Can bipolar disorder be cured? Unfortunately, like most other chronic mental health disorders, bipolar disorder can’t be completely eradicated or fixed. It is based on inborn differences in brain chemistry and function that can’t be permanently changed. However, bipolar disorder can be successfully managed to the point that people are mostly or completely symptom-free for long periods of time. The key factor that determines whether a person experiences worsening mood episodes over time or has only minor symptoms is whether they receive proper bipolar disorder treatment.
Therapy Options for Bipolar Disorder
Therapy for bipolar disorder is an important part of any treatment plan. In therapy, people can process trauma, learn how to recognize the signs of impending mood episodes and gain insight into behavior patterns that either worsen or improve bipolar symptoms.
In addition to talk therapy, other types of therapy can be important for people with bipolar disorder. Behavior modification for people with bipolar disorder can include changes to diet, exercise routines and daily schedules. These changes can help people naturally improve their moods and the quality of their sleep, which can decrease the frequency of mood episodes.
For some people, a service dog can be a good option. In addition to providing affection and companionship, a service dog can help by:
- Indicating when it’s time for bed
- Interrupting dangerous behaviors
- Reminding a person to take medication
- Waking a person up at the same time every day
- Calming a person who exhibits signs of agitation or mania
Any form of regular or complementary bipolar therapy focuses on helping people regulate their moods and sleep cycles, take their medications regularly, address social or functional issues, and respond to serious symptoms by reaching out for help as needed.
Psychotherapy is an essential component of treatment for bipolar disorder. People with bipolar disorder can benefit from different therapeutic styles, but successful bipolar disorder therapy should include an educational component to help people learn:
- How to recognize the warning signs of oncoming mood episodes
- The effects of certain behaviors on bipolar symptoms
- Consequences of discontinuing medication or treatment
- Techniques for managing stress and regulating emotions
Traditional styles of insight-based psychotherapy are less likely to be helpful for people with bipolar disorder because the condition is rooted in biological factors, not cognitive ones. Gaining insight into the meaning of childhood experiences won’t have as much impact for someone with bipolar disorder as it will for someone whose depressive symptoms are rooted in ways of thinking about themselves that originated in childhood.
Supportive psychotherapy, which focuses on the relationship between a therapist and a client, may be a better option for people with bipolar disorder. In this style of therapy, clients receive emotional support and are encouraged to continue using successful strategies or behaviors. Supportive psychotherapy promotes acceptance of treatment and increases adherence to medication and treatment plans.
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy (CBT) helps people identify distorted or irrational thoughts or beliefs that trigger negative emotions and behaviors. They then learn how to challenge and change these ways of thinking. For people with bipolar disorder, CBT functions in a similar way as supportive psychotherapy. Instead of focusing on the origins of their disorder, the therapy tactics help people manage symptoms and follow through on important behavioral strategies.
Bipolar symptoms are linked to neurochemical changes that do not rely on styles of thinking but can be worsened or triggered by maladaptive thought patterns. This is especially true in depressive episodes. Thinking things are hopeless can make depressive symptoms worse and make people less likely to address these thoughts or feelings.
Cognitive behavioral therapy for bipolar disorder focuses on the following outcomes:
- Stabilizing daily routines
- Improving symptom recognition
- Increasing problem-solving abilities
- Enhancing interpersonal and communication skills
- Identifying and addressing thoughts that affect mood
- Encouraging early and consistent intervention when mood symptoms arise
Research shows that people who receive CBT for bipolar disorder have a better quality of life, fewer and less intense mood episodes, improved treatment compliance and fewer hospitalizations.
People who experience severe manic or depressive symptoms may require brief inpatient hospitalization for their safety and stabilization before they are able to continue treatment in an outpatient setting. Some people receive treatment in specialized bipolar treatment centers but most inpatient or residential mental health treatment facilities are able to provide tailored treatment for people with bipolar disorder.
People usually enter inpatient treatment for bipolar disorder for one of three reasons:
- They are at risk of harming themselves or others
- They are in an environment that is triggering their symptoms
- They have symptoms too severe to be treated in an outpatient setting
People present a risk of harm to themselves not only when they have a plan for suicide but also when they are at risk of acting on delusional thoughts like believing they can stop traffic telepathically. People can also be at risk of harm when their thinking is so disordered that they are unable to properly care for themselves.
People with severe bipolar symptoms may have enough awareness of their condition to seek inpatient treatment voluntarily or may need to be admitted involuntarily through a process of civil commitment. When friends, family members or professionals are concerned, they can reach out to local authorities to have the person with the disorder evaluated for involuntary admission.
Regardless of whether treatment is voluntary or involuntary, inpatient treatment for bipolar disorder has the same goals:
- Starting or resuming medication for bipolar disorder to stabilize brain chemistry
- Participating in individual and group therapy to address immediate symptoms
- Identifying and addressing psychological factors that led to the admission
- Developing a discharge plan with referrals to outpatient treatment providers
For some people with bipolar disorder, hospitalization can become a regular part of their lives. However, following a consistent outpatient treatment plan can help people reduce the number of times they are admitted for inpatient treatment.
Group or Family Therapy
Group and family therapy can be important components of treatment for people with bipolar disorder. Group therapy or support groups can help people with bipolar disorder learn effective symptom-management strategies from their peers and reduce feelings of stigma, shame and loneliness. Treatment groups might be the first places that people with bipolar disorder feel understood and not alone.
Both group and family therapy can help people with bipolar disorder improve communication deficits caused by the disorder’s common symptoms. People think and act differently when they are depressed or manic and can alienate others without realizing they are doing so.
In joint therapy sessions, people can learn how others perceive them and how they can be more effective in conversing or interacting with others. Family therapy can help people with bipolar disorder and their loved ones understand one another and practice different communication strategies in real time.
Medications Used for Treating Bipolar Disorder
Bipolar medication is an important treatment component for people with bipolar disorder. Because it is rooted in biological factors, bipolar disorder nearly always requires medication to treat, even when people participate in other therapies. Many different types of medication can be used, but mood stabilizers are the most common medication for bipolar disorder.
Scientists and mental health professionals do not fully understand how mood stabilizers for bipolar disorder work, but these medications are effective in reducing the frequency of mood episodes. Any bipolar medication list includes mood stabilizers.
Lithium was one of the first mood stabilizers used to treat bipolar disorder and is still a common bipolar medication, though it requires more monitoring and management than other bipolar medications. Some people consider taking lithium orotate for bipolar disorder instead of regular lithium, but this over-the-counter supplement is not supported by the Food and Drug Administration (FDA) or most clinical professionals as a safe or effective alternative to lithium.
Other commonly prescribed mood stabilizers include drugs that were originally formulated to treat epilepsy or control seizures. These drugs are generally known as anticonvulsants.
In addition to lithium, lists of bipolar medications typically feature the six most commonly prescribed anticonvulsant medications:
- Oxcarbazepine (Trileptal)
- Carbamazepine (Tegretol)
- Valproic acid (Depakote)
- Lamotrigine (Lamictal)
- Gabapentin (Neurontin)
- Topiramate (Topamax)
Researchers believe that these medications work by controlling levels of neurotransmitters in the brain. There are significant differences in how they are formulated that can make some of them more useful than others for treating certain aspects of bipolar disorder.
Trileptal for bipolar might be especially effective in reducing the frequency of mood cycling and is safer to use than the similarly formulated drug Tegretol. Gabapentin for bipolar is usually not prescribed by itself but in addition to other medications when symptoms are too severe to be fully controlled by a single medication.
Lamictal or lamotrigine for bipolar not only reduces the frequency of mood cycles but diminishes depressive symptoms more effectively than other anticonvulsant medications. Due to a potentially serious skin reaction that some people develop in response to lamotrigine, the Lamictal dosage that bipolar patients receive at the beginning of treatment is typically low. As people show tolerance to the medication, a prescribing physician slowly increases the dose.
Sometimes people with bipolar disorder experience psychotic symptoms and need medication to control them. However, antipsychotic medications have many uses aside from managing psychotic symptoms. They are frequently prescribed to help people control aggression or anger. Antipsychotics are also prescribed instead of anticonvulsants to stabilize mood or reduce manic symptoms. Second-generation or atypical antipsychotic medications have been found to work as antidepressants for bipolar disorder. These medications include:
- Aripiprazole (Abilify)
- Risperidone (Risperdal)
- Quetiapine (Seroquel)
- Olanzapine (Zyprexa)
- Lurasidone (Latuda)
Research shows that Abilify for bipolar disorder is effective in treating and preventing manic and mixed episodes but not as effective in treating bipolar depression. Research supports the use of Seroquel for bipolar depression, though it may not be the best option for people with diabetes or other medical conditions. Using Latuda for bipolar depression is as effective as using Seroquel and also comes with fewer risks and side effects.
Clinicians frequently prescribe antidepressants, including selective serotonin reuptake inhibitors (SSRIs), as bipolar depression medication, though they are usually prescribed in addition to mood stabilizers to avoid triggering manic or hypomanic episodes. Many professionals are not comfortable with the risks and prefer to try anticonvulsant or antipsychotic medications with antidepressant properties first, especially for people with histories of severe mania.
In place of Prozac for bipolar disorder, physicians may prescribe Symbyax, a newer drug that combines fluoxetine (Prozac) with olanzapine. Using this medication can prevent some of the negative outcomes that occur when SSRIs are used to treat bipolar depression. Research shows that using SSRIs like Lexapro for bipolar disorder can help with severe depression but frequently causes adverse effects like mania, psychosis and suicidal ideation.
For these reasons, professionals usually only prescribe SSRIs like Zoloft for bipolar disorder when people are in an acute depressive episode and the risks of inducing manic symptoms are less severe than the risks of worsening depression. Even though it is an entirely different kind of antidepressant medication, using Wellbutrin for bipolar disorder also risks triggering mania.
Serotonin-norepinephrine reuptake inhibitors (SNRIs) like Effexor for bipolar depression are still being studied.
Anti-anxiety medications like benzodiazepines are sometimes prescribed to people who have bipolar disorder and comorbid anxiety disorders, or to address bipolar agitation or insomnia. However, using this type of medication comes with many risks, including triggering depressive symptoms. These medications also have addictive properties and are not recommended for people with substance use disorders. For these reasons, clinicians often try to treat anxiety in people with bipolar disorder in other ways.
Treatment for Bipolar Disorder with Co-Occurring Disorders
People with bipolar disorder frequently have co-occurring disorders. Research suggests that they may be especially prone to obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD) and substance use disorders. The reason PTSD and bipolar disorder commonly occur together is that people with each disorder often have histories of childhood trauma.
Other research shows that comorbid adult attention-deficit hyperactivity disorder (ADHD) is also common, with up to 21 percent of people with bipolar disorder having comorbid ADHD and almost half of the people with adult ADHD having comorbid bipolar disorder. Comorbid adult ADHD and bipolar disorder may cause symptoms that resemble traditional bipolar manic depression symptoms like highly unstable mood episodes, as well as higher rates of comorbid disorders.
Autism and bipolar disorder are common co-occurring disorders for children who have pediatric bipolar disorder. As many as 30 percent of children with bipolar disorder also meet criteria for autism spectrum disorder (ASD). These comorbid disorders are associated with more severe symptoms and more intensive treatment like assertive community outreach programs.
Regardless of the type of co-occurring disorder a person with bipolar disorder experiences, the approach to treatment is similar. People with co-occurring conditions require separate services that target different aspects of each condition. The best outcomes occur in integrated treatment programs in which mental health professionals closely coordinate services and communicate regularly with one another. This prevents advancements in treating one condition from causing regression in another.
Anxiety and Bipolar
While it is not part of the criteria for the disorder, the bipolar-anxiety combination is common. People with bipolar disorder frequently experience co-occurring panic disorder or OCD. These comorbid disorders can make it harder for clinicians to make an accurate diagnosis and can complicate the course of each disorder. Co-occurring symptoms of anxiety and mania can cause a person to become severely agitated and make them more likely to require hospitalization.
Depression and Bipolar
Most people with bipolar disorder experience depressive episodes at some point. A diagnosis of bipolar disorder rules out a diagnosis of major depressive disorder. When considering unipolar versus bipolar depression, the only factor that makes a difference is whether people experience the opposite “pole” of mania. One way to think of this is that bipolar disorder is essentially a combination of major depressive disorder with episodes of mania. Some depressive symptoms can be especially acute for people with bipolar disorder; bipolar insomnia can be worse than insomnia in unipolar depression.
Borderline Personality Disorder and Bipolar
One of the alternative diagnoses clinicians must rule out when evaluating a person for bipolar disorder is borderline personality disorder. Both conditions are marked by episodes of rage, unstable moods and high-risk behavior. However, there are key differences that distinguish each disorder.
When considering borderline personality disorder versus bipolar disorder, an important factor to evaluate is how frequently moods shift. People with borderline personality disorder have labile moods that vary from day to day while people with bipolar disorder have discrete mood episodes that last for weeks or months.
Another consideration in evaluating borderline personality disorder versus bipolar disorder is the extent to which a person struggles with their sense of identity. People with BPD normally experience more identity confusion and more fear of abandonment than people with bipolar disorder.
It is not always a matter of comparing bipolar versus borderline personality disorder. Research shows that people can have co-occurring borderline personality and bipolar disorders. Both disorders are associated with childhood abuse or neglect and are linked to higher rates of suicide attempts and co-occurring substance use disorders.
Schizophrenia and Bipolar
Some people who experience bipolar psychosis wonder if it means that they have bipolar schizophrenia. It is important to understand that psychotic symptoms naturally occur in severe bipolar disorder and do not indicate a secondary diagnosis of schizophrenia.
Evaluating schizophrenia versus bipolar disorder is relatively straightforward for clinicians who are familiar with both disorders. Schizophrenia is a thought disorder while bipolar disorder is a mood condition. This means the primary symptoms of schizophrenia affect thought and the primary symptoms of bipolar disorder affect emotions. Mood symptoms always occur first in bipolar disorder and bipolar psychosis only occurs when mood symptoms become particularly severe.
Schizoaffective Disorder and Bipolar
It can be trickier to distinguish what makes schizoaffective disorder bipolar type different from bipolar disorder. Schizoaffective disorder is a thought disorder that includes mood episodes like those of bipolar disorder. However, even for people with schizoaffective bipolar type, psychotic symptoms like delusions and hallucinations are primary, persistent and severe. For people with schizoaffective disorder, mood symptoms follow psychosis.
For example, delusions of grandeur can incite elevated mood for people with schizoaffective disorder, while auditory hallucinations of malicious voices can trigger depression. For people with bipolar disorder, mood symptoms like depression or elevated mood are primary and psychotic symptoms follow. For example, particularly severe bipolar depression can trigger auditory hallucinations of cruel or mocking voices.
Schizoid and Schizotypal Personality Disorders and Bipolar
Schizoid and schizotypal personality disorders are often considered schizophrenia spectrum disorders because they resemble schizophrenia but are different. Hallucinations are rare in these personality disorders and the delusions that people with schizoid or schizotypal disorders experience are usually less florid and bizarre than schizophrenic delusions. It is very rare for people with these personality disorders to have co-occurring bipolar disorder.
Co-Occurring Bipolar Disorder and Substance Abuse
People with bipolar disorder often use substances to try to change or enhance their moods. Due to the severity and persistence of bipolar symptoms, this can frequently lead to addiction. These co-occurring disorders come with many risks. Having comorbid substance use and bipolar disorders increases the risk of suicide and reckless behavior with severe legal, financial and social consequences.
Bipolar hypersexuality might be especially pronounced in people who have bipolar disorder with comorbid PTSD and substance use disorders. A history of childhood sexual trauma is strongly linked with all three conditions. These experiences can drive people to act out their trauma in an effort to cope with painful feelings or to feel in control of a similar experience. The effects of many drugs can also make bipolar insomnia worse for people with co-occurring substance use disorders.
Bipolar disorder can be overwhelming on its own and even more so when it is combined with a substance use disorder. The key to breaking the cycle of crisis and hospitalization associated with addiction and bipolar disorder is receiving the appropriate type of care. Contact The Recovery Village to learn about how targeted intensive treatment can change the lives of people with these serious and persistent comorbid disorders.