Treatment for the Symptoms of Bipolar Disorder
How to address the symptoms of bipolar disorder with medication, therapy, diet, and lifestyle changes.
In the days and weeks following a diagnosis of bipolar disorder, relief is a common emotion. Finally, you have an explanation for the emotional roller coaster that has turned your life upside down and right-side up again for so many years. Knowing the answer can feel comforting, particularly for those who have been misdiagnosed or improperly treated in the past.
Perhaps more common, however, are feelings of fear, confusion, and apprehension. What treatment plan will work best? 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.
Treating Bipolar Disorder with Medication
Medication is the most universally effective treatment option, and likely will be the first and most important step in your therapy. Medications used to treat bipolar disorder work by stabilizing your moods — untangling you from the dramatic ups and downs of mania and depression — and, if you respond well to them, allowing you to function more or less normally.
If you’re nervous about possible side effects, or angry that you have to take medications just to be “normal,” you’re not alone — most (if not all) 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.
The most commonly prescribed medication is lithium, a mood stabilizer that’s been used to treat bipolar disorder for more than 60 years. Experts know that lithium works with the central nervous system and spinal cord — primarily with certain neurotransmitters in your brain that seem to contribute to both mania and depression — but it’s exact mode of action is still unclear. About 75 percent of patients respond positively to lithium, making it the most effective option for treating bipolar disorder — but about the same percent of patients experience at least minor side effects.
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 to demonstrate 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 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.
As with most psychiatric prescriptions, side effects do exist with bipolar medications, but in most cases, they’re mild. Common ones include changes in weight, feeling “dull” or unfocused, 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 feel “zombie-like” on medication, you’re likely taking too high a dose — talk to your doctor about reducing it, or switching to a different class of medications.
Treating Bipolar Disorder with Therapy
Many people taking medication for bipolar disorder still suffer from shame and anger related to being bipolar — particularly if they have spent years undiagnosed — and medication alone is often not enough to repair the relationships damaged by symptoms. This is where therapy comes in — to fill in the gaps and boost the overall effectiveness of your treatment plan.
While traditional psychotherapy is used occasionally, cognitive behavioral therapy (CBT) is the most common form of therapy for patients with bipolar disorder. Working together with a trained CBT therapist, bipolar patients examine possible triggers for mania or depression, and talk through their thinking processes to identify distortions that may be negatively impacting their view of a situation. Patients also learn coping mechanisms and relaxation techniques to — ideally — stop episodes in their tracks. When applied effectively, CBT can help patients improve social and romantic relationships, and greatly reduces their chance of relapse.
The first topic you’ll need to address is the shame and resentment associated with finding out that you have a major mental illness that is going to affect you for the rest of your life — one that may be passed on to your children. This is never easy. It will likely take work — with an experienced counselor you trust — to sort through this drastic change in your life and your future.
Luckily, CBT can help a lot with these areas, plus it has the added benefit of empowering patients to take control of their treatment process. Since CBT is interactive and can be highly cathartic, patients report feeling like active participants in their fight against bipolar — not just spectators to a medication.
In some cases, the entire family will need to be involved in therapy. Probably the single biggest factor in achieving a good outcome is having the support, understanding, and acceptance of the important people in your life. In this same vein, bipolar support groups can be invaluable. Being able to talk with and gain support from people who “really know what it’s like” provides a new level of support and understanding that can’t be found anywhere else.
In order for CBT to properly work, however, the patient’s bipolar disorder should be relatively stable and under control when therapy begins. If someone is in the grips of a dramatic episode of mania, CBT won’t be of much help.
Treating Bipolar Disorder with Dietary Changes
It’s true that medication and therapy are the most effective treatment options for bipolar disorder. But they can take weeks to reach their full effect, and they are certainly not the only solutions for managing your symptoms and keeping your moods in line. Eating certain foods — and avoiding others that have been linked to exacerbated symptoms — is one way you can take control of your treatment (as well as your overall health).
A healthy bipolar diet includes the following:
Omega-3s: Multiple studies have shown that Omega-3 fatty acids like the kinds found in fish and fish oil supplements can help decrease the feelings of depression so common in bipolar patients. Vegetarian? Try getting your Omega-3s from eggs or nuts instead.
Magnesium: Magnesium — found in whole grains, beans, and dark leafy vegetables like spinach — has been shown to have an effect similar to lithium, the most common bipolar medication. Upping your intake of magnesium, a natural mood stabilizer, may decrease your need for medication. (It should be noted, however, that magnesium cannot and should not replace lithium entirely.)
Salt: Seems counterintuitive, right? Many people who are trying to “eat healthy” try to dramatically lower their salt intake, but this isn’t necessarily the best idea — especially if you have bipolar disorder. Once you start treatment, don’t let your salt intake get too low, and definitely don’t cut out salt entirely — salt is very necessary to regulate the levels of bipolar medication in your bloodstream.
Healthy Fats: Healthy fats like those found in avocados and olive oil won’t have any effect on your bipolar symptoms themselves, but they can help keep you feeling full longer and decrease your cravings for the “foods to avoid” listed below.
Individuals with bipolar disorder should cut back on the following:
Caffeine: Caffeine and other stimulants can kick mania up a notch. When experiencing a manic phase, avoid coffee, soda, and energy drinks. Try herbal teas or infused water instead — the herbs can give you a natural energy boost to overcome slumps.
Sugar: Sugar highs and lows can make an already unbalanced mood even more erratic, and sugar crashes can make a depressive phase much worse. If you really need something sweet, reach for fruit — the natural sugars won’t cause such a drastic blood sugar spike.
Refined Carbohydrates: Bipolar patients may be more prone to obesity, since imbalances of seratonin in their brains may lead them to crave more unhealthy carbohydrates. Ditch the processed junk and get your carbs from whole grains, fruits, and vegetables instead.
Alcohol: Alcohol and bipolar disorder just don’t mix. Not only can alcohol interact poorly with psychiatric medications, it can also disrupt sleep — bad news for an already high-strung bipolar person. Bipolar patients are also more likely than neurotypical people to develop drug or alcohol addictions. In other words, alcohol is not worth the risk.
Grapefruit: Talk to your doctor about your specific situation, but some bipolar medications — particularly anticonvulsants — interact poorly with grapefruit and grapefruit juice.
Food can’t cure your bipolar disorder, and it’s always best to talk to your doctor about the best treatment plan for you. But proper diet can, in some cases, help keep your symptoms stabilized.
Treating Bipolar Disorder with Lifestyle Changes
Though there is little hard data behind it, anecdotal evidence suggest that getting regular exercise and following a proper sleep schedule can have positive effects on bipolar symptoms, too — at least during a depressive phase. At the very least, one study found a correlation between a sedentary lifestyle and an increased risk of bipolar episodes, indicating there may be some connection between low activity levels and difficult bipolar symptoms.
Since exercise boosts endorphins, it seems to have the most positive effects during depressive phases, helping patients who are not being treated with medication lift their moods. For the same reason, however, some patients find that it tends to exacerbate their manic phases — meaning a dangerous high can go from bad to worse thanks to a big rush of endorphins.
For patients who are being treated with medications, regular exercise can help combat the weight gain that can be an unwelcome side effect. Patients taking lithium, however, should talk to their doctor before embarking on an exercise plan — the medication can affect your salt levels and potentially dehydrate you if proper precautions aren’t taken. Make sure you eat a healthy level of salt and drink a lot of water if you plan to exercise while taking lithium.
Since sleep disturbance is a common symptom of untreated bipolar disorder, it can be a chicken-egg situation — are you not getting enough sleep because escalating symptoms are keeping you up, or are your symptoms getting worse because you’re not getting enough sleep? Regardless, working toward restoring a normal sleep cycle can help you manage symptoms and feel more in control during a manic phase. CBT can — and often does — help with this, but there are at-home solutions you can try on your own:
Keep a sleep diary: Track when you go to sleep, how long it takes you to fall asleep, how well you slept, and what time you wake up. This will help you notice patterns and identify triggers for poor sleep — and if you’re tracking your moods as well, can help you identify whether sleep problems preceded a mood swing, or vice versa.
Avoid alcohol and caffeine: As mentioned above, alcohol and caffeine can affect your sleep cycle in a negative way — even more than they would a neurotypical person.
Create a perfect sleep environment: Make your room as dark as possible, and keep the room cool. Try to go to bed at the same time every night, even on the weekend. Visualization and relaxation exercises can also help someone with bipolar disorder quiet a racing mind and fall asleep.
Updated on March 5, 2018