The most effective treatment for bipolar disorder can differ from other mood disorders. Bipolar disorder is characterized by shifts in mood between a manic and neutral, or manic, neutral, and depressed state.
On the other hand, most mood disorders are characterized primarily by symptoms of depression, or low mood. And while treatment for most mood disorders involves the use of talk therapy, bipolar disorder is often pharmacologically treated with mood stabilizers, rather than antidepressants.
Mood stabilizers affect the brain differently compared to antidepressant drugs. Whereas antidepressants try to help the brain compensate for low mood, mood stabilizers are more about bringing things back to baseline. Antipsychotics are another common class of drugs prescribed in cases of bipolar disorder, meant to help a patient identify and reduce manic symptoms ranging from aimless or troubling thoughts to delusions and hallucinations.
Between different classes of drugs and therapeutic methods, it’s difficult to identify the “most effective.” Bipolar disorder itself can be classified into at least three distinct types, and every case reacts differently to medication, therapy, or a combination of both.
What is Bipolar Disorder?
To understand the treatment, you need to understand the condition. Bipolar disorder is a mood disorder characterized by periods of very high mood (mania) or very low mood (depression), sometimes with neutral periods in between (euthymia). Manic periods don’t always lead to depressive periods, and vice versa. A person can be experiencing one episode of mania after another. Bipolar disorder also used to be called manic depression, or manic-depressive disorder.
Mania is described as a high mood, but one should take care not to use it interchangeably with joy. To be manic is to be filled with energy and a false sense of grandeur. In some cases, mania can be coupled with seeing or hearing things that aren’t always real. Mania is often accompanied by insomnia and restlessness, as well as irritability. Manic patients are much more likely to engage in risky behavior, from overspending to drunk driving or unprotected sex.
Depression is a persistent low mood accompanied by a lack of motivation, physical fatigue, and hopelessness. A person with depression may have a hard time enjoying the things they used to enjoy and may even feel cold or distant towards their loved ones. They might still know how to laugh or smile, but any happiness feels fleeting. Sadness becomes the new baseline.
These episodes grow and wane in symptoms and severity. They tend to cycle at a rate of a few episodes per year. Contrary to popular belief, someone who is bipolar isn’t experiencing massive mood and personality shifts every single day. Most episodes last a few days to a few weeks, and while some episodes can be mixed (exhibiting both manic and depressive symptoms), it’s a condition that comes and goes.
The Three Forms of Bipolar Disorder
Being bipolar means more than just being very happy or very sad for periods of time. Your condition affects your energy levels, fatigue, cognition, capacity for focus and concentration, creativity, and more. It can have an impact on your life socially, physically, and mentally. For most people, bipolar disorder takes on one of three forms:
1. Bipolar I
Bipolar I is defined as full-blown mania lasting at least 7 days, as well as at least one depressive episode (usually lasting 2 weeks). It’s common for patients with bipolar I to also experience mixed symptoms, i.e., symptoms of depression and mania within the same episode.
2. Bipolar II
Bipolar II is defined as a combination of depressive episodes and hypomanic episodes. Hypomania is an abnormally elevated mood without some of the more extreme symptoms of mania, such as insomnia, constant risk-taking, or psychotic symptoms (delusions and hallucinations).
Cyclothymia is characterized by recurring hypomanic and depressive symptoms over the course of at least two years (1 year in kids and teens), without the severity needed to diagnose a proper depressive or hypomanic episode. Cyclothymia is a much milder form of bipolar disorder and is generally quite rare, in part because it can be difficult to diagnose.
While not often considered a type in and of itself, some patients can be diagnosed with rapid-cycling bipolar disorder. This is effectively a diagnostic term for patients with more than four distinct episodes within the same 12-month window. A person can experience rapid cycling bipolar I or rapid cycling bipolar II, for example.
In short: mania is almost always accompanied by depression because a crash follows the emotional high. The relative severity of the mania usually decides whether a person is diagnosed with bipolar I or bipolar II. Hypomanic and depressive symptoms, too mild to categorize as bipolar disorder, might be considered cyclothymia if they persist over years.
Treating Bipolar Disorder
As with most other mood disorders, bipolar disorder is primarily treated through a combination of therapy and medication. Some patients have a predisposition towards certain treatments, responding better to one drug over another. Some respond better to one method of therapy than another.
In general, a doctor or psychiatrist will work with a patient to identify effective medication, as well as find a therapist they can work with for the long term. It’s important to trust and like your therapist and find one you can easily reach in a time of crisis.
Mood Stabilizers and Other Medication
Mood stabilizers, atypical antipsychotic medication, and antidepressants play the most important roles in tackling and reducing the symptoms of bipolar disorder, which in turn helps patients become more receptive towards therapy.
In many cases, these medications are meant to help calm down the symptoms of bipolar disorder so patients can find and hone healthy coping skills to lead a productive and happy life despite their diagnosis. There are dozens of mood stabilizers, antidepressants, and other drugs used to treat bipolar disorder.
Finding the Most Effective Treatment for Bipolar Disorder
Your doctor will recommend different medications depending on your medical history, and co-occurring conditions. If a medication does not work, speak to your doctor about switching drugs. Do not stop taking your meds altogether – it’s important to consult your doctor about how to safely wean off your medication when switching to a different treatment.