What Are the Treatment Options for Bipolar Disorder?

Learn how medications, therapy, lifestyle changes, and other approaches fit into a management plan.

a young women smiles as she sits on a coach for a psychotherapy session

Medically reviewed in May 2022

Updated on June 2, 2022

Are you or a loved one living with bipolar disorder? If so, you know that the illness can cause major shifts in mood, energy and activity levels, and other disruptive symptoms. These, in turn, may significantly impact job performance, relationships, and daily living. If not properly managed, symptoms can worsen.

Fortunately, people with bipolar disorder can lead healthy lives when they receive effective treatment. Discover the options and how to choose what works best for you in managing the condition.

Types of bipolar disorder
Symptoms of bipolar disorder can be divided into two emotional states: the highs of mania and the lows of depression.

In the manic stage, people may feel agitated, restless, and have racing thoughts. (Hypomania involves milder manic periods.) The depressive stage typically brings on feelings of extreme sadness. A bipolar diagnosis is determined by the frequency and severity of the mania and depression experienced, which can vary dramatically between individuals.

A diagnosis may also specify one of several types of bipolar, including the following:

Bipolar I disorder involves having at least one episode of mania. For a diagnosis of bipolar I, someone must have manic episodes that last at least seven days or are so severe that hospital care is required. Some people will have mixed episodes of both mania and depression.

Bipolar II disorder is characterized by having depressive periods that shift to hypomania, which are manic periods that are milder than those that characterize bipolar I.

Cyclothymic disorder (or cyclothymia) is a less severe type of bipolar, where people will have milder symptoms of both depression and hypomania lasting for at least two years.

Other specified and unspecified bipolar disorder refers to symptoms that do not fit the categories above, but still involve abnormal mood elevation.

Additionally, rapid cycling can occur with any type of bipolar disorder. It is diagnosed when someone has at least four episodes of depression, mania, or hypomania within a 12-month period. For most people, rapid cycling is temporary. It’s thought to be more common among women. A mixed episode (also known as an episode with mixed features) involves feeling symptoms of mania and depression at the same time.

Symptoms to understand
Manic symptoms may include:

  • Exaggerated optimism and self-confidence
  • Fast talking and racing thoughts
  • Grandiose ideas about oneself
  • Impulsive and reckless behavior (such as wild shopping sprees, irresponsible driving choices, engaging in risky sexual activity, or abusing drugs)
  • Extreme agitation and irritability
  • Restlessness and getting little to no sleep
  • Psychotic behaviors (such as delusions or hallucinations)

Depressive symptoms may include:

  • Hopelessness and sadness
  • Fatigue and exhaustion
  • Nervousness
  • Irritability
  • Loss of interest in daily matters
  • Suicidal thoughts or actions

Main treatment options for bipolar disorder
Effective treatment for bipolar disorder often involves several approaches. These may include:

Medication: While there is no cure for bipolar disorder, medication prescribed by a healthcare provider (HCP) can go a long way toward helping to regulate symptoms. Some of the most common choices include the following:

  • Mood stabilizers help control moods and are usually the go-to medication for treating bipolar disorder. Lithium is a popular mood stabilizer.
  • Anticonvulsants like valproic acid and lamotrigine can also act as mood stabilizers and are used to treat mania and to delay episodes in some patients.
  • Atypical antipsychotic medications (also known as second-generation antipsychotics)  often help control acute mania, mixed episodes, and acute bipolar depression. They are often paired with other bipolar medications.  
  • Antidepressants can sometimes be effective in treating the depressive side of the disease. Taking antidepressants alone, however, may sometimes lead to increased mania or hypomania, which is why HCPs tend to prescribe antidepressants with mood-stabilizing medication as well.

Therapy: While taking medication is key to treatment, having counseling sessions with a psychiatrist or psychologist who is knowledgeable about treating bipolar can also help. Psychotherapy, also known as talk therapy, can offer guidance and support to patients and their families. The following are common forms of psychotherapy:

  • Cognitive behavioral therapy (CBT) teaches patients how to change negative or destructive thoughts, patterns, and behaviors.
  • Family-focused therapy includes family members and enhances family coping strategies. 
  • Interpersonal and social rhythm therapy helps patients improve their daily routines, relationships, and interactions.
  • Psychoeducation is typically done in a group setting. This type of therapy gives patients a more in-depth look into their illness and treatments, as well as how to manage symptoms before they turn into a full-blown illness.

Electroconvulsive Therapy (ECT): When symptoms are severe, and when medication and psychotherapy don’t ease symptoms to an acceptable degree, electroconvulsive therapy, formerly called “electroshock therapy,” may be recommended. While this form of therapy has gained a bad reputation in previous years, the way it’s administered has improved. In its current form, it can offer relief for patients with severe bipolar symptoms.  

Transcranial Magnetic Stimulation (TMS): Another treatment used when medication and therapy aren’t effective is transcranial magnetic stimulation. This therapy involves applying magnetic pulses to overactive or underactive areas of the cerebral cortex in the brain. This newer technique is noninvasive and has been shown to reduce depressive symptoms in people with bipolar disorder.  

Lifestyle habits: In addition to consulting regularly with an HCP and following the treatment plan you develop together, certain lifestyle habits can help manage symptoms.

For example, getting regular physical activity can help you fend off depression with the release of feel-good hormones called endorphins. It may also improve sleep and help curb weight gain, which is one possible side effect of bipolar medication.

Writing or journaling can also be a constructive outlet during traumatizing experiences. It’s also important to refrain from drinking or using illegal drugs; substance abuse is common among bipolar patients.

Guidelines for getting the right treatment
Take medications as prescribed and tell your HCP about any side effects or symptoms you experience. Keeping track of your moods, treatment progress, and sleep patterns can help your provider see if medication is working properly. Your HCP may switch or add medications if your symptoms worsen or become unbearable.

Remember to be patient with your treatment plan. Medications don't all work the same for everyone. You may need to try several prescriptions (sometimes more than one at a time) before you and your HCP determine what works. Continue to communicate with your provider for an overall treatment plan that is best for you. 

Article sources open article sources

Depression and Bipolar Support Alliance. Bipolar Disorder. Accessed May 20, 2022.
National Alliance on Mental Illness. Bipolar Disorder. Accessed May 20,2022.
Gold AK, Ornelas AC, Cirillo P, et al. Clinical applications of transcranial magnetic stimulation in bipolar disorder. Brain Behav. 2019;9(10):e01419.
Tavares, D., Myczkowski, M., Alberto, R. et al. Treatment of Bipolar Depression with Deep TMS: Results from a Double-Blind, Randomized, Parallel Group, Sham-Controlled Clinical Trial. Neuropsychopharmacol. 42, 2593–2601 (2017).
Connolly KR, Helmer A, Cristancho MA, Cristancho P, O'Reardon JP. Effectiveness of transcranial magnetic stimulation in clinical practice post-FDA approval in the United States: results observed with the first 100 consecutive cases of depression at an academic medical center. J Clin Psychiatry. 2012;73(4):e567-e573.
National Institute of Mental Health. Bipolar Disorder. Accessed June 2, 2022.
National Alliance on Mental Illness. Bipolar Disorder. Reviewed August 2017.
Depression and Bipolar Support Alliance. Bipolar Disorder. Accessed June 2, 2022.
Steardo, L., Luciano, M., Sampogna, G. et al. Efficacy of the interpersonal and social rhythm therapy (IPSRT) in patients with bipolar disorder: results from a real-world, controlled trial. Ann Gen Psychiatry 19, 15 (2020).

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