Treating Bipolar I Disorder

Bipolar I disorder is a very serious psychiatric disorder.  If left untreated, it can result in disastrous consequences, tearing families apart and destroying lives in many ways.  For most people who are diagnosed with it, bipolar I disorder is a lifelong condition that requires ongoing treatment.  Currently, there is no cure for this complex, challenging disorder.


In order to be diagnosed with bipolar I disorder, there must be a history of at least one manic episode.  Most people with the disorder also experience episodes of major depression, although a history of depression is not required for the diagnosis. The term “bipolar” refers to these two contrasting, or polar-opposite, moods.  Individuals with bipolar II disorder have “hypomanic” episodes, which are less severe than manic episodes.


During a manic episode, individuals often behave as if they’re high on a stimulant drug like speed.  They’re full of energy and may be very happy or highly irritable.  Manic symptoms may also include:

  • Grandiosity or an expansive mood
  • Decreased need for sleep; restlessness
  • Talkativeness; rapid, pressured speech
  • Taking on multiple tasks, projects and goals at once
  • High degree of distractibility; limited or no focus; impulsivity
  • Racing thoughts; changing topics quickly when talking
  • Engaging in activities that are very pleasurable and often very risky (e.g. having sex with multiple partners in a brief period of time; going on spending sprees)
  • Psychosis (hallucinations and / or delusions)

To meet the clinical criteria, a manic episode must last at least seven days and may last much longer.

Major Depression

 During a major depressive episode, a person feels depressed most of the time and / or has little to no interest in doing things he or she normally enjoys.  Other symptoms may include tiredness or low energy, feeling agitated or slowed down, having difficulties concentrating or making decisions, problems with sleep or appetite, excessive guilt, feelings of worthlessness or hopelessness, and thoughts of death or suicide.

Major depressive episodes last at least two weeks and may last much longer.

Mixed Episode

Sometimes individuals with bipolar I disorder experience “mixed” mood episodes.  This means they are experiencing significant symptoms of both major depression and mania at the same time.


Importance of Treatment

One of the reasons why treating bipolar I disorder is so crucial is because manic episodes can be particularly dangerous.  Mania causes people to have poor judgment and engage in reckless, erratic behavior.  They often inadvertently put themselves and others in danger.   Another reason treatment is crucial is that individuals with bipolar I disorder have a high risk for suicide, particularly during a period of depression.

Treatment serves multiple purposes:

1)      It helps the individual understand the disorder and learn ways to manage it

2)      It helps reduce symptoms

3)      It helps prevent or at least reduce the likeliness of future manic and depressive episodes

4)      It stabilizes current mood symptoms

5)      It helps keep the patient and others safe

Treatment Options


It’s not uncommon for individuals with undiagnosed bipolar I disorder to end up hospitalized during their first manic episode.  Since manic episodes are, by their nature, pretty extreme, they tend to be noticed and cause significant concern.  The individual is often brought in to a hospital ER or mental health clinic by family members, paramedics, or the police for an evaluation.  With mania, several days of inpatient treatment are often required in order to stabilize the patient.  Once stabilized, outpatient treatment is crucial.

Recurrent hospitalizations for manic episodes are not uncommon for individuals with bipolar I disorder.  While this is less likely to occur for patients who continue with treatment (including medication) on an outpatient basis, it can also occur even with treatment in some situations.

Sometimes individuals with bipolar I disorder need hospitalization during a major depressive episode.  This level of treatment is most likely indicated if the patient is severely depressed and / or suicidal.  Mixed episodes also typically require inpatient treatment.

Advantages of inpatient treatment include:  1) it keeps the patient (and others) safe as he or she is being stabilized.  2)  It allows for 24/7 observation which a) helps ensure an accurate diagnosis (sometimes initial diagnoses are inaccurate) and b) gives the attending psychiatrist the opportunity to note the effects (and side effects) of medication.  3)  It gives the patient a break from outside stressors, which can help facilitate stabilization and recovery.  4) It provides intensive treatment over a short period of time, including both group and individual therapy.


 Although depression, anxiety, and many other psychiatric disorders can often be effectively treated with psychotherapy alone, bipolar I disorder treatment generally requires medication as well.  This is because medication – in the form of mood stabilizers – plays a key role in preventing future manic episodes, or at least in reducing the risk of more episodes.   Other medications, such as antipsychotics and antidepressants, are also commonly used in the treatment of bipolar I disorder.

Mood stabilizers – Lithium is one of the most commonly prescribed mood stabilizers for the treatment of bipolar disorder.  Other medications that help to stabilize mood symptoms and prevent mania are anticonvulsants.  These include Depakote (valproic acid), Trileptal (oxcarbazepine), Tegretol (carbamazepine), and Lamictal (lamotrigine).

Antidepressants – Many individuals with bipolar I disorder are also prescribed antidepressant medications.  The danger of antidepressants – particularly the older tricyclics – is that they can potentially trigger a manic episode if the patient is not also taking a mood stabilizer (or appropriate antipsychotic).  SSRIs such as Paxil, Zoloft, and Prozac are often prescribed.

Antipsychotics – With bipolar disorder, atypical antipsychotics are often used in conjunction with other medications.  Some antipsychotics have been approved specifically for the treatment of bipolar mania, while others primarily target bipolar depression.  Seroquel (quetiapine), for example, is approved for both mania as well as the “maintenance” treatment of bipolar disorder.

Antipsychotics help reduce psychotic symptoms that often occur during a manic episode.  Abilify (aripiprazole), Zyprexa (olanzapine), Risperdal (risperidone), and Geodon (ziprasidone) are all antipsychotic medications used to treat bipolar symptoms.  Individuals who do not benefit from lithium or other mood stabilizers may be prescribed Clozaril (clozapine).


The importance of psychotherapy in the treatment of bipolar I disorder should never be underestimated.  Far too often, patients rely solely on medication and bypass psychotherapy.  This is unfortunate, because a skilled therapist can help bipolar individuals in many ways.  For example, since stress is often a trigger for manic episodes, therapy can help patients learn to manage stress and keep future episodes at bay or to a minimum.  Therapy can also help patients identify mood triggers, as well as manage symptoms when they do start to appear.

Psychotherapy is often done on an individual basis.  However, couples and family therapy can be extremely beneficial.  Involving one’s spouse and / or family in therapy is a good way to educate them about the disorder.  The better they understand the disorder, the more supportive and helpful they can be, particularly when symptoms appear.  Involving them in therapy will also help bolster support for the patient.

Group therapy can also be invaluable to individuals with bipolar disorder.  It’s easy for individuals with a serious psychiatric disorder to feel misunderstood, stigmatized and isolated.  Participating in group therapy gives each individual the opportunity to share personal experiences while learning from other members’ experiences.  Group therapy also provides a sense of community and additional support for each member, both of which can be invaluable to anyone suffering from a serious mental illness.

 Other Treatment Options

 Not everyone with bipolar I disorder responds to traditional treatment. Or, they may obtain some benefit, but it’s not enough.  Two other treatment options that may be considered, if indicated, are ECT (electroconvulsive therapy or “shock therapy”) and TMS (transcranial magnetic stimulation).  These two treatments can be particularly beneficial for depressive symptoms that are severe.  There are side effects, however, with both types of treatment.  These must always be weighed to determine if the risks are worth the potential benefits.

Potential side effects of ECT include memory loss (including retrograde amnesia, which means memory loss of things that happened prior to the treatment), brief periods of confusion, and minor physical side effects such as headaches, muscle spasms, nausea and vomiting. ECT can also result in medical complications, such as elevated blood pressure.

Potential short-term side effects of TMS include discomfort, dizziness, muscle spasms, and headaches.  Less common but more serious side effects include seizures, hearing loss, and mania (in individuals with bipolar disorder).

Lifestyle Changes and Other Remedies

It would be amiss to discuss treatment for any disorder without briefly discussing lifestyle changes that may also help reduce symptoms.  As mentioned earlier, stress is a key trigger for mood episodes (especially mania) for those with bipolar I disorder.  That’s why it’s imperative to find ways to reduce stress and learn to manage it properly.

Beneficial lifestyle changes include:

Avoid alcohol and recreational (or non-prescribed) drugs – As with many psychiatric disorders, individuals with bipolar I disorder are especially prone to self-medicating with alcohol and drugs.  Alcohol and drugs can both trigger and exacerbate mood symptoms.  It’s best to avoid both altogether.  If you have a substance use problem, or are addicted to alcohol or drugs, an alcohol and drug rehab program can help you get on the path to recovery.  Be sure to let your treatment providers know that you have bipolar disorder.

Avoid high stress jobs and relationships.  If you work at a job you hate or one that is highly stressful, consider changing jobs to something less stressful and more enjoyable.  Even if doing so means a cut in pay, it may be less costly in the long run.  Toxic relationships can also trigger mood episodes, so it’s best to avoid them as much as possible.  If you’re in a troubled marriage and don’t want a divorce, consider marriage counseling to help improve your relationship.

Take good care of yourself.  It’s important to make self-care a priority if you want to keep mood symptoms at bay.  This includes getting plenty of restful sleep (on a regular schedule), eating a healthy diet, exercising regularly (talk to your doctor first!), and keeping your life as balanced as possible.  Don’t overload your schedule (learn to say “no” when necessary).  Allow time for fun and relaxation.

Other things that can help reduce stress and improve your overall well being when practiced regularly include:

  • Yoga
  • Tai Chi or Qigong
  • Meditation
  • Deep breathing
  • Relaxation techniques such as guided imagery or progressive muscle relaxation

With proper treatment, good self-care, and careful stress management, many people with bipolar I disorder live happy, fulfilling lives.  If you aren’t getting treatment, now is the time to start.  If you suspect you may have bipolar disorder but have never been diagnosed, talk to your doctor or set up an appointment with a psychiatrist for an evaluation as soon as possible. If you are taking medication, always take it exactly as prescribed by your doctor.  Don’t stop it abruptly or make any changes without consulting with your doctor.  Always make sure all your healthcare providers are aware that you have bipolar disorder.

There is still hope.

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