Bipolar Disorder: Which Therapy Is Best?

Do you or a loved one suffer from bipolar disorder? The good news is that there is a range of treatment options. But which therapy is best for you?

A bipolar diagnosis can feel frightening. Bipolar disorder is a serious mental illness that makes it difficult to function on a day-to-day basis. However, a diagnosis is a good start on the journey towards mental wellness.

There are still many misconceptions about how bipolar disorder is treated, which is one reason people suffering with the disorder may be reluctant to get help. It is important to know that we’ve come a very long way from the days when heavy medication was the only option.

Let’s take a look at the particular challenges of bipolar before diving into the therapy options and weighing up their pros and cons.

What are the Challenges of Bipolar Disorder?

Traditionally, bipolar disorder has been a tricky illness to treat because, at different times, it affects the sufferer in two very different ways. There are extended periods of severe depression, as well as extended periods of mania or hypomania. Whereas unipolar depression can be treated with antidepressants that lift the person’s mood, treatment for bipolar disorder needs to ensure the person’s mood stays balanced at all times.

The Individual’s Dilemma

This can lead to incredibly frustrating situations for the individual. Take Dave, for example, who was experiencing the most severe depression of his life. He felt desperate to take whatever means necessary to lift his mood and end the suffering. But his doctor couldn’t prescribe many types of antidepressants due to the significant risk that it would worsen Dave’s condition in the long run.

In contrast, Jenny was going through a weeks-long manic episode. She felt like she was on top of the world and could achieve anything, leading to a number of dangerous situations for herself and her loved ones. Her doctor prescribed antipsychotics and mood stabilizers, but she resisted taking them, as it felt like he wanted to strip her of her joy.

The Doctor’s Dilemma

The frustration felt by people like Dave and Jenny create a dilemma for the psychiatrist. Psychiatry is still not a perfect science, and sometimes requires trial and error. This is not helped by the fact that many medications take weeks of daily use to start working. The psychiatrist has to do their best to identify the medication(s) most likely to work.

They also have to do as much as possible to make sure the treatment is sustainable. At least 40% of people with bipolar disorder will stop taking their medication or skip more than 30% of doses. The reasons vary. For someone like Jenny, the medication might seem unnecessary. To someone like Dave, medication that takes time to work might seem pointless.

There is also the matter of side effects, which can be severe, especially in the first days and weeks after it is prescribed.

So what can a doctor do?

Education and Therapy

One fundamental step that mental health providers need to take with people with bipolar is to educate them on the disorder and its treatments. They need to make it clear that depression can be alleviated and that any positive feelings associated with mania are likely to lead to disaster. They also need to inform their patients that the side effects will go away on their own or with additional treatment, and that there are dangerous consequences of non-adherence to the regimen.

Unfortunately, a primary symptom of both depression and mania is warped thinking. Statements that may seem undeniable to the psychiatrist can fall apart when exposed to this type of thinking.

As such, therapy is incredibly important. A therapist will help the individual challenge irrational thoughts, while guiding them to the recognition that treatment will improve their lives.

It’s clear from this that one treatment in isolation does not often work. Treatment plans need to be customized for each person to find the right balance. No therapy can be objextively considered ‘the best’ for bipolar.

Let’s take a look at the therapy options available in more detail to understand how a person with bipolar disorder can get help.

Medication: A Cost-Benefit Analysis

There are 3 types of medication prescribed in most cases of bipolar:

1. Mood Stabilizers: These are the cornerstone of bipolar disorder treatment. Lithium, valproate, and carbamazepine are commonly used mood stabilizers. They help to balance mood swings and prevent the extremes of highs (mania) and lows (depression).
2. Antipsychotics: These medications, such as olanzapine, quetiapine, and risperidone, are used to treat manic episodes and can also be effective in preventing relapse. Some antipsychotics have additional mood-stabilizing properties.
3. Antidepressants: While their use comes at the risk of triggering manic episodes, antidepressants can be effective in managing the depressive phases of bipolar disorder when used in conjunction with mood stabilizers or antipsychotics.

There is a cost-benefit analysis involved for both the provider and the patient that often requires trial and error to find the perfect balance. Psychiatrists need to take into account the risks of non-adherence, as well as the risks of side-effects. Patients need to keep in mind that things might get worse before they get better, understanding that side-effects and pitfalls along the way are normal and, in most cases, well worth the benefits.

* The word ‘psychosis’ has a particular meaning in mental health terminology. It is very different from the way it is used in common conversation.

Therapy: Finding a Way Forward

There are 4 types of therapy often used to treat bipolar disorder:

1. Cognitive Behavioral Therapy (CBT):

Cognitive Behavioral Therapy (CBT) helps individuals identify and change negative thought patterns and behaviors. It can be effective in managing bipolar disorder by teaching coping strategies to deal with stressors that can trigger mood episodes.

2. Psychoeducation:

As we mentioned earlier, this involves teaching individuals about bipolar disorder and its treatment. It helps patients recognize early signs of mood swings and how treatment works, contributing to better long-term management.

3. Dialectical-Behavior Therapy (DBT):

The basis of Dialectical-Behavior Therapy (DBT) is Eastern mindfulness, which has proven an effective means of regulating both the highs and lows of various emotions. It is helpful not just for people with bipolar disorder, but for anyone who has difficulty coping with certain feelings.

4. Family-Focused Therapy:

Since family support plays a crucial role in the treatment of bipolar disorder, this therapy involves family members in the treatment process. It educates them about the disorder, helps improve family communication, and teaches coping strategies.

These types of therapy help the individual see that there are ways to manage bipolar disorder in the long term, providing a path to a meaningful life.

Lifestyle and Complementary Therapies

Improving your lifestyle in certain ways can make a big difference in the treatment of bipolar. The following are particualrly important:

1. Exercise: Regular physical activity can help manage symptoms of depression, improve overall mood, and reduce stress.
2. Diet: A balanced diet can have a positive effect on overall well-being. Some studies suggest that omega-3 fatty acids found in fish and other foods may have mood-stabilizing effects.
3. Sleep Hygiene: Maintaining a regular sleep schedule is vital for individuals with bipolar disorder, as sleep disturbances can trigger mood episodes.
4. Mindfulness and Meditation: Even outside of a therapeutic approach like DBT, these practices can help reduce stress and increase self-awareness, aiding in the management of mood swings.

Emerging Therapies

In 2024, the outlook for the treatment of bipolar disorder is more positive than ever before. Ketamine infusions have shown immense promise in treating the disorder. Transcranial magnetic stimulation (TMS), which uses magnetic fields to stimulate nerve cells in the brain, has positive effects as well. And, there are new medications in the clinical trial phase.

Furthermore, research is ongoing, with experts getting closer to a more comprehensive understanding of the origins of bipolar disorder and how it works in the body and mind. This research is helping shape exciting treatment approaches.

Conclusion

There is no treatment or therapy for bipolar disorder that can be categorized as ‘the best’. On the contrary, it is often necessary to balance a number of treatments in order to achieve the best results. The good news is that, in 2024, there are many reasons to be optimistic, due to exciting advances that will help improve treatment.