Can bipolar depression be prevented?

Dr. Jeanne Morrison, PhD
Family Practitioner

Bipolar depression cannot be initially prevented. However, early intervention and consistent treatment can help limit the occurrence of bipolar depression episodes.

The imbalances in the brain cannot be permanently reversed and people who do not effectively treat their symptoms go on to have more episodes. A regimen of medication and preventative measures like adequate sleep and regular exercise can keep manic bipolar depressive episodes to a minimum. A combination of medication including mood balancers, a healthy lifestyle that avoids non-medical drugs and alcohol, and cognitive and behavioral therapy is the most effective form of lifelong bipolar treatment.

Donna Hill Howes, RN
Family Practitioner

For depression with bipolar disorder, your doctor will prescribe mood-stabilizing medications and perhaps an antidepressant to boost the low mood. If you want to complement your doctor's conventional medical treatment with alternative medicine therapies, you need to first talk with your doctor. Some scientific research shows that omega-3 fatty acids may reduce depressive symptoms linked with bipolar disorder. The popular herbal treatment St. John's wort may trigger mania in some people and can interact with antidepressants. Acupuncture can ease depression, but more scientific research is necessary to determine if acupuncture is effective in specifically treating bipolar disorder depressive episodes.

Dr. Thomas Jensen
Psychiatrist (Therapist)

Bipolar disorder can't be prevented, but deep brain stimulation can help treat the disorder. In deep brain stimulation, microelectrodes are inserted into a very specific nest of cells in the brain. Once the appropriate frequency and amplitude of the electrical impulses are found, this seems to treat bipolar depression. Surgical technique is critical for success, and it may be some time before the technique gets Food and Drug Administration (FDA) approval.

There is no cure or prevention that does not require ongoing treatment. However, many people do very well on mood stabilizing medications and may go for decades with few symptoms. Often it takes trying many different medications before the right medication is found for an individual patient. But be patient, usually an effective medication is found and someone may be relatively symptom free for many years. Many people live normal lives with the help of the right mood stabilizing medication. But almost everyone with bipolar I will require medication for much of their lives.

Dr. Michael D. Banov, MD
Psychiatrist (Therapist)

Bipolar depression cannot be prevented, but you can do things to manage episodes. Some people with bipolar depression try natural supplements. Not all natural supplements are safe in bipolar disorder. Treating depression with SAMe and St John's wort, for example, has been shown to trigger manic episodes in some people. Do not treat yourself with over-the-counter supplements without talking with your doctor first.

There have been very few studies and very few people with bipolar depression treated in those studies. While preliminary results look promising, it is too early to make a conclusion whether the benefits outweigh the risks. Further studies are being conducted that will help determine whether this may be a treatment option in the future.

Dr. Ruth White, MPH
Social Work Specialist

There are many medications that are approved by the FDA to manage bipolar disorder. There are also many medications that are used 'off-label' for bipolar depression which means that they are approved for use to treat other conditions. The reason for this 'off-label' use is that the requirements for FDA approval are very rigorous and may cost millions of dollars that the pharmaceutical company may not recoup.

Because depression is part of the bipolar spectrum, I am including drugs that are mood stabilizers. When it comes to depression as a unique symptom, whatever drugs that are FDA approved for treating depression, may be used to relieve symptoms in bipolar disorder with close supervision from a psychiatrist but strictly defined this would be an off-label use. Also note that most people with bipolar disorder take a combination of medications to stabilize moods over the long-term and at the same time there is treatment of episodes that may require periodic use of the medication.

The drugs that are FDA approved for use in bipolar disorder are Eskalith or Lithobid (lithium: mood stabilizer), Depakote (aka olanzapine: mood stabilizer), Lamictal (lamotrogine: mood stabilizer), Saphris (asenephine: mood stabilizer), Zyprexa (aka olanzapine: anti-psychotic) and Abilify (aripiprazole: mood stabilizer).

Specifically for bipolar depression, a combination of Symbyax (fluoxetine and olanzapine) and Seroquel (quetiapine) have been specifically used for bipolar depression.

Sheri Van Dijk
Psychiatrist (Therapist)

Unfortunately, there is no cure for bipolar disorder, and there is no way to reliably prevent bipolar episodes. However, there are many things you can do that will reduce the likelihood of future episodes of depression or mania:

  • Take your medications as prescribed for your bipolar and any other illnesses you might have; when physical illnesses go untreated, they can impact you emotionally, which could eventually result in bipolar episodes
  • Maintain structure in your life: have a regular bedtime and wake time (sleep deprivation has been identified as one of the major triggers for mania); incorporate exercise (this gets the endorphins or "feel good" chemicals going in your brain) and pleasant activities into your life in order to generate positive emotions
  • Make sure you have positive relationships in your life; consider eliminating or reducing relationships in which you feel abused, drained, unsatisfied, etc.
  • Practice mindfulness: this is a technique that helps people focus on the present moment (rather than living in the past or future as we often do) with acceptance (instead of judging like we usually do). Mindfulness has been shown to be effective in reducing emotional pain and stress, improving sleep and immune function, and is also helpful in all sorts of other ways—it's just a healthier way of living.

These are just some general tips to preventing depression or manic relapses in bipolar disorder. Remember that working with a psychotherapist, if this is an option for you, can also help you stay on a healthier track.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.