Treatment for bipolar disorder generally involves medications and psychotherapy — whether you have bipolar I or bipolar II. Bipolar II disorder is not a milder form of bipolar I disorder, but a separate diagnosis.
If they are not treated, episodes of bipolar-related depression or mania can last for 6-12 months. On average, someone with bipolar disorder will have 5 or 6 episodes over a period of 20 years and without treatment, relapse is more likely. However, with effective treatment, episodes usually improve within about 3 months.
Treatment efficacy research for bipolar disorder generally looked at the treatment effect on manic/hypomanic and depressive episodes separately.
Effective treatments for manic/hypomanic episodes include:
Psychoeducation involves providing patients with information about bipolar disorder and its treatment. The primary goal of psychoeducation is to help patients take their medication as prescribed by helping them understand the biological aspects of bipolar disorder and how medicine can help them manage their symptoms.
Cognitive Therapy (CT) based on the manual developed by Dr. D. Lam and colleagues have been particularly effective for bipolar disorder. It focuses on promoting regular sleep and regulating extreme goal striving in addition to usual cognitive components such as identifying maladaptive negative thoughts about the self, and skills to challenge these overly negative thoughts.
Effective treatments for depressive episodes include:
Family-Focused Therapy (FFT) focuses on how to help families respond early to emergent symptoms, and the best coping responses. They are also taught communication and problem-solving skills for reducing conflict and resolving family problems.
Cognitive Therapy (CT) based on the manual developed by Dr. D. Lam and colleagues have been particularly effective for bipolar disorder. It focuses on promoting regular sleep and regulating extreme goal striving in addition to usual cognitive components such as identifying maladaptively negative thoughts about the self, and skills to challenge these overly negative thoughts.
The types and doses of medications prescribed are based on your particular symptoms. Whether you have bipolar I or II, medications may include:
- Mood stabilizers. You'll typically need mood-stabilizing medication to control episodes of mania or hypomania, which is a less severe form of mania. Examples of mood stabilizers include:
- Lithium (Lithobid)
- Valproic acid (Depakene)
- Divalproex sodium (Depakote)
- Carbamazepine (Tegretol, Equetro)
- Lamotrigine (Lamictal)
- Mood-stabilizing antipsychotics. If symptoms of depression or mania persist in spite of treatment with other medications, adding an antipsychotic medication such as:
- Olanzapine (Zyprexa)
- Risperidone (Risperdal)
- Quetiapine (Seroquel)
- Aripiprazole (Abilify)
- Ziprasidone (Geodon)
- Lurasidone (Latuda)
- Asenapine (Saphris) may help. Your psychiatric care provider may prescribe some of these medications alone or along with a mood stabilizer.
- Antidepressants. Your provider may add a certain type of antidepressant to help manage depression. Because an antidepressant can sometimes trigger a manic episode, it needs to be prescribed along with a mood stabilizer or antipsychotic in bipolar I disorder.
- Antidepressant-antipsychotic. The medication Symbyax combines the antidepressant fluoxetine and the antipsychotic olanzapine. It works as a depression treatment and a mood stabilizer. Symbyax is approved by the Food and Drug Administration specifically for the treatment of depressive episodes associated with bipolar I disorder.