
3. Self-management strategies, like education and identifying the early symptoms of an episode or possible triggers of episodes.
4. Helpful lifestyle habits, such as exercise, yoga and meditation. These can support, but not replace, treatment.
5. Other therapies, such as electroconvulsive therapy (ECT) in cases that are poorly responsive to medication or where rapid control of symptoms is necessary to prevent harm.
Bipolar disorder is a lifelong condition, so treatment is a lifelong commitment. It can sometimes take several months to years before you and your healthcare provider find a comprehensive treatment plan that works best for you. Although this can be discouraging, it’s important to continue treatment.
Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder don’t have mood changes, but some people may have lingering symptoms. Long-term, continuous treatment can help manage these symptoms.
If you have other mental health conditions in addition to bipolar disorder, such as anxiety or ADHD, it can be more difficult to treat the conditions. For example, the antidepressants healthcare providers prescribe to treat obsessive-compulsive disorder (OCD) and the stimulants they prescribe to treat ADHD may worsen symptoms of bipolar disorder and may even trigger a manic episode. Again, even though it may be difficult to treat these conditions, it’s not impossible. Be sure to stay committed to finding a treatment plan that works for you.
What Types of Therapy are Used to Treat Bipolar Disorder?
Psychotherapy, also called “talk therapy,” can be an effective part of the treatment plan for people with bipolar disorder. Psychotherapy is a term for a variety of treatment techniques that aim to help you identify and change troubling emotions, thoughts and behaviors. Working with a mental health professional, such as a psychologist or psychiatrist, can provide support, education and guidance to you and your family. Different types of therapy for bipolar disorder include:
1. Psychoeducation. Psychoeducation is the way mental health professionals teach people about their mental health conditions. As bipolar disorder is a complex condition, learning about the condition and how it can affect your life can help you and your loved ones manage and cope with it better.
2. Interpersonal and Social Rhythm Therapy (IPSRT). This therapy is designed to help you improve your moods by understanding and working with your biological and social rhythms. IPSRT is an effective therapy for people with mood disorders, including bipolar disorder. It emphasizes techniques to improve medication adherence (taking your medication regularly), manage stressful life events and reduce disruptions in social rhythms (day-to-day differences in habitual behaviors). IPSRT teaches you skills that let you protect yourself against the development of future manic or depressive episodes.
3. Family-Focused Therapy. This therapy is for adults and children with bipolar disorder and their caregivers. During this treatment, your loved ones will join you in therapy sessions of psychoeducation regarding bipolar disorder, communication improvement training and problem-solving skills training.
4. Cognitive Behavioral Therapy (CBT). This is a structured, goal-oriented type of therapy. Your therapist or psychologist helps you take a close look at your thoughts and emotions. You’ll come to understand how your thoughts affect your actions. Through CBT, you can unlearn negative thoughts and behaviors and learn to adopt healthier thinking patterns and habits.
What Medications are Used to Treat Bipolar Disorder?
Certain medications can help manage symptoms of bipolar disorder. You may need to try several different medications, with guidance from your healthcare provider, before finding what works best. Medications healthcare providers generally prescribe to treat bipolar disorder include:
1. Mood stabilizers.
2. Second-generation (“atypical”) neuroleptics (also called antipsychotics).
3. Antidepressants.
If you’re taking medication for bipolar disorder, you should:
1. Talk with your healthcare provider to understand the risks, side effects and benefits of the medication.
2. Tell your healthcare provider about any prescription drugs, over-the-counter medications or supplements you’re already taking.
3. Tell your healthcare provider right away if you’re experiencing concerning side effects. They may need to change your dose or try a different medication.
4. Remember that medication for bipolar disorder must be taken consistently, as prescribed.
Mood Stabilizers for Bipolar Disorder
People with bipolar disorder typically need mood-stabilizing medication to manage manic or hypomanic episodes. Types of mood stabilizers and their brand names include:
1. Lithium (Eskalith®, Lithobid®, Lithonate®).
2. Valproic acid (Depakene®).
3. Divalproex sodium (Depakote®).
4. Carbamazepine (Tegretol®, Equetro®).
5. Lamotrigine (Lamictal®).
Lithium is one of the most widely prescribed and studied medications for treating bipolar disorder. Lithium is a natural salt and will reduce symptoms of mania within two weeks of starting therapy, but it may take weeks to months before the manic symptoms are fully managed. Because of this, healthcare providers often prescribe other drugs like antipsychotic drugs or antidepressant drugs to help manage symptoms.
Thyroid gland and kidney problems can sometimes develop when taking lithium, so your healthcare provider will monitor the function of your thyroid and kidneys, as well as monitor the levels of lithium in your blood, as levels can easily become too high. Anything that lowers the level of sodium in your body, such as switching to a low-sodium diet, heavy sweating, fever, vomiting or diarrhea may cause a toxic buildup of lithium in your body. Be aware of these conditions and alert your doctor if you’re on lithium and experience them.
The following are signs of lithium toxicity (lithium overdose). Call your healthcare provider immediately or go to the nearest emergency room if you experience:
1. Blurred vision or double vision.
2. Irregular pulse.
3. Extremely fast or slow heartbeat.
4. Difficulty breathing.
5. Confusion and dizziness.
6. Severe trembling or convulsions.
7. Passing large amounts of pee.
8. Uncontrolled eye movements.
9. Unusual bruising or bleeding.
Neuroleptic Medications for Bipolar Disorder
Healthcare providers often prescribe second-generation or atypical neuroleptics (antipsychotics) in combination with a mood stabilizer for people with bipolar disorder. These medications help with both manic and depressive episodes. Only four of these drugs are U.S. Food and Drug Administration (FDA) approved to help treat bipolar depression, including:
1. Cariprazine (Vraylar®).
2. Lurasidone (Latuda®).
3. Olanzapine-fluoxetine combination (Symbyax®).
4. Quetiapine (Seroquel®).
However, other medications, such as olanzapine (Zyprexa®), risperidone (Risperdal®) and aripiprazole (Abilify®), are commonly prescribed as well.
Antidepressants for Bipolar Disorder
Healthcare providers sometimes prescribe antidepressant medication to treat depressive episodes in bipolar disorder, combining the antidepressant with a mood stabilizer to prevent triggering a manic episode. Antidepressants are never used as the only medication to treat bipolar disorder because only taking an antidepressant drug can trigger a manic episode.
What are The Side Effects of Bipolar Disorder Medications?
Side effects of bipolar disorder medications are common and vary by medication. It’s important to talk with your healthcare provider about what you can expect when taking certain medications. It’s also important to tell them if you’re experiencing side effects. Never stop taking your medication unless your healthcare provider tells you to do so. Abruptly stopping medication can cause severe side effects and trigger severe episodes. The most common side effects of bipolar disorder medications include:
1. Weight gain.
2. Metabolic dysregulation, including abnormal lipid levels (dyslipidemia), high blood pressure (hypertension) and high blood sugar (hyperglycemia).
3. Drowsiness.
4. Akathisia — feelings of restlessness and agitation with a compelling need to move, rock or pace.
What Other Medical Treatments are Used for Bipolar Disorder?
Other treatment options your healthcare provider may consider for treating bipolar disorder include:
1. Electroconvulsive Therapy (ECT). This is a procedure in which a brief application of an electric current to your brain, through your scalp, induces a seizure. It’s most often used to treat people with severe depression. ECT is very safe and highly effective for medication-resistant depression or acute life-threatening mania. It’s the best treatment for mania in people who are pregnant. ECT is uses general anesthesia, so you’ll be asleep during the procedure and won’t feel any pain.
2. Transcranial Magnetic Stimulation (TMS). This therapy involves a short electromagnetic coil that passes an electric current into your brain. Healthcare providers sometimes use it to treat medication-resistant depression. It’s an alternative to ECT. TMS isn’t painful and doesn’t require general anesthesia.
3. Thyroid Medications. These medications can sometimes act as mood stabilizers. Studies have shown positive results in reducing symptoms in people AFAB with hard-to-treat, rapid-cycling bipolar disorder.
4. Ketamine Treatment. Ketamine, an anesthetic, given at low doses through an IV, has been proven to provide short-term antidepressant and antisuicidal effects for people with bipolar disorder.
5. Hospitalization. This is considered an emergency option in bipolar disorder care. It becomes necessary when someone is experiencing a severe depressive or manic episode and they’re an immediate threat to themselves or others.
What Lifestyle Changes Can Help with Bipolar Disorder?
Your healthcare team will likely recommend making lifestyle changes to stop patterns of behavior that worsen the symptoms of bipolar disorder. Some of these lifestyle changes include:
1. Quit Drinking Alcohol and Using Recreational Drugs and Tobacco. It’s essential to quit drinking and using drugs, including tobacco, since they can interfere with medications you may take. They can also worsen bipolar disorder and trigger a mood episode.
2. Keep A Daily Diary or Mood Chart. Keeping track of your daily thoughts, feelings and behaviors can help you be aware of how well your treatment is working and/or help you identify potential triggers of manic or depressive episodes.
3. Maintain A Healthy Sleep Schedule. Bipolar disorder can greatly affect your sleep patterns, and changes in your frequency of sleep can even trigger an episode. Prioritize a routine sleeping schedule, including going to sleep and getting up at the same times every day.
4. Exercise. Exercise has been proven to improve mood and mental health in general, so it may help manage your symptoms related to bipolar disorder. Since weight gain is a common side effect of bipolar disorder medications, exercise may also help with weight management.
5. Meditation. Meditation has been shown to be effective in improving the depression that’s part of bipolar disorder.
6. Manage Stress and Maintain Healthy Relationships. Stress and anxiety can worsen mood symptoms in many people with bipolar disorder. It’s important to manage your stress in a healthy way and to try to eliminate stressors when you can. A big part of this is maintaining healthy relationships with friends and family who support you, and letting go of toxic relationships with people who add stress to your life.
Can Bipolar Disorder be Prevented?
Unfortunately, there’s no known way to prevent bipolar disorder because scientists don’t know its exact cause. But it’s important to know the signs and symptoms of bipolar disorder and to seek early intervention.
What is The Outlook (Prognosis) of Bipolar Disorder?
The prognosis for bipolar disorder is often poor unless it’s properly treated. Many people with bipolar disorder who receive appropriate treatment can live fulfilling and productive lives. Bipolar disorder results in approximately nine years reduction in expected life span, and as many as1 in 5 people with bipolar disorder commit suicide. An estimated 60% of all people with bipolar disorder have drug or alcohol dependence. This is why it’s essential to seek medical care and stay committed to treatment for bipolar disorder.
Regular and continued use of medication can help reduce episodes of mania and depression. By knowing how to recognize the symptoms and triggers of these episodes, there’s a better chance for effective treatment and finding coping methods that may prevent long periods of illness, extended hospital stays and suicide.
When Should I See My Healthcare Provider about Bipolar Disorder?
If you’ve been diagnosed with bipolar disorder, you’ll need to see your healthcare team regularly throughout your life to make sure your treatment is working well for you. This team may include your:
1. Primary healthcare provider.
2. Psychiatrist.
3. Psychologist or therapist.
4. Neurologist.
When Should I Go to The Emergency Room (ER) for Bipolar Disorder?
If you’re experiencing any of these situations, it’s essential to call 911 or get to the nearest emergency room:
1. Thoughts of death or suicide.
2. Thoughts or plans of hurting yourself or others.
3. Experiencing hallucinations and delusions.
4. Symptoms of lithium toxicity (overdose), such as severe nausea and vomiting, severe hand tremors, confusion and vision changes.