Bipolar Treatment: Meds or CBT?

What is the most effective treatment plan for bipolar disorder? Here, find details on common bipolar medications and cognitive behavioral therapy, the leading non-drug treatment.

A cartoon woman feeling more positive after bipolar treatment

How to Get the Most from Medication

1. Get in the habit: Take your bipolar medication at the same time every day to get the best results. Try taking it with breakfast or right before you go to sleep to build a solid routine.

2. Explore alternative therapies: Proper sleep, dietary changes, and meditation can give an extra boost to your treatment plan, and may reduce the overall amount of medication you need.

3. Continue taking your medication even when you feel better: Bipolar treatment is all about consistency. Even when you’re feeling stable, it’s never a good idea to suddenly stop taking your medication. If you think you need to make adjustments or switch medication, talk to your doctor first.

More on Bipolar Disorder

Bipolar Disorder: Overview and Facts

Bipolar Disorder: Symptoms

Bipolar Disorder: Natural Treatments

Quiz: Could It Be Bipolar?

10 Biggest Misconceptions About Bipolar Disorder

Does Your Child have ADHD or Bipolar Disorder?

Expert Q&A: Treating Two Conditions

Personal Essay

In the days and weeks following a diagnosis of bipolar disorder, relief is a prevailing emotion. Finally, you have an explanation for the emotional roller coaster that has turned your adult life upside down. Knowing the answer feels comforting.

Perhaps more common, however, are feelings of fear, confusion, and apprehension. What treatment plan should you try? Will you need to go on meds? Is therapy an option? Is anything even going to work? It can feel overwhelming.

Fortunately, treatment for bipolar disorder is fairly straightforward, and has been proven highly effective in most cases. The best treatment plans usually involve a combination of medication and therapy — particularly a specific branch of psychotherapy known as cognitive behavioral therapy, or CBT.

Medication is the most universally effective option, and is therefore the first step in most bipolar treatment plans. Bipolar medications stabilize your moods and steady the seesaw of mania/depression — allowing you to return to your daily routine and to function more or less normally.

How Does Medication Help?

The most commonly prescribed medication is lithium, a mood stabilizer that’s been used to treat bipolar disorder for more than 60 years. Experts are still not quite sure how lithium works, but the primary hypothesis is that it works with neurotransmitters in your brain that contribute to both mania and depression.

Anticonvulsants — normally used to treat epilepsy — have also proven effective in treating bipolar disorder. If a patient doesn’t respond well to lithium, anticonvulsants are usually the next step, since they’ve been shown to be as effective as lithium in some cases. Antipsychotics are another option, usually given to patients who experience hallucinations or delusions during extreme periods of mania. In particular, a newer atypical neuroleptic, lurasidone, has been the first medication that has demonstrated significant ability to treat the depressed phase of bipolar.

Benzodiazepines are also used, primarily to treat bipolar patients who are severely anxious in both the depressed and manic phases. Benzodiazepines can produce a physical and psychological dependence if used for long periods of time, so they're best for short-term treatment.

Most bipolar medications, and particularly lithium, need time to build up in the body to a therapeutic blood level — a few weeks, in most cases. Your doctor will ask you to get blood levels drawn at regular intervals to be sure that the level is neither too low nor too high. If you don’t see results right away, be patient. Be sure you talk to your doctor frequently about changes in your mood, or if you’re worried that the medication isn’t effective.

Side Effects

Side effects do exist with bipolar medications, but they’re generally mild — common ones include changes in weight, not feeling sharp and focused, drowsiness, reduced libido, dry mouth, and shifts in appetite. Some more serious side effects have also been reported — including comas and kidney failure — but they’re extremely rare. Working with your doctor, start at a low dosage and increase it slowly to find the right balance of meds that works most effectively with the least side effects.

If you’re nervous about possible side effects, or feeling angry that you have to take medications just to be “normal,” it’s perfectly understandable — a lot of recently diagnosed bipolar patients feel this way. But medication is nothing to be ashamed of and, in most cases, nothing to worry about. Untreated bipolar disorder is far more detrimental to your life than are the medications used to treat it, and proper dosage shouldn’t alter your personality — it just works to stabilize your mood and help you avoid frightening extremes that can have drastic consequences.

If you feel “zombie-like” on medication, you’re likely taking too high a dose — talk to your doctor about reducing it.

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TAGS: Bipolar Disorder, Comorbid Conditions with ADD

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