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Bipolar disorder treatment

Treatments for bipolar disorder aim to reduce the severity and frequency of the episodes of depression and mania so that a person can live life as normally as possible. The condition needs to be managed and treated long term.

If they are not treated, episodes of bipolar-related depression or mania can last for 6-12 months. On average, someone with bipolar disorder will have 5 or 6 episodes over a period of 20 years and without medication, relapse is more likely. However, with effective treatment, episodes usually improve within about 3 months.

Most people with bipolar disorder can be treated using a combination of different treatments. The treatment may include one or more of the following:

  • medication to prevent episodes of mania, hypomania (less severe mania) and depression - these are known as 'mood stabilisers' and are taken every day, on a long-term basis
  • medication to treat the main symptoms of depression and mania when they occur
  • learning to recognise the triggers and signs of an episode of depression or mania
  • psychological treatment such as talking therapy to help deal with depression and to give you advice about how to improve your relationships
  • lifestyle advice such as doing regular exercise, planning activities that you enjoy and that give you a sense of achievement, and advice on improving your diet and getting more sleep.

Most people with bipolar disorder can receive most of their treatment without having to stay in hospital.

However, treatment in hospital may be required if your symptoms are severe, or if you are being treated under the Mental Health Act applicable in your state or territory, because there is a danger that you will harm yourself or others. In some circumstances, you may be able to have treatment in a day hospital and return home at night.

Medicine

Several medications are available to help stabilise mood swings. These include:

  • Lithium carbonate (often referred to as just 'lithium') is the medication that is most commonly used to treat bipolar disorder. Lithium is a long-term method of treatment for episodes of mania, hypomania and depression. It is usually prescribed for a minimum of 6 months.
  • Anticonvulsant medicines include sodium valproate, carbamazepine and lamotrigine. These medicines are sometimes used to treat episodes of mania. Like lithium, they are long-term mood stabilisers.
  • Antipsychotic medicines include aripiprazole, olanzapine, quetiapine and risperidone. Antipsychotic medicines are sometimes prescribed to treat episodes of mania or hypomania. They may also be used as a long-term mood stabiliser.

If you are prescribed an antipsychotic medicine, you will need to have regular health checks (at least every 3 months but possibly more often), particularly if you have diabetes.

If you are already taking medication for bipolar disorder and you develop depression, your doctor or specialist will check that you are taking the correct dose and, if necessary, will adjust it.

Episodes of depression in bipolar disorder can be treated in a similar way to clinical depression. This includes using antidepressant medication.

If your doctor or psychiatrist recommends that you stop taking medication for bipolar disorder, the dose should be gradually reduced over a minimum of 4 weeks, and up to 3 months if you are taking an antipsychotic medicine or lithium. If you have to stop taking lithium for any reason, see your doctor about taking an antipsychotic medicine or valproate (see below) instead.

Psychological treatment

Some people find psychological treatment helpful when used alongside medicine in between episodes of mania or depression. This may include:

  • psychoeducation to help you find out more about bipolar disorder
  • cognitive behavioural therapy (CBT), which is most useful when treating depression
  • family therapy, a type of psychotherapy that focuses on family relationships (such as marriage) and encourages everyone within the family or relationship to work together to improve mental health.

Pregnancy

The management of bipolar disorder in women who are pregnant, or those who are trying to conceive, is complex and challenging. One of the main problems is that the risks of taking medication during pregnancy are not always that well understood. Therefore, where possible, women with bipolar disorder need careful planning for their pregnancy and the management of their bipolar disorder. Consultation should include the patient, her partner, her obstetrician, midwife, psychiatrist and local doctor.

The following medicines are not routinely prescribed for pregnant women with bipolar disorder:

  • valproate - there is a risk to the fetus and the subsequent development of the child
  • carbamazepine - it has limited effectiveness and there is risk of harm to the fetus
  • lithium - there is a risk of harm to the fetus, such as cardiac problems
  • lamotrigine - there is a risk of harm to the fetus
  • paroxetine - there is a risk of harm to the fetus, such as cardiovascular malformations
  • long-term treatment with benzodiazepines - there are risks during the pregnancy and immediately after the birth, such as cleft palate and floppy baby syndrome.

Where to get help

If you need help, talking to your doctor is a good place to start. If you'd like to find out more, or talk to someone else, here are some organisations that can help:

  • Black Dog Institute (people affected by mood disorders) - online help
  • Lifeline (anyone having a personal crisis) - call 13 11 14 or chat online
  • Suicide Call Back Service (anyone thinking about suicide) - call 1300 659 467
  • SANE Australia (people living with a mental illness) - call 1800 18 7263
  • beyondblue (anyone feeling depressed or anxious) - call 1300 22 4636 or chat online

Last reviewed: September 2016

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