What are the treatment options for Bipolar Disorder?

Bipolar Disorder is associated with severe mood fluctuations ranging from depressive lows to manic highs. These manic episodes may vary in intensity and duration, from person to person. When mania is severe and lasts for a week or more, the person is diagnosed with Bipolar I Disorder. When less severe and lasting for less than a week, it is known as hypomania, and the person is often diagnosed with Bipolar II disorder. 

Can you treat Bipolar Disorder? 

Yes.

That being said, Bipolar Disorder cannot be cured. 

But it can be managed using a multidisciplinary approach: Medication, Therapy and Community care. This holistic approach minimises the severity of symptoms and maximises benefits to the individual. 

But before starting treatment, it is crucial to psycho-educate the individual and their family. Knowledge is power, and understanding an illness is often the key to managing it. 

The client and their family must be educated on the disorder, the need for treating it and increasing treatment adherence. Additionally, it will empower the individual to look out for any warning signs, and triggers, as well as help foster self-acceptance. 

The end goal of treatment is not to cure, but to facilitate more personalised coping resources to encourage autonomy. This includes stabilizing mood in the long run, increasing adherence to medication and preventing any fluctuation or relapse. 

What kind of medication treats Bipolar disorder? 

In the case of Bipolar Disorder, medication is often the first line of intervention. The disorder is very biological in its origins, and therefore requires symptoms to be managed by frequent medication. The different categories of medications used to treat bipolar disorder are:

Mood Stabilizer: helps control manic or hypomanic episodes.

Anticonvulsants: act as long-term mood stabilizers and also help treat mania. 

Antipsychotic: prescribed along with antidepressants. They help stabilize mood and reduce episodes. 

Antidepressant: helps reduce depressive episodes.

Antianxiety medication: offer a short-term solution to anxiety, and improve sleep. 

Medicines are not a one-size-fits-all solution. They may not work the same for different people, and clients will have to experiment with combinations until they find the right fit. It can be tedious, and very difficult to juggle between medications. Do not lose hope! It’s important to consistently adhere to the medicines provided so that they take effect as soon as possible. A complete lack of remission is a concern. 

Just like any other drug, medications or Bipolar disorder can cause some side effects. These include: 

• Nausea
• Tremors
• Hair loss
• Sexual problems
• Weight gain
• Liver damage
• Kidney damage
• Diarrhoea
• Belly pain
• Skin reaction

If these side effects do not dissipate in a few weeks or cause unduly stress, seek alternative opinions from your doctor instead of stopping treatment on your own. You do not have to live with these side effects. Your doctor may alter your dosage, provide another medicine to curb any side effects or you may try a different medicine altogether.

What kind of therapy manages Bipolar disorder?

Non-pharmaceutical interventions for Bipolar disorder include: 

• Cognitive Behavioural Therapy
• IPSRT
• Family-focused Therapy

These psychotherapies can be conducted in either: one-on-one sessions, family sessions or group session formats.

1. Cognitive Behavioural Therapy focuses on identifying unhealthy, negative beliefs and behaviours, and replacing those with healthier ones. 

In the case of Bipolar disorder, CBT helps identify what triggers bipolar episodes. You also learn effective strategies to manage any distress. It also focuses on helping you develop coping skills to manage the illness post-therapy.

Specifically:

• addressing depressive symptoms that occur as part of periods or episodes of depression
• addressing feelings of guilt or other negative thoughts and beliefs about manic episodes
• addressing feelings of losing friends or relationships

CBT aims to psycho-educate the client about how their disorder presents. It also shows them the links between feelings, thoughts and behaviour. 

CBT aims to: 

• Help the client learn strategies to promote problem-solving
• Find ways to eat regularly, sleep and exercise. 
• Learn to identify triggers for changes in mood
• Learn to prevent a full-blown mood episode from occurring
• Use personal and professional support networks
• Cognitively restructuring any negative thoughts or beliefs

CBT does come with limitations. Its effects tend to decrease over time, and it may be less efficient in clients with more severe illnesses. Therapeutic techniques impact depressive symptoms more than manic ones. There is also a lack of human resources trained to apply these techniques. 

1. Interpersonal and Social Rhythm Therapy emphasises both interpersonal relationships and the regulation of biological rhythms. It helps the client manage their symptoms by regulating the fluctuations caused by Bipolar disorder. 

According to research, depressed individuals tend to have inconsistent biological rhythms which slow down their recovery after stressful events. 

IPSRT aims to:

• Improve daily routine to influence biological processes and mood
• Encourage engagement by following a daily routine
• Understand the disturbance and set a routine to address it

There are 4 phases of treatment in IPSRT:

• Initially, the individual and the therapist explore how disruptions in the routine lead to bipolar episodes in the past
• The intermediate phase involves developing a new structure for social rhythms. By charting things like mood, sleep, eating and exercise, they pick up on how they are all connected. 
• The maintenance phase is meant to help reinforce the social rhythms so the client can adhere to them. 
• Finally, IPSRT is slowly phased out and reduced in frequency. Treatment is meant to be weekly at first, then monthly, no longer regularly centred around this technique. 

Overall, it acts as a preventive measure against Bipolar episodes. Studies show that it is typically well-received by users and reduces any psychological burden. It can be implemented easily and has lesser training requirements. 

1. Family-Focused therapy consists of conjoint sessions of psychoeducation regarding Bipolar disorder and training to enhance communication and improve problem-solving skills.

FFT aims to:

• Assist both individual and their caregivers in integrating their experiences associated with episodes of mania or depression
• Accepting vulnerability to future episodes
• Accepting mood-stabilising medication as a necessity
• Distinguishing between the person and their disorder
• Learning to cope with stressful life events 
• Re-establishing functional relationships after an illness episode

FFT improves the emotional support available to both the client as well as their caregivers. It helps promote understanding and reduce the stigma associated with Bipolar Disorder. Its group setting format allows for bonding and empathy between members. 

Hospitalisation is another resource that can be accessed in cases of self-harm, depending on the circumstances. Some warning signs that hospitalisation may be necessary include: 

• Exhibition of extreme or dangerous behaviour
• Periods of mood swings where the individual or others are at risk

While Bipolar disorder can be difficult to manage for the individual and their caretakers, so many people with Bipolar disorder have gone ahead to live normal, fulfilling lives. With the right medication, psychotherapy and support, nothing is impossible. 

References:

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