Expert Writer & Bipolar Disorder Advocate #Bipolar Disorder

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Comprehensive Approaches to Managing Bipolar Disorder

Effective management of bipolar disorder combines medication, psychotherapy, and lifestyle adjustments to stabilize mood and control symptoms.

Medications, Therapy, and Holistic Care

Bipolar disorder is a chronic condition characterized by fluctuating episodes unique to each individual. Managing this complex illness often requires a combination of medications tailored over time. In addition to pharmacological treatments, psychotherapy and lifestyle changes play critical roles in symptom management. Nonetheless, psychiatric medications remain the cornerstone of treatment.

bipolar disorder treatments — Verywell / Emily Roberts

Prescription Medications

Medications assist individuals with bipolar disorder in regulating their mood swings, preventing severe manic highs and depressive lows, and maintaining daily functioning. Since bipolar disorder involves mood instability, specific drugs are prescribed to stabilize these fluctuations.

Understanding the medication options is vital, as psychiatrists select treatments based on symptom profiles. Medication regimens may require adjustments to optimize effectiveness and minimize side effects.

Never discontinue or modify medication dosages without consulting your healthcare provider to avoid adverse effects or relapse. Your psychiatrist will guide safe transitions if medication changes are necessary.

Anticonvulsants

Anticonvulsants, also known as anti-seizure drugs, frequently serve as mood stabilizers in bipolar disorder management:

Carbamazepine (Atretol, Tegretol, Epitol)
Divalproex Sodium (Depakote, Epival)
Gabapentin (Neurontin)
Lamotrigine (Lamictal)
Oxcarbazepine (Trielptal)
Topiramate (Topamax)
Valproic Acid (Depakene)

Antipsychotics

Typical (first-generation) antipsychotics include:

Chlorpromazine (Thorazine)
Haloperidol (Haldol)
Fluphenazine (Prolixin, Permitil)

Atypical antipsychotics generally have fewer motor side effects but may pose metabolic risks, especially clozapine and olanzapine. These include:

Aripiprazole (Abilify)
Lumateperone (Caplyta)
Clozapine (Clozaril)
Lurasidone (Latuda)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Brexpiprazole (Rexulti)
Risperidone (Risperdal)
Cariprazine (Vraylar)
Ziprasidone (Geodon)

Black Box Warning

Both typical and atypical antipsychotics carry a black box warning for use in elderly patients with dementia-related psychosis due to increased mortality risks from pneumonia and cardiovascular complications.

Antidepressants

Selective serotonin reuptake inhibitors (SSRIs), commonly prescribed for depression, are also used cautiously for bipolar depression:

Citalopram (Celexa)
Fluoxetine (Prozac, Sarafem)
Fluvoxamine (Luvox)
Escitalopram (Lexapro, Cipralex)
Paroxetine (Paxil)
Sertraline (Zoloft)

Serotonin-norepinephrine reuptake inhibitors (SNRIs) include:

Desvenlafaxine (Pristiq, Desfax)
Duloxetine (Cymbalta)
Levomilnacipran (Fetzima)
Venlafaxine (Effexor)

Tricyclic antidepressants, while effective for some, have notable side effects such as cardiac arrhythmias and anticholinergic symptoms:

Amitriptyline (Amitrip, Elevil, Endep, Levate, Amitril, Enovil)
Amoxapine (Asendin)
Clomipramine (Anafril)
Desipramine (Norpramin, Pertofrane)
Doxepin (Sinequan)
Imipramine (Tofranil)
Nortriptyline (Aventyl, Pamelor)

Monoamine oxidase inhibitors (MAOIs) prevent the breakdown of neurotransmitters and include:

Selegiline (Emsam)
Isocarboxazid (Marplan)
Moclobemide (Manerix)
Phenelzine (Nardil)
Tranylcypromine (Parnate)

Other antidepressants such as mirtazapine (Remeron), trazodone (Oleptro, Desyrel), vilazodone (Viibryd), vortioxetine (Trintellix), and bupropion (Wellbutrin) are also utilized based on individual needs.

Benzodiazepines

Benzodiazepines, which depress the central nervous system, are prescribed for anxiety, insomnia, and seizure control. Their duration of action varies from short to long-acting:

Alprazolam (Xanax, Novo-Alprazol, Nu-Alpraz)
Clonazepam (Klonopin, Rivotril)
Chlordiazepoxide (Librium, Libritabs)
Diazepam (Valium)
Flurazepam (Dalmane)
Lorazepam (Ativan)
Oxazepam (Serax)
Temazepam (Restoril)
Triazolam (Halcion)

Additional Medications

Lithium (Lithane, Lithobid, Eskalith, among others) remains a foundational mood stabilizer requiring careful monitoring. Verapamil (Calan, Isoptin), primarily a blood pressure medication, has been explored experimentally for mania treatment.

Psychological Therapies

Psychotherapy is essential in addressing the emotional challenges of bipolar disorder. Working with trained mental health professionals helps patients recognize mood changes, identify triggers, and develop coping strategies. Therapy also promotes medication adherence, fosters community connection, and mitigates behaviors that impair quality of life.

Common therapeutic approaches include cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), interpersonal and social rhythm therapy (IPSRT), and family-focused treatment. Involving family members enhances understanding and support.

Complementary Treatments

Always consult your healthcare provider before starting alternative therapies. Herbal supplements like St. John's Wort may interact with medications or provoke manic episodes, though they may relieve mild to moderate depression.

Phototherapy (lightbox therapy) is effective for seasonal depression associated with bipolar disorder.

Evidence on omega-3 fatty acids and acupuncture is mixed, and while practices like aromatherapy, massage, and yoga may support general well-being, their effectiveness in bipolar disorder remains unproven.

Lifestyle Modifications

Your care team will likely recommend lifestyle changes to support mood stability, including:

Avoidance of drugs and alcohol that can exacerbate symptoms
Developing healthy stress management techniques
Maintaining balanced nutrition
Ensuring sufficient sleep and regular physical activity
Seeking support from friends, family, or support groups for bipolar disorder

Accessing Treatment

After diagnosis, treatment usually involves referral to a psychiatrist or mental health specialist. Honest communication about your symptoms and daily experiences is crucial for effective care.

Bipolar Disorder Discussion Guide

Download our printable guide to help you prepare for your next medical appointment and ask pertinent questions.

Learn proven strategies to manage stress and negativity in your life.

Bipolar disorder management is most successful with a collaborative team approach, enabling many individuals to achieve long-term remission and lead fulfilling lives. Stability typically requires ongoing medication and comprehensive support.

If you or someone you know is struggling, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for local resources and treatment options.

For additional mental health support, explore our National Helpline Database.

Explore more:

Conditions A-Z
Bipolar Disorder
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References

Bostock E, Kirkby K, Garry M, Taylor B, Hawrelak JA. Mania linked to herbal medicines excluding cannabis: A systematic review and quality assessment of case reports. Front Psychiatry. 2018;9:280. doi:10.3389/fpsyt.2018.00280
Apaydin EA, Maher AR, Shanman R, et al. Systematic review of St. John’s Wort for major depressive disorder. Syst Rev. 2016;5(1):148. doi:10.1186/s13643-016-0325-2
Sarris J, Mischoulon D, Schweitzer I. Meta-analyses of omega-3 use in mania and bipolar depression. J Clin Psychiatry. 2012;73(1):81-86. doi:10.4088/JCP.10r06710
Sarris J, Lake J, Hoenders R. Complementary medicine in bipolar disorder: Evidence, safety, and clinical considerations. J Altern Complement Med. 2011;17(10):881-890. doi:10.1089/acm.2010.0481

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