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Bipolar disorder

Treatment of bipolar disorder

Treatment for bipolar disorder has two main aims:

  • to deal with symptoms when they occur
  • to stop symptoms from coming back.

Treatments include:

  • medications for mania, hypomania and depression
  • medication to stop symptoms returning
  • psychological treatments (talking therapies).

In some circumstances, electroconvulsive therapy (ECT) might be recommended.

You and your health-care team will work together to find the treatment that works best for you.

Most people with bipolar disorder will need medication to control symptoms.

Psychological treatments can help you deal with depression, live well with bipolar disorder, and control stress (which can set off mania).

What works?

People with bipolar disorder do best if they:

  • get the right medications
  • get psychological treatment
  • get education about their illness (individual psychoeducation)
  • have a supportive partner, family member or friend involved in their care
  • have access to 24-hour crisis support
  • have a mental health professional who takes care of planning and coordinating their individual care
  • have support to find a job or continue education
  • have somewhere safe and affordable to live
  • have a healthy lifestyle (eat well, stay physically active, quit smoking and other drugs, get regular sleep).

Why should I get treatment?

The right treatment can help you:

  • control your symptoms, thoughts, feelings and actions
  • get back to school, study or work
  • keep your friendships and social life
  • avoid suicidal thinking or self-harm
  • stay healthy.

Treatments for mania

If you have mania, you need urgent care from a doctor – even if you feel great.

You will need medication, and you may need to go to hospital. Severe mania is a medical emergency.

Medications for mania include:

  • short-term sedatives to calm you down when the symptoms are at their worst.
  • antipsychotic medications, such as aripiprazole, asenapine, haloperidol, olanzapine, quetiapine, risperidone and ziprasidone
  • mood-stabilising medications such as lithium, sodium valproate and carbamazepine.

These treatments can also be used to treat hypomania.

ECT is occasionally used to control some types of severe mania. It is a safe and effective treatment.

Treatments for bipolar depression

A combination of medication and a psychological treatment (talking therapy) is the best treatment for bipolar depression.

Medications for treating bipolar depression include:

  • antipsychotic medications, such as quetiapine
  • mood-stabilising medications, such as lithium
  • a combination of an antidepressant medication and a mood stabiliser.

Antidepressants can sometimes set off mania. People with bipolar depression should only have antidepressants in combination with medications that prevent this happening (mood stabilisers).

ECT is sometimes used for people with severe bipolar depression.

Psychological treatment for bipolar disorder

Psychological treatment aims to help you learn skills to:

  • cope with having bipolar disorder
  • have fewer episodes of mania or depression
  • recognise the signs of mania or depression early, so you can get treatment
  • improve your quality of life.

Treatments are provided by trained therapists (e.g. psychiatrists, other doctors, or psychologists).

Psychological treatments that are effective for bipolar disorder include:

  • cognitive behavioural therapy (CBT) – a type of psychological treatment that asks you to challenge unhelpful thoughts.
  • psychoeducation – a program to help you become an expert in managing your own illness
  • family-focused therapy – helps whole families learn to communicate and solve problems better, to reduce stress on the person with bipolar disorder
  • interpersonal and social rhythm therapy – aims to reduce stress, improve relationships, and set up a pattern of regular sleep.

For psychological treatment to work, you and your therapist need to work well together. This means being honest, and being able to trust them.

More about psychological treatments

Medication for bipolar disorder

Getting the most out of your bipolar disorder medication

  • Take every dose of your medication at the time recommended to you by your psychiatrist.
  • When starting a medication, give it time to start working properly.
  • Don’t change your medication without talking to your psychiatrist.
  • If you have symptoms that you think could be a side effect of medications, tell your doctor as soon as possible.

Side effects of medication

Bipolar disorder medications can sometimes cause side effects, especially when you start a new medication.

Side effects differ between medications and between people. Ask your doctor or pharmacist to explain the possible side effects of your medication. You can ask for a printed leaflet, or read about the medication at:

More about psychiatric medications

If you have side effects that bother you, speak to your doctor about them. They will carefully assess how the medication is working for you as well as the side effects. They might be able to reduce the side effects by changing the dose of the medication, or switching to a different medication. Some side effects can be treated with other medications.

Some medications for bipolar disorder can cause problems such as:

  • nausea
  • headache
  • weight gain
  • fluid retention
  • drowsiness or sleepiness
  • constipation
  • sexual problems (e.g. problems getting an erection, not feeling aroused, or problems reaching orgasm)
  • increased levels of blood fats (lipids) and glucose
  • high blood pressure
  • breast problems
  • skin problems
  • dizziness or light-headedness
  • problems with nerves and muscles
  • blurred vision
  • dry mouth.

Most people will only have one or two side effects.

How long will I have to keep taking medication?

Most people need to keep taking medication long-term to stop symptoms returning.

After recovering from mania or depression, you will normally need to continue your medication for weeks or months. After that, your doctor may adjust your treatment.

If you take your medication regularly, you have less chance of having mania or depression. Some people will be advised to keep taking medication for many years.

Will I have to go to hospital?

Your usual treatment will involve regular visits to your GP, hospital outpatient clinic, a psychiatrist, a psychologist or other therapist.

There may be times when you need to stay in hospital. If you have severe mania or depression, going to hospital will keep you safe, allow for close monitoring of medications and get your symptoms under control.

Your doctor may also arrange a hospital stay if you are at risk of harming yourself or other people, or if you have not been eating or drinking enough.

About psychiatric hospitals

Can I be forced to have treatment?

Having mania or hypomania stops you being able to think clearly and avoid risks. At the time, you may not believe you need treatment.

You can be given treatment without your consent if you are at risk of harming yourself or others. This is called involuntary treatment. If the risks are very severe you may have to spend time in hospital while you receive treatment.  

If this happens, your doctor should give you a booklet that explains your rights. If you don’t get a booklet, ask for it.

Involuntary treatment can only continue while it is necessary to keep you safe. You, and your family or carers, have the right to have the decision reviewed by an independent authority, such as a court or tribunal. 

Page last reviewed Feb 2017 | C1034V1

This is a general guide only, and does not replace individual medical advice. Please speak to your doctor for advice about your situation. The RANZCP is not liable for any consequences arising from relying on this information. Subject matter experts, people with lived experience of mental illness and carers all contributed to this fact sheet.