Treating Bipolar Disorder

Once an accurate diagnosis is made, determining the appropriate treatment is the next challenge. Given the variations in how the disease manifests itself, not all treatments will have the same results for everyone.

Still, the goals remain the same regardless of the type of bipolar disorder diagnosed: to control a manic or depressive episode in progress, to prevent further episodes, to increase the time between episodes, and to decrease the severity of episodes when they occur. The latter is called maintenance therapy.

The mood-stabilizing drug lithium (Lithobid) is the mainstay for treating a manic episode. Many other types of medications are used as well. For example, mood stabilizers like valproic acid (Depakene, Stavzor) and divalproex (Depakote) are increasingly used as an alternative to lithium when side effects are a problem. Other options include antipsychotics (neuroleptics) like aripiprazole (Abilify) and olanzapine (Zyprexa), anticonvulsants like carbamazepine (Equetro), and benzodiazepines like lorazepam (Ativan). Most of these drugs are effective for mixed episodes as well.

For depressive episodes, lithium and antipsychotics such as quetiapine (Seroquel) are typically used. When they do not offer relief, doctors often turn to the anticonvulsant lamotrigine (Lamictal). Antidepressants are an option but must be used with extreme care because they can trigger manic episodes. Electroconvulsive therapy (ECT) is also a choice but only for severe depressive episodes that do not respond to medication. ECT is also sometimes used for difficult-to-treat mania.

After a depressive, manic, or mixed episode is brought under control, people with bipolar disorder must continue to take medication to prevent further episodes. The most commonly prescribed maintenance therapy is lithium alone or in combination with valproic acid, Depakote, Equetro, or Lamictal. Antipsychotics like Abilify and Zyprexa also help prevent relapses, especially when used in combination with lithium.

Psychotherapy is another important component of treatment, helping a person manage stress, stay on medications, solve problems, and prevent relapse.

Publication Review By: Karen L. Swartz, M.D.

Published: 03 Mar 2011

Last Modified: 08 May 2014