Bipolar Disorder Treatment: Medicines, Therapy & Management

How is Bipolar Disorder Diagnosed?

A bipolar disorder diagnosis involves an evaluation of the symptoms, a pattern of mood episodes over time, and an extensive personal and family history. There are no blood tests that can confirm a bipolar diagnosis. Early diagnosis is vital since bipolar disorder is often misdiagnosed as just depression.

The most common tests used to diagnose bipolar disorder are:

An extensive psychiatric evaluation
DSM-5 criteria of diagnosis
Monitoring of mood using a mood chart
Family history evaluation
Rating scale tests
Blood tests and thyroid function tests
Medication use, alcohol, and substance use evaluation

How is Bipolar Disorder Treated Based on Severity?

Recommended bipolar disorder treatment based on severity is as follows:

Severity	Symptoms	Recommended Treatment
Mild	Gentle mood fluctuations, less sleep, irritability or depressed moods that do not interfere with daily functioning	Start or continuation of mood stabiliser, psychotherapy, correction of sleep and routine and follow-up in outpatient clinic
Moderate	Full episodes of mania or depression, insomnia, impaired judgment, lack of energy, and difficulties functioning at work or at home	Mood stabiliser along with atypical antipsychotic, psychotherapy and monitoring
Severe	Severe mania or depression, psychosis like delusional thinking, inability to take care of oneself, and suicidal ideation	In-patient treatment, combination medicines and ECT in case of high risk or non-responsiveness

Types of Bipolar Disorder and Their Treatment

Various types of bipolar disorder, along with how they present and their treatments, are as follows:

Type of Bipolar Disorder	How It Presents	Treatment
Bipolar I Disorder	One or more full manic episodes lasting a week, requiring hospitalisation, along with recurrent and possibly long-lasting depressive episodes	A combination of lithium or valproate and atypical antipsychotics, with maintenance therapy
Bipolar II Disorder	Recurrent hypomanic episodes accompanied by depressive episodes	Quetiapine, lamotrigine or lithium, combined with psychotherapy during the depressive phase
Cyclothymic Disorder	Less intense mood disturbances that last for two or more years without full mood episodes	Mood stabilisers in low doses, psychotherapy, and lifestyle modifications
Rapid Cycling Bipolar Disorder	Four or more mood episodes occurring within one year, more difficult to manage	Combination of mood stabilisers, thyroid review, and no use of antidepressants alone
Mixed Features	Manic and depressive symptoms co-occurring, posing a greater danger of harming oneself	Valproate or atypical antipsychotics with close monitoring of risks

Other Treatments for Bipolar Disorder

Other treatments for bipolar disorder are as follows:

Cognitive behavioural therapy identifies and manages negative thinking patterns.
Psychoeducation enables the individual and his/her family members to be aware of the early warning signs of a bipolar episode.
Family-focused therapy promotes better communication within the family environment.
Interpersonal and social rhythm therapy stabilises the patient's daily rhythms and sleep patterns.
Electroconvulsive therapy can be applied to a very manic, very depressed, or suicidal individual.
Hospitalisation is done for severe cases of bipolar disorder.

Oral Medications for Bipolar Disorder

Oral drugs are essential for long-term treatment of bipolar disorder and are administered on a frequent basis with a specialist review. Common oral drugs for bipolar disorder include:

Lithium is used to treat manic states and prevent future episodes.
Sodium valproate is used in the treatment of mania and mixed conditions.
Lamotrigine helps prevent depression during maintenance treatment.
Carbamazepine is used as an alternative mood stabiliser.
Quetiapine is used to treat mania, depression, and maintenance.
Olanzapine and aripiprazole can help control mania and long-term maintenance.

Ayurvedic and Alternative Treatments for Bipolar Disorder

Although the use of complementary measures can assist with well-being, they cannot take the place of prescribed treatments for bipolar disorder. Some complementary therapies that are typically considered for bipolar disorder include:

Ashwagandha for stress management.
Brahmi for mental calmness.
Yoga for relaxing and body awareness.
Meditation and mindfulness for stress and mood management.
Breathing exercises for calming down anxiety.

These treatments can only be considered in conjunction with advice from a psychiatrist since discontinuation of medication can lead to relapse.

Home Care for Managing Bipolar Disorder

Self-care on a day-to-day basis will not only help in bipolar disorder treatment but also help stabilise the moods in between visits. Some useful home care tips for managing bipolar disorder include:

Take medication as prescribed and do not stop them abruptly.
Maintain a constant sleeping and waking schedule because disrupted sleep can trigger an episode.
Record mood on a daily basis to catch any warning signs.
Have a consistent schedule for meals, work, and activities.
Do not take alcohol and recreational drugs.
Inform family members of any warning signs.
Seek help immediately in case of any thoughts of self-harm.

Latest Treatment for Bipolar Disorder

Recent advances in bipolar disorder treatment include newer atypical antipsychotics and long-acting injectable medicines that may help in symptom control and adherence to treatment in selected patients. Neuromodulation therapies, such as repetitive transcranial magnetic stimulation (rTMS), are also being studied and may be considered for treatment-resistant bipolar depression in specialised centres.

However, mood stabilisers, atypical antipsychotics, psychotherapy, and regular follow-up remain the foundation of treatment.

How Long Does Bipolar Disorder Treatment Take?

Bipolar disorder treatment length varies with the type and severity of the condition. The following table shows approximate timelines:

Treatment	Approximate Duration
Acute Episode Treatment	Improvement usually occurs within two to six weeks.
Hospital Stay (Severe)	Two to four weeks most of the time.
Psychotherapy	Twelve to twenty sessions, over a few months.
Electroconvulsive Therapy	Six to twelve sessions within three to four weeks.
Maintenance Treatment	Long-term, lasting many years or a lifetime.

Note: Treatment duration may vary depending on the type of bipolar disorder, the number of past episodes, the response to medication and the level of family support.

Bipolar Disorder Treatment Side Effects

Generally, patients tolerate treatment for bipolar disorder well. However, certain medications may cause side effects that can be detected through regular monitoring. Some common side effects of bipolar disorder treatment may be:

Weight gain
Sleepiness
Tremors
Increased thirst and frequent urination
Nausea
Thyroid problems
Skin rash
High blood sugar and cholesterol
Memory problems due to electroconvulsive therapy

It is advisable to seek immediate medical care in case of:

Persistent vomiting
Severe skin rash
Confusion
Severe tremors
Thoughts of suicide

Lifestyle Changes for Managing Bipolar Disorder

A few small day-to-day things could help to keep your mood steady. The following suggestions can be useful to better manage bipolar disorder:

Get adequate sleep daily.
Get regular exercise.
Maintain a balanced diet.
Reduce the intake of caffeine, particularly in the evenings.
Do not consume any alcohol or drugs.
Control stress.
Go for all appointments and do the recommended blood tests.

Triggers That Can Worsen Bipolar Disorder Symptoms

Several conditions make bipolar disorder difficult to manage. Managing these factors can help lower the risk of relapse. Some triggers of bipolar disorder include:

Sudden withdrawal from drugs.
Disrupted sleep or lack of sleep.
Consumption of alcohol and substances.
Stressful environment or stressful life.
Taking antidepressant drugs without using mood stabilisers.
Unresolved issues related to the thyroid.
A poor sleeping schedule and working on night shifts.

Bipolar Disorder Treatment Cost in India

The cost of treatment for bipolar disorder in India varies based on the type of facilities and the mode of treatment. Usually, consultation fees with a psychiatrist range between ₹500 and ₹5000 per session, depending on the city. On the other hand, the cost of consulting a psychologist for treatment may range between ₹500 and ₹5000, depending on the city.

Mood stabilisers like lithium have cost less, but new antipsychotic drugs are expensive. Testing of blood samples is done periodically and it incurs additional cost. Moreover, hospitalisation due to an episode can be quite expensive. However, government hospitals and district mental health programmes offer free or low-cost care.

Does Health Insurance Cover Bipolar Disorder Treatment in India?

Yes. Bipolar disorder treatment is covered by health insurance plans in India. In accordance with the Mental Healthcare Act, 2017, insurers offer health insurance for mental illnesses, including bipolar disorders. However, coverage can be claimed after a waiting period of up to 2 years. Outpatient treatment expenses incurred on doctor consultations, medications, and blood tests are usually not covered by a mediclaim policy. However, it is best to contact the insurance company to know if bipolar disorder is covered.

FAQs

Q1. Is bipolar disorder curable?

Ans: No, bipolar disorder cannot be cured permanently. However, it can be effectively managed with the right treatment, allowing many people to lead healthy and productive lives.
Q2. What is the best treatment for bipolar disorder?

Ans: The most effective treatment for bipolar disorder usually includes mood stabilisers, such as lithium, along with psychotherapy and regular follow-up with a mental health professional.
Q3. How long does bipolar disorder treatment last?

Ans: Acute episodes of bipolar disorder may last for several weeks, but maintenance treatment is usually required for many years or throughout life to prevent relapse.
Q4. Will I need to take bipolar disorder medicines for life?

Ans: In many cases, long-term or lifelong medication is recommended to reduce the risk of future manic or depressive episodes. Your doctor will decide the duration based on your condition.
Q5. Can therapy alone treat bipolar disorder?

Ans: No, therapy alone is usually not enough. Psychotherapy is most effective when combined with medicines that help stabilise mood swings.
Q6. Can antidepressants be used for bipolar disorder?

Ans: Yes, antidepressants may be prescribed in some cases, but they are usually given together with a mood stabiliser to reduce the risk of triggering a manic episode.
Q7. Is bipolar disorder treatment covered by health insurance in India?

Ans: Yes, health insurance providers in India are required to cover mental illnesses, including bipolar disorder, in accordance with applicable laws and the terms of the policy.
Q8. When should I seek emergency help for bipolar disorder?

Ans: Seek immediate medical attention if you experience severe mania, psychotic symptoms, suicidal thoughts, self-harm behaviour or if you believe you may be a danger to yourself or others.

References
- https://pmc.ncbi.nlm.nih.gov/articles/PMC5310104/
- https://www.nimh.nih.gov/health/topics/bipolar-disorder
- https://pmc.ncbi.nlm.nih.gov/articles/PMC10826869/
- https://www.maxhealthcare.in/technology/repetitive-transcranial-magnetic-stimulation