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The Role of Medication and Therapy in Bipolar Disorder Treatment

Recent research suggests that as many as 5% of us are on the bipolar spectrum with 1.3 million people having bipolar in the UK; this is according to Bipolar UK.

Bipolar is one of the UK’s most common long-term health conditions and living with bipolar increases a person’s risk of suicide by up to 20 times. On average it takes 9.5 years to receive a correct diagnosis.

Understanding Bipolar Disorder

Bipolar disorder, which was previously called manic depression, is where a person has extreme mood swings. These include emotional highs, known as mania or hypomania, and lows, otherwise known as depression. It is a severe mental illness where people can have long or short periods of stability before experiencing a low or a high. People with bipolar experience an extreme range of moods from deep depression with recurring suicidal thoughts to an extreme manic high with psychosis and hallucinations. They can also experience a mixed state, where symptoms of depression and mania occur at the same time.

There are different types of bipolar disorder which include:

  • Bipolar I disorder – this involves manic episodes that last at least seven days or are severe enough to require hospitalisation. Depressive episodes may also occur.
  • Bipolar II disorder – this is characterised by a pattern of depressive episodes and hypomanic episodes, which are less severe than full-blown mania.
  • Cyclothymic disorder – this involves chronic fluctuations in mood with periods of hypomania and mild depression that lasts for at least two years.

Bipolar disorder has a genetic component, which means that there is an increased likelihood of developing the condition if you have a close relative, such as a parent or sibling, with bipolar disorder. Genetics alone do not determine whether someone will develop bipolar disorder, there are also other factors, such as environmental influences and life experiences, which also play a role in the development of the disorder. Biological factors, for example imbalances in certain neurotransmitters, such as dopamine, serotonin and norepinephrine, are thought to contribute to bipolar disorder. These imbalances can affect mood regulation. Environmental factors such as experiencing traumatic events, or drug and alcohol use, can increase the risk and severity of bipolar disorder in susceptible individuals.

Bipolar disorder is a complex mental health condition and the exact cause of bipolar disorder is not yet fully understood; however, both genetic and environmental factors are believed to have an influence in the development of the condition.

Medication in BD Treatment

Medication management in bipolar disorder is highly individualised, and what works for one person may not work for another. Finding the right combination of medications often involves a process of trial and error and should be done under the guidance of a psychiatrist or other mental health professional. Additionally, medication treatment is usually combined with psychotherapy and lifestyle changes for optimal management of bipolar disorder. Regular monitoring and adjustment of medications may also be necessary in order to maintain stability and manage any side effects. The goals of medication treatment for bipolar disorder typically include stabilising mood, reducing episodes of mania and depression, reducing the frequency and severity of mood swings, and improving the overall quality of life.

Some of the different types of medication which are used to treat bipolar disorder include:

  • Mood stabilisers – these medications help regulate mood and prevent extreme highs and lows. Lithium is one of the oldest and most commonly used mood stabilisers.
  • Antipsychotic medications – antipsychotics can help manage symptoms of mania and psychosis associated with bipolar disorder. Some antipsychotic medications are also used as mood stabilisers.
  • Antidepressants – antidepressants are sometimes used in bipolar disorder treatment, particularly to manage depressive episodes. They are usually prescribed along with a mood stabiliser or antipsychotic to reduce the risk of triggering manic episodes.
  • Benzodiazepines – these medications may be used on a short-term basis in order to help manage severe symptoms of anxiety or agitation associated with bipolar disorder or to help with sleep disturbances.

In some cases, other medications may be prescribed to address specific symptoms or comorbid conditions such as anxiety or insomnia.

Medications

Psychotherapy in BD Treatment

Psychotherapy plays an important role in bipolar disorder treatment by providing people with the knowledge, skills and support they need to manage their symptoms effectively and lead fulfilling lives. It complements medication management and other aspects of treatment in order to promote long-term stability and well-being. Understanding bipolar disorder is important for managing the condition effectively. Psychotherapy sessions often begin with psychoeducation. This is where people learn about the symptoms, triggers and causes of the disorder. Understanding the illness empowers people to recognise symptoms early and make informed decisions about their treatment.

Psychotherapy is often used to:

  • Promote medication adherence – psychotherapy can help people to understand the importance of medication adherence in managing bipolar disorder. Therapists can work with people to address concerns about medications, explore any barriers to adherence, and develop strategies to promote consistent medication use.
  • Help people to identify triggers and early warning signs – psychotherapy can help people to identify triggers and early warning signs of mood episodes, such as mania, hypomania or depression. By recognising these signs early, people can take proactive steps to prevent or minimise the severity of mood episodes.
  • Implement relapse prevention – psychotherapy can help people to develop a relapse prevention plan to identify potential triggers, early warning signs and coping strategies to prevent mood episodes from escalating. Having a relapse prevention plan in place can empower people to take proactive steps to maintain stability in the long term.

There are different types of therapy that can be used, including:

  • Cognitive behavioural therapy (CBT) – CBT is one of the most commonly used forms of psychotherapy for bipolar disorder. It focuses on identifying and challenging negative thought patterns and beliefs that contribute to mood symptoms. CBT also teaches people coping skills to manage stress, regulate emotions and improve problem-solving abilities.
  • Interpersonal and social rhythm therapy (IPSRT) – IPSRT is specifically designed for bipolar disorder and focuses on stabilising daily routines and sleep patterns. This therapy helps people regulate their biological rhythms, which can help prevent mood episodes. IPSRT also addresses interpersonal issues and relationship difficulties that may contribute to mood instability.
  • Family therapy – family therapy can be beneficial for people with bipolar disorder, as it involves educating family members and teaching effective communication and problem-solving skills. Family support is crucial in managing bipolar disorder, and involving family members in therapy can improve treatment outcomes.
  • Supportive therapy – supportive therapy provides a safe space for people to discuss their experiences, emotions and challenges related to bipolar disorder. The therapist offers empathy, validation and encouragement, which can help people to feel understood and supported as they navigate the ups and downs of bipolar disorder.
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The Combination Approach

Combining medication with therapy offers a comprehensive approach to managing bipolar disorder. While medication primarily targets the biological aspects of the condition, therapy addresses the emotional, cognitive and behavioural components. Medications such as mood stabilisers, antipsychotics and antidepressants are commonly prescribed to help stabilise mood, reduce the frequency and severity of mood swings, and manage symptoms such as depression, mania or psychosis. Therapy can be beneficial in addressing the psychological and behavioural aspects of bipolar disorder as it can help people understand their condition, learn coping strategies, develop skills to manage stressors, identify triggers for mood episodes, improve communication and relationships, and enhance problem-solving skills.

This comprehensive approach is often more effective in reducing symptoms, preventing relapses, improving overall functioning and enhancing quality of life for people with bipolar disorder.

Medication Management

Medication management is an important aspect of managing bipolar disorder. Regular monitoring by a healthcare provider is essential in order to assess the effectiveness of medication and make adjustments as needed. This may involve tracking mood symptoms, side effects and medication adherence. Treatment plans for bipolar disorder should be tailored to each individual’s specific needs and may evolve over time based on their response to medication and changes in symptoms.

Taking medication as prescribed is crucial for managing bipolar disorder in order to:

  • Stabilise mood – bipolar disorder involves significant mood swings, from manic or hypomanic episodes to depressive episodes. Medications such as mood stabilisers, antipsychotics and antidepressants help to regulate these mood swings. Consistent medication adherence helps to maintain stability in mood, reducing the frequency and severity of mood episodes.
  • Prevent relapses – bipolar disorder tends to be a chronic condition characterised by recurrent episodes. Proper medication adherence reduces the likelihood of relapses or the exacerbation of symptoms. Missing doses or discontinuing medication without medical supervision can increase the risk of relapse.
  • Reduce hospitalisations – non-adherence to medication increases the risk of acute episodes, which may require hospitalisation. Consistent medication use can help prevent these crisis situations from occurring.
  • Improve functioning – medications not only help manage acute symptoms but also enhance overall functioning and therefore quality of life. By stabilising mood, medications enable individuals with bipolar disorder to better engage in work, relationships and other daily activities.
  • Minimise risks of harmful behaviours – during manic or hypomanic episodes, people with bipolar disorder may engage in risky behaviours such as overspending, substance abuse or risky sexual activities. Medications can help to mitigate these impulses, reducing the risks associated with these behaviours.
  • Enhance treatment effectiveness – medications are often a cornerstone of bipolar disorder treatment, particularly for stabilising mood. When taken consistently as prescribed, they can work more effectively in managing symptoms and preventing recurrences.
  • Address co-occurring conditions – many people with bipolar disorder have co-occurring conditions such as anxiety disorders. Proper medication adherence can help manage these comorbidities more effectively, as medications may address the overlapping symptoms.
  • Improve the long-term prognosis – consistent medication use can lead to better long-term outcomes for people with bipolar disorder. By effectively managing symptoms and reducing the impact of the illness on daily life, medications contribute to a more stable and fulfilling future

Therapy Modalities

Therapy modalities for bipolar disorder typically involve a combination of psychotherapy and pharmacotherapy. Some common therapy modalities used in the treatment of bipolar disorder include:

  • Cognitive behavioural therapy (CBT) – CBT is a widely used therapy for bipolar disorder. It helps people identify and change negative thought patterns and behaviours that contribute to mood swings. It also teaches coping strategies for managing stress and preventing relapses.
  • Interpersonal and social rhythm therapy (IPSRT) – IPSRT focuses on stabilising daily routines and improving interpersonal relationships. It helps people with bipolar disorder regulate their sleep-wake cycles, mealtimes and other daily activities in order to prevent mood episodes. It also addresses conflicts in relationships that may exacerbate symptoms.
  • Family-Focused Therapy (FFT) – FFT involves the family members of individuals with bipolar disorder. It educates family members about the disorder and teaches communication and problem-solving skills in order to improve family dynamics and support the person’s recovery.
  • Psychoeducation – psychoeducation involves teaching people with bipolar disorder and their families about the nature of the illness, its symptoms, triggers and treatment options. It helps people understand their condition better and empowers them to manage it effectively.
  • Mindfulness-based cognitive therapy (MBCT) – MBCT combines elements of cognitive therapy with mindfulness practices. It helps people to develop awareness of their thoughts and feelings without judgement, which can be helpful in managing mood symptoms and preventing relapses.
  • Dialectical behaviour therapy (DBT) – DBT is a type of therapy originally developed for borderline personality disorder but has been adapted for various mental health conditions, including bipolar disorder. It focuses on teaching skills for emotion regulation, distress tolerance, interpersonal effectiveness and mindfulness.
  • Supportive therapy – supportive therapy provides a safe and non-judgemental space for people to express their feelings and concerns. It focuses on providing emotional support, encouragement and validation while helping people to develop coping strategies for managing their symptoms.

Recovery and Maintenance

With appropriate treatment, which often involves a combination of medication, therapy, lifestyle changes and support from mental health professionals and loved ones, people with bipolar disorder can manage their symptoms effectively and lead fulfilling lives.

Adopting a healthy lifestyle can significantly impact mood stability. This includes engaging in regular exercise, maintaining a healthy balanced diet, prioritising sleep hygiene, and avoiding drugs and alcohol, which can exacerbate symptoms. Having a strong support network of family, friends, support groups and mental health professionals is essential for people with bipolar disorder. Support from others can provide encouragement, understanding and practical assistance during difficult times. Regular check-ins with healthcare providers are also crucial to monitor symptoms, adjust treatment plans as needed, and address any emerging issues quickly. Learning to recognise early warning signs of mood episodes and developing coping strategies can empower people to manage their condition effectively and prevent relapses.

There are several different services available if you are being treated for bipolar disorder. Some of these are accessed through a referral from your GP, while others can be accessed through your local authority. Some of the different services include:

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  • Community mental health teams (CMHT) – these provide the main part of local specialist mental health services. They offer assessment, treatment and social care support.
  • Early intervention teams – these services provide early identification and treatment if you have the first signs of psychosis. Your GP is usually able to refer you directly to an early intervention team.
  • Crisis services – crisis services can treat you for a sudden episode and they allow you to be treated at home, instead of in hospital. They are specialist mental health teams that can deal with crises that happen outside normal office hours, for example in the evening or at weekends.
  • Acute day hospitals – these are an alternative to inpatient care in a hospital setting. You can visit every day or be seen as often as you need.
  • Assertive outreach teams – these teams provide intensive treatment and rehabilitation within the community. Staff can visit you at home and liaise with other services, such as your GP or social services, to get you the ongoing support that you need. They can also provide practical help, such as helping to find suitable housing and work.

Conclusion

The treatment of bipolar disorder requires a comprehensive approach that combines medication and therapy. Medications such as mood stabilisers, antipsychotics and antidepressants play an important role in managing symptoms and stabilising mood swings.

Therapy, particularly cognitive behavioural therapy and psychoeducation, provides essential tools for people to better understand their condition, develop coping strategies and maintain long-term stability. Treatment of medication and therapy addresses not only the symptoms of bipolar disorder but also the underlying psychological and emotional factors and helps people to achieve better symptom management, improved quality of life, and enhanced overall well-being.

Ongoing research and advancements in both medication and therapy continue to refine treatment approaches, offering hope for even more effective interventions in the future.

The Depression and Bipolar Support Alliance provide support for anyone affected by bipolar disorder.

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About the author

Claire Vain

Claire Vain

Claire graduated with a degree in Social Work in 2010. She is currently enjoying her career moving in a different direction, working as a professional writer and editor. Outside of work Claire loves to travel, spend time with her family and two dogs and she practices yoga at every opportunity!



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