A person can learn to manage their bipolar disorder with long-term medicines and psychotherapy (talk therapy). They may also need treatment for substance misuse or other mental health problems.
Keeping a diary of moods and sleep helps people spot early symptoms of an episode and help their doctor check how well medications are working. Other self-management strategies include stress management, healthy eating and regular exercise, support groups and family therapy.
Symptoms
People with bipolar disorder have unusual shifts in their mood, from highs (mania or “manic” episodes) to lows (depression). These episodes affect your energy, thinking, sleep patterns and sex drive. They may also interfere with your relationships, work and school performance.
The extreme highs of mania or a manic episode may cause you to feel overly confident, happy, elated or excited, and have racing thoughts. You may be irritable, and you may make reckless or risky decisions, like spending too much money or taking sexual risks. About half of the time during a manic episode, you may have delusions — believing things that aren’t true. This is called psychosis.
During depression, you may have severe sadness and feelings of hopelessness, guilt or helplessness. You may have trouble sleeping, eat less than usual and gain weight. You may have suicidal thoughts or feelings of worthlessness.
A person who has a depression episode that interferes with daily life usually gets a mental health evaluation. The healthcare professional may do a physical exam and order medical tests to rule out other illnesses.
Your doctor will diagnose bipolar disorder based on your history and symptoms. Your family and friends will help by watching for your mood swings and telling your doctor when you have them.
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Your doctor will prescribe medicines to treat your bipolar disorder. It’s important to take your medication exactly as your doctor tells you. If you stop your medicine, your symptoms may get worse or come back. Some bipolar disorder medications, such as divalproic acid and carbamazepine, have a warning that they should not be used during pregnancy or breastfeeding. Talk to your doctor about using other birth control methods while taking these medicines. Many antidepressants can be safely taken with bipolar disorder medicines, but you should tell your doctor about any over-the-counter or prescription drugs you are taking, including herbs and vitamins. Some can pass through your breast milk and cause harm to your baby.
Diagnosis
People with bipolar disorder often have other mental health conditions, such as anxiety disorders or attention deficit/hyperactivity disorder (ADHD). Some people also have medical problems like low thyroid or drug or alcohol misuse. These can cause symptoms similar to those of bipolar disorder, so it’s important for a healthcare professional to rule out other causes before making a diagnosis of bipolar disorder. A person with bipolar disorder may also have psychotic symptoms, such as delusions or hallucinations. These usually match the extreme mood they’re in — for example, people with severe mania may have hallucinations that they’re famous or have special powers.
A healthcare professional will ask about your or your loved one’s symptoms and when they occur, as well as about any family history of mental illness or other health issues. Then they’ll do a physical exam and order lab tests, such as blood and urine tests.
Most people with bipolar disorder need mental health treatment, such as medicine or talk therapy. But some people need other treatments, such as electroconvulsive therapy (ECT). During ECT, a mild electrical current is passed through your brain while you’re under general anesthesia. It can help relieve severe depression or when other treatments don’t work. It’s also used when someone is at risk of harming themselves or others, such as when they’re at high risk of suicide or are catatonic (unresponsive).
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Some people with bipolar disorder need to stay in hospital for treatment. They can get care that helps keep them calm and safe, such as a sedative for seizures. They may also need other types of mental health treatment, such as cognitive behavioral therapy. This helps them learn to replace negative thoughts and behaviors with healthy ones. It can also teach them how to recognize early warning signs of an episode.
To stay well, you need to follow your treatment plan and take your medicines as prescribed. Also, do activities that you enjoy and spend time with supportive friends and family members. If you have a chance, tell them about your bipolar disorder so they can help you watch for warning signs of an episode. You can also help yourself by staying away from drugs and alcohol.
Treatment
There is no cure for bipolar disorder, but working closely with a healthcare professional and following treatment plans can help make symptoms manageable and reduce the frequency and severity of episodes. The main treatments are medicines and psychotherapy, also called talk therapy. Treatment for bipolar disorder may also include lifestyle changes and other therapies such as electroconvulsive therapy. It can take months or years before a person with bipolar disorder and their healthcare provider find a treatment plan that works best for them.
It is important to take medicine as directed, even when you feel better, because it can help prevent manic and depressive episodes. Trying to change your dose or stop taking the medication on your own can cause serious problems. If you have any concerns about the effects of your medicine, talk with your healthcare provider.
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You should avoid alcohol and illicit drugs, including cigarettes, because they can worsen moods and interfere with prescription medicines that treat bipolar disorder. Getting enough sleep, avoiding excessive stimulation and avoiding triggers of mood episodes can also help prevent a manic or depressive episode. It’s helpful to keep a daily diary or mood chart to track your symptoms and notice warning signs.
Mental health professionals use a variety of talking therapies to help people with bipolar disorder. These include cognitive behavioral therapy (CBT), a type of treatment that helps people find healthier ways to think and act, and family-focused therapies that can help with relationships and communication. It is also helpful to learn about bipolar disorder and how to recognize the early symptoms of an episode so you can seek treatment sooner.
If you have severe mania or depression or if you have thoughts of suicide, you should get emergency care or call 911. In some cases, a healthcare professional may suggest a hospital stay to keep you safe and provide quick treatment for an episode. A hospital can monitor you, give you the medications and other care that you need, and teach you coping skills to use at home. This will help you avoid future hospital stays and improve your quality of life.
Prevention
There’s no way to prevent bipolar disorder, but treatment can help decrease the frequency and intensity of high and low episodes. The most effective treatments include long-term medication, psychotherapy and lifestyle changes.
Talk therapy (psychotherapy) helps people accept their condition and learn coping skills. It can also help people recognize the early warning signs of a manic or depressive episode and stick to a medication schedule. It can be helpful for families to receive psychoeducation as well, which can improve communication and support among family members.
Medications to treat bipolar disorder may include mood stabilizers, antipsychotics and antidepressants. Usually more than one type of medicine is needed, and it can take several months to years before the right combination of medications is found. People with bipolar disorder should never stop or lower their dose on their own without talking to a health care professional. This can cause withdrawal symptoms or make their symptoms worse or come back.
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It’s important to avoid drugs and alcohol, which can trigger or worsen episodes of mania or depression. It’s also a good idea to get plenty of sleep and keep a regular routine. Being underweight, drinking too much caffeine or eating a poor diet can also contribute to mood swings. A health care provider can recommend healthy diet and exercise plans.
People with bipolar disorder should always take their prescribed medicines as directed, even when they feel better. They should not take over-the-counter medicines unless they have been cleared by a health care professional, as some can interfere with the effectiveness of certain bipolar medications.
If you know someone who has bipolar disorder, be a positive influence by encouraging them to see a mental health professional when they are having symptoms. They can find hope and encouragement from a professional who will listen to them without judgment.
If you know someone who is having suicidal thoughts, call 911 or your local emergency number or text TALK to 741741. If you can’t get through to a live person, call the National Suicide Prevention Lifeline at 1-800-273-8255 or go to a local crisis center.
