Bipolar Disorder Treatment – Free Page

Bipolar disorder treatment to get her in the happy middle
Bipolar disorder treatment to get her in the happy middle

Much Is Known About Bipolar Disorder Treatment

There was a time not that long ago when successfully treating bipolar disorder was a hit-and-miss affair. This is no longer true. A lot is now known about bipolar disorder and its different presentations and phases and how to best treat each. A quick Google search would give the wrong impression with discouraging words about how hard it is to treat bipolar disorder. This is usually not true. Find a good psychiatrist with experience in treating bipolar disorder. A doctor who has access to provide both outpatient and inpatient care. Things will go well.

Bipolar Disorder Treatment – The Three Moods

Here’s the thing about bipolar disorder treatment. There are three moods that are part of bipolar disorder. Okay, yes, we know bipolar is two moods. But to target where a person needs to be, one needs all three moods. And, each of them needs medical care. One is mania, the bipolar “high”. The second one is depression, the down mood. Finally, the third is the mood in the middle. Normal mood. Or, near normal. You might ask, “Why does a person with a normal mood need a doctor?” Because in bipolar disorder one is striving for a consistent normal mood. And, it can be hard to get to and stay at a normal mood. Without medical care and medication a normal mood can easily, quickly, and unpredictably slide into depression or mania. So, here they are, one at a time.

Bipolar Disorder Treatment – Mania

Mania is often such a high-energy, super-active mood that family, friends, doctors, and everybody is thrown into chaos trying to calm the person. Or, trying to hide from the person. It’s most always a crisis. They need medication and medical care. They might wind up in an emergency room. Every book on Emergency Psychiatry has a chapter on mania. If it’s just mild mania, that’s good news. It still needs to be stopped or it could get worse, slide quickly right into full mania. A medication to stabilize mood would help. Maybe lithium or valproate along with a calming medication like quetiapine.

Bipolar Disorder Treatment – Depression

Depression in bipolar disorder is usually (but not always) less of an emergency than mania. The exception is if thoughts of suicide come with the depression. Depression without thoughts of suicide can still be difficult to treat. The depression can really stubbornly resist treatment. While treating the depression there is a risk of the person becoming less depressed but then suddenly suicidal or suddenly manic. The situation requires a careful balance of medication and concerned watching. So, because of this risk, one treats the depression while all the time watching for thoughts of suicide and signs of mania.

Bipolar Disorder Treatment – Suicidality in Bipolar Depression

What if a person is so severely depressed that suicide seems like a good idea? The fast miracle treatment in the past was electroconvulsive therapy (ECT). But some places and some people don’t like ECT, miracle or not. The good news is that now we have fast-acting medications, like Esketamine nasal spray (Spravato) and ketamine. The past ten years many ketamine clinics have been started that treat depression with suicidal ideas with ketamine. The esketamine nasal spray or ketamine injections give short term relief from suicidal thoughts and depression. ECT works fast and gives longer lasting relief from depression. So, you see, we have good treatments to save lives. And once the person is feeling better with a short lasting medication, a longer-lasting medication can be started that will take a few weeks to start working but then will work for years.

A Reader Asks:

Why is it necessary to treat mania? I’ve heard of people getting really rich when they’re manic.

It’s true, there are stories about people who, when manic, develop an idea and make a lot of money. Almost always these pursuits are get-rich-quick schemes that work at first, though truthfully most of the time they don’t even work at first. Rarely they do work at all and allow the person to accumulate a lot of money. And, as with Paul Harvey’s The Rest of The Story, there’s more to it and the situation usually does not end well. If the mania continues, judgment continues to deteriorate. At some point a decision is made that puts too much at risk for no reason, and the wealth goes down the drain quickly. If the mania stops and the person becomes depressed, the house of cards usually falls without the energy of mania to keep it going. Depression and huge financial losses are one path to thinking of suicide.

Medications for Bipolar Depression

As we said above, depression in bipolar disorder can be difficult to treat. Most doctors would probably start two medications right away to stop the depression as fast as possible. And when those two medications work, leave them at the same dose for at least a few months. Then, if the medications have worked well, some doctors would leave them as they are for a long time to prevent any more depressions. If the depression is not that bad maybe a doctor might start just one medication. For a severe, treatment-resistant depression it might be time for esketamine, ketamine, or ECT, along with one or two added medications to keep mood stable once it’s closer to normal.

What Are These Other Bipolar Disorder Medications? 

Common medications to keep mood stable are lithium, valproate, and carbamazepine. Others that a physician might use are lamotrigine, topiramate, and oxcarbazepine. A medicine from a family of medications called “atypical antipsychotics” might be used. (It’s not a pleasant name but sadly that’s what they’re called.) They’re medications like quetiapine, olanzapine, and others. Medications often used just for depression are imipramine or, if added to olanzepine, fluoxetine. Others might be tried.

Why Not Treat Bipolar Depression like Any Other Depression?

This question is a hot topic in medicine, and has been for half a century. At times the debate becomes heated. There are some studies that say that treating bipolar depression like ordinary depression can cause a manic episode. Yes, the medication for depression stops the depression, but then sends the person into mania. The person might be out of the frying pan but he’s into the fire! The other viewpoint comes from other studies that don’t find that depressed people change to mania when taking a medication for depression. If you or a family member has bipolar depression, go see your doctor. You and your doctor need to decide this choice together. Do understand, though, that if you become manic, your doctor then has to treat your mania to get you to a normal mood.

Bipolar Disorder Treatment – Once Mood is Normal

Okay, so you are no longer manic and not depressed. All is good and you don’t need to worry about anything, right? Nope. You have to decide some things. You’re balanced in the middle of a teeter-totter and it’s too easy to tip one way or the other. Which medication will be the best to keep you stable? There are many, many good ones. You and your doctor will be able to discuss a few and you can choose one as a place to start.

Oh, Yeah, Real Life

Okay, you got us. We’ve made it sound easy. It’s not. Real life is not always a smooth road. You’re on good medications that you don’t dislike too much and that seem to be working. And then, you get depressed. Or manic. It’s a shocker that surprises everyone, especially you. When this happens, and it probably will, call your doctor. Then you and your doctor agree on a treatment plan. And you need to follow it. Look forward, look toward the future. Look back only to learn any lessons and to try to avoid any more surprises. Don’t blame anyone. It happens. Life happens.

Why Medication is Necessary

No one wants to take a medication all the time. We’re all the same in this regard. Having a doctor tell you that you have to take a medication (or two or three) every day feels bad. It’s like she’s giving you orders. Orders to do something that you don’t want to do. Everyone feels this way whether he/she has bipolar disorder or not. But if you want life to go well, you gotta do it, you gotta take your medication. Once you find the right medications that work for you and the side effects aren’t that bad, stay with them. Every day. As the years roll by you will be so happy that you did.

It’s a Gamble Without Medication

Are you a gambler? Without the medication every day you’re gambling. You’re standing at the roulette wheel of life. You wait to see whether the ball lands in a red or black pocket with your number. A manic high might start as a feeling-good hypomania, but then break through into a full mania. Or that bit of a tired feeling could slide slowly into a deep depression. Without medication you will do well only if Lady Luck is on your side. Lady Luck is never on anyone’s side for long. If you want to have a normal mood and a good day, take you meds.

Friends Forever

Once you find the right set of medications that work well with few side effects, it needs to become and stay your best friend for a long time. Your successful medication regimen will help you live well, live long, and have a good life. It’s hard to see medication as a good friend if you don’t like taking it. But you’ve got to do what you’ve got to do.

About the Search for the Right Medication

Eventually everyone who sticks with the search finds the right medication. But still it’s true that finding the right medication for you is the hard part. Your doctor can guide you on where to start. But no one knows, you don’t know, how a medication is going to feel until you take it. You try a first medication but its side effects are awful. Then on to try a second one and maybe it’s okay, but does it work? You don’t know until months and years go by and you’ve been able to avoid any mania or depression. And remember, eventually everyone who sticks with the search finds the right medication.

All the Good Medications Stabilize Your Mood

All the good medications stabilize your mood but not all of them are called “mood stabilizers”. The medications that keep bipolar mood stable come from a variety of medication families. One group is actually called “mood stabilizers, like lithium and valproate. Another group comes from a family called “atypical antipsychotics”. “Atypical antipsychotic” is not a relevant name when used for bipolar because in bipolar they just stabilize mood. They usually have nothing to do with psychosis. And, the “atypical” part of the drug family name is only about chemistry. The word “atypical” has nothing to do with the disorder being treated. The third medication group is the group of medications used for depression.

Bipolar is a Real Medical Disorder Needing Real Medications

We at the Neuroscience Research and Development Consultancy would recommend against trying to rely on “natural” medications, nutritional supplements, or homeopathic remedies. Bipolar is a real, physical, medical disorder, like heart disease or diabetes. “Natural” medications or supplements for bipolar disorder are like using a Band-Aid on cancer or a fruit smoothie for a heart attack. That is to say, it ain’t gonna work. It is true that too little is known about this area and it would be great if more research could be funded. But with what medical science knows now, these herbs and supplements do not work for bipolar disorder.

About Medication Side Effects

All medications have side effects. Any medication anyone takes or uses has side effects. If the medicine works, if it does something good, it’s going also to have some effect that you don’t want. And it’s frustrating that you might not know about the benefits for months but side effects are there right away.

You Can’t Treat Someone by Throwing Them a Capsule

Diabetes, For Example

Take diabetes, for example. Type I diabetes, where the person needs insulin. If a teenager develops Type I diabetes, how well would he do if you gave him a bottle of insulin and a syringe with a needle and said, “There you are.” No instructions. No explanations. The situation would not go well. Because of this all-to-human reality, diabetes experts have set up entire medical clinics just for diabetes education.

Same With Bipolar

Bipolar disorder is the same. If you have bipolar disorder you need instruction and education in addition to the right medication. But it’s even more of a dilemma because at least with diabetes the person’s brain is working fairly well most of the time. In bipolar, the brain is the organ with the problem. Enter “psychotherapy”. Learn about bipolar disorder. Educate yourself. Learn about your brain. Learn about what are you up against. Find the path to success and a good life.

One More Mention of ECT

As we mentioned at the start of this article, when the manic up or the depressed down is severe, just medications might not be enough.  ECT might provide a safe rescue.  There are times when ECT is safer than a medication. Like during pregnancy. Or someone who’s too elderly and/or medically ill to take the needed medication. Today’s ECT is actually a relatively gentle treatment.

Helpful links:

National Institute of Mental Health on Bipolar Disorder

National Library of Medicine PubMed Central on Treatment of Bipolar Disorder

Department of Health and Human Services Food and Drug Administration with

 The Facts on Bipolar Disorder and FDA-Approved Treatments

The Mayo Clinic on Bipolar Disorder Diagnosis

National Alliance on Mental Illness on Treatment of Bipolar Disorder

Bipolar Disorder

black and white photo of a casually-dressed 40 year old woman looking concerned standing on the front area of a cement building

There Is Actually Good News About Bipolar Disorder

There’s a lot of good news about treating bipolar disorder. We now know that treating it appropriately and aggressively during the first episode can change the course of the illness lifelong. We’ve gained a new understanding on when to add in an atypical antipsychotic (that is, more often), when to use a “mood stabilizer” (that is, less often), and when to add an antidepressant (again, more often). Psychosocial therapies for bipolar disorder help remarkably to prevent a relapse as months and years go by. A “psychoeducational” approach might be the most helpful. These therapies can now be built into any treatment plan. So be encouraged. The whole treatment approach has gotten better. As always, we’re on your side. We praise what works, debunk anything that doesn’t work, and encourage you to better health and better care.

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Articles related to Bipolar Disorder:

Defining Bipolar Disorder – Big Mood Ricochets in Opposite Directions

Bipolar means 2 poles. Like a north and a south pole, but in this case it’s a manic pole and a depressed pole. And they are, pardon the pun, polar opposites. For a long time bipolar disorder was called manic depression. Both mania and depression are caused by physical brain changes. Each of these two physical brain states affect a person’s behavior in specific ways. And changed behavior changes lives. These effects are mostly the opposite of each other, the low, slowed, miserable depths of a severe depression and the accelerated highs of a roaring, chaotic, destructive mania.

A Reader in Melbourne Asked:

My uncle is a mess of a family black sheep. Recently a doctor said he had bipolar. My dad said it’s not a real illness, that my uncle is just a mess. What’s the truth?

Bipolar disorder is a real medical illness, as you’ve been reading on this page. If your uncle has had bipolar disorder and it wasn’t diagnosed and treated appropriately it’s easy to see why he’s viewed as a black sheep member of the family. With all due respect, because he is your father, you’re Dad’s wrong. The hope would be that now that your uncle has seen a doctor and knows he has bipolar disorder, he will get appropriate treatment and get to a normal mood. Maybe over time he’ll no longer be a black sheep and the rest of the family will stop saying that he’s a mess. He needs the right medications to get his mood normal and a quality psychotherapist to guide him on a productive life path. Bipolar disorder doesn’t go away. It’s a lifelong medical condition, just like type-1 diabetes is a lifelong medical condition.

Bipolar Disorder Symptoms

Below we go into more detail on the signs and symptoms of mania, of depression, and of that perhaps good but perhaps concerning brain state of “not-quite-manic” (hypomania). For the person with bipolar disorder, the times of mania might last a few weeks or months. The depressed times, on the other hand, can last a few months or several years. The goal of treatment is a normal mood, the same normal mood like everyone has. The length of time in the normal mood in the middle between depression and mania  is harder to predict, but it can last a lot longer with the right medication and stabilizing, educational psychotherapy. The not-quite-manic mood, hypomania, is even harder to predict and, as good as it might feel, it can be dangerous.

Bipolar Mania Symptoms – The Accelerated Pole of Bipolar Disorder

Mania actually erupts in any one of several different moods. It can be an up mood, full of energy, and optimism, and self-confidence. On the other hand, mania can also be irritable, angry, and high-energy hostile. Some people, when manic, have changing moods, at times happy and engaging and at other times angry, driving people away. The inability for people to predict which mood will come next is a real problem. That said, at times the anger can come out in reaction to the attitudes of people around the manic individual. They might be moving with optimism and high energy toward some goal they have set. When some sensible person around them points out that what they’re planning to do is highly risky or won’t work, they get angry and hostile.

a middle-age intense looking man with blond hair with an image of his head to the left with an angry face and to the right with a smiling face

More on Symptoms of Mania

Mania is much more than feeling “up”. It is possible to feel too good (though feeling too good is hard for most of us to imagine!) and mania is feeling way too good. Mania is the up mood and a driven acceleration. Unfortunately, it also involves a loss of judgment. Poor choices, one after another, create big problems. The guy with mania believes he’s right even when he’s dead, flat wrong. When manic, an individual feels that nothing can go wrong. Even in really bad situations, they falsely believe it’s all going to be okay. So they take risks, big risks, that they should not take. They can’t see the risk, can’t see any possible downside. They can feel super capable or even powerful. As a result, they might take big risks with money, or with sex, or with relationships. It can get ugly.

Even More Signs and Symptoms of Mania

When manic, people have big energy surges, and these drive the need to be far too active. And since they view the world as free of any risk, active high energy is a problem. Another possible dilemma for people around a manic individual is their tendency to talk quickly and continuously. Their thoughts and their comments can hop from one topic to another faster than people around them can keep up, faster than people around them can think. But if helpful people try to slow them down, as we mentioned above, a person in the midst of a manic episode can easily turn from up and driven to high energy irritable and even nasty angry.

Bipolar Depression Symptoms – The Depressed Pole of Bipolar Disorder

People with bipolar depression are really, badly depressed. That is, bipolar depression is bad. An ordinary sad mood is familiar to everyone. This bipolar depressed mood is not only worse, it’s just plain completely different, a completely different type of mood. It’s a brain-based medical condition that’s an extreme form of gloom, pessimism, and often irritability. They have little energy and don’t do much. They usually either can’t sleep or they sleep too much, and they’re either not hungry or they eat too much. Nothing is fun or enjoyable. They can’t think clearly, can’t concentrate, and are forgetful. They’re tired and slow, feeling worried, anxious, and empty. At the worst, they can think they know with certainty that life is not worth living and attempt suicide. At times, sadly, they succeed at taking their own life.

Bipolar Disorder Treatment

Click this link to see our free public page on bipolar disorder treatment.  And for a discussion of something quite strange, if you’re a subscriber, see our page on lessening the symptoms of bipolar depression by adding the antibiotic minocycline to a person’s standard bipolar disorder medications.  It’s on the page called Minocycline + Aspirin for Bipolar Disorder.

black silhouettes against a grey background of a woman with a ponytail taking a pill and another woman, more distant, with her head in her hand

The Special Case of Not-Quite-Manic and the Roller-Coaster of Bipolar Life

There is a “mood-in-the-middle” in bipolar disorder that’s not a normal mood. This mood-in-the-middle is more accelerated than a normal mood but not as accelerated as mania. An important difference to understand here is that the variance between this not-quite manic mood and full mania has less to do with acceleration and more to do with keeping or losing good judgement. Judging situations well is the ability to know what makes sense and what makes no sense at all. The person in a mood of not-quite manic hypomania usually keeps their good, common sense. When that person goes into full mania they lose the ability to tell what makes sense and what doesn’t.

More on Hypomania, the Not-Quite Manic Mood

This not-quite-manic mental state feels fine, and can be fine, but it’s dangerous. It’s like a traffic crash or a sports injury. Everything seems fine, maybe better than fine, until, all of a sudden, it’s not fine anymore. The person with bipolar disorder who is in this hypomanic state just feels really good. They can do really well with everything in life. It’s almost not possible for them to think that there’s anything wrong, and if their mood could stay right where it is, maybe nothing would be wrong. And people around the individual who do not know them might not see anything wrong, either. When hypomanic, an individual might have charisma and success. But people who know them well can see the change and understand that it’s a warning, like a bright yellow flashing light. Caution, a full manic episode might be on the way.

The Life History of the Successful Bipolar Person

People through the centuries have noticed that many individuals with bipolar disorder are quite successful. It’s true. Through their life the person with bipolar disorder might go through years of great success, big wins, the good life. That’s because, if they are in the state of not-quite manic hypomania, they keep good judgment but are accelerated. They think faster, see strategies, and understand situations that most people of normal mood don’t see or don’t see as quickly. If they had control of their moods (which they don’t) and could stay hypomanic, it might be great for them. But it doesn’t work that way. At some point, without them realizing it, the hypomania slides subtly, imperceptibly into mania. With real mania, the person’s judgement falls apart. All their successes might well go down the drain.

Alternating Life Styles with Bipolar Disorder

People with bipolar disorder can become billionaires and yet die poor. They can have several cycles of boom and bust during their lives, on top of the world then down and out, over and over again. If they’re lucky, in their final years that can remain wealthy. Hopefully wealthy enough to have their final years be comfortable. Yet again, they can be rich and world famous, liked and loved, yet end life by suicide at a young an age. (As an illustration in literature, do a search for the 1897 poem “Richard Cory” by Edwin Arlington Robinson. The singer and song writer Paul Simon turned the poem into a song, “Richard Cory“, that the musical duo Simon and Garfunkel recorded.  It’s on their second album, “Sounds of Silence”.)

middle-age man weather-beaten man, face in hand, upset, in a black hoodie and blue shirt

Similarities with Both Mania and Depression

Both mania and the severe depression that is bipolar depression can land a person in a doctor’s office and maybe in the hospital. Both of these disordered brain states need to be treated with medication and quality medical care. There is no psychotherapy that, by itself, works for mania or for bipolar depression. Both can and do destroy relationships, families, friendships, businesses, and lives. More and better medications are being developed and approved to treat bipolar disorder, both the mania and the depression.

Bipolar Disorder is a Common Disorder

Bipolar disorder is not a rare medical condition. At least 1 out of every 100 people have bipolar disorder, and the percentage could be as high as 3 out of every 100. Doing the arithmetic, that calculates to 75 million to 225 million people worldwide. These are not small numbers. Many people have bipolar disorder.

Once Bipolar Disorder Starts It Lasts a Lifetime

Bipolar disorder is the way that a person’s brain is built, the way the cells and circuits connect and react. It’s a lifelong medical condition, a brain dysfunction. Mania follows depression and depression comes after mania. There might or might not be a time of normal mood in between the mania and depression, as the individual goes from one mood extreme to the other. The right medication and quality psychotherapy throughout their life is the best path to a productive, enriched life. And, quality psychotherapy is not with any random therapist on the next corner. The therapist needs to be well-trained, experienced, conscientious, and, well, likable. The person with bipolar disorder has to like meeting and working with them.

The Cause of Bipolar Disorder Is Not Known

No clear and single cause for bipolar disorder has been found. There are risk factors that add together to make the likelihood of a person having bipolar disorder higher. A family history of bipolar disorder or schizophrenia, for example. And, adverse life events at any age, but especially in childhood or adolescence.

Anguished young woman in tears sitting on a grey couch talking on her mobile phone

You Also Need a Bipolar Disorder Guide – Therapy

The roller coaster moods of bipolar disorder are frightening and uncontrollable without medication. It takes years for the person with bipolar disorder to understand what is happening to them. While we say that medication is necessary to treat it, that does not mean that psychotherapy is not necessary. As with most medical conditions, medications can’t solve everything. Call it education, call it psychotherapy, call is a “bipolar disorder user’s group”, but whatever name is most comfortable for the person with bipolar disorder, the therapist is a necessary person who knows the territory and can be a guide. A guide for how to live better with the bipolar disorder.

Helpful links:

National Institutes of Health, National Institute of Mental Health
NIH/NIMH on Bipolar Disorder

National Library of Medicine (United States), MedlinePlus
MedLinePlus on Bipolar Disorder

The Mayo Clinic on Bipolar Disorder
American Psychiatric Association on Bipolar Disorder
National Alliance on Mental Illness on Bipolar Disorder