What treatments can help?
The National Institute for Health and Care Excellence (NICE) – the organisation that produces guidelines on best practice in health care – suggests that treatment for bipolar disorder should include both talking treatments and medication.
This section covers:
- What treatment could I get to manage a current episode?
- What can I do in the longer term?
- Which talking therapies might I be offered?
- How can talking therapies help in the long term?
- What treatment can I get in a crisis?
The exact combination of treatments you’re offered will depend on whether you’re managing a current bipolar episode, or managing your mental health in the long term. For information on drug treatments, see our separate page on medication for bipolar disorder.
“[I find] the biggest step is accepting that is who you are. Changing your ways with meds and therapy is a hard slog.”
What treatment could I get to manage a current episode?
This will usually depend on what kind of episode you’re experiencing.
During depressive episodes
- You’re likely to be offered medication – this might be new medication or adjusting your current medication.
- You might also be offered a structured psychological treatment that’s proven to help with depression, such as cognitive behavioural therapy (CBT). (See our pages on CBT for more information about this treatment.)
(See our pages on depression for more information on treatments and self-care tips for depression.)
During manic or hypomanic episodes
- You’re likely to be offered medication – this might be new medication or adjusting your current medication.
- You’re unlikely to be offered a talking treatment if you are currently experiencing a manic or hypomanic episode.
(See our pages on hypomania and mania for more information on treatments and self- care tips for mania and hypomania.)
What can I do in the longer term?
The aim of treatment should be to help you maintain stable moods and manage your symptoms well. As you start to feel more stable, the majority of your support could come from an integrated community centre for mental wellness (ICCMW) or your GP, although your GP should arrange for you to still be in touch with a mental health specialist.
Your health professionals should work with you to help you identify:
- Clear emotional and social recovery goals for you to work towards and regularly reflect on and revise with your doctor.
- A crisis plan, so you know what to do if you experience any of your early warning signs or triggers, or begin to feel very distressed.
- How you feel day-to-day, so you can be aware of how best to manage your mood and notice any changes.
- A medication plan, including dates where you can review your dose, how well the medication is working and any side effects that you experience.
If you are receiving a talking therapy, you might set some of these goals with your therapist. You should share these goals with your GP. You may also want to share them with your family, friends and carer if you have one.
“It has been 13 years since I was hospitalized or sectioned, and [I’ve] done so well. My medication is working.”
Which talking therapies might I be offered?
There are several talking therapies you might be offered to help you manage your bipolar disorder in the long term. These are a few that have been tested and shown to work well for some people, although other therapies may work too:
- Cognitive behavioural therapy (CBT) – looks at how your feelings, thoughts and behaviour influence each other and how you can change these patterns.
- Interpersonal therapy – focuses on your relationships with other people and how your thoughts, feelings and behaviour are affected by your relationships, and how they affect your relationships in turn.
- Behavioural couples therapy – focuses on recognising and trying to resolve the emotional problems that can happen between partners.
Other types of talking therapies you may be offered are:
- Enhanced relapse prevention/ individual psychoeducation – this is a brief intervention to help you learn coping strategies.
- Group psychoeducation – this involves working in a group of people with shared experiences, led by a trained therapist, to build up knowledge about bipolar disorder and self-management.
- Family-focused therapy – this involves working as a family to look at behavioural traits, identify risks and build communication and problem-solving skills.
Some of these treatments are more widely available than others. What you are offered can also depend on what you and your doctor agree would be most useful for you.
(For more information on different types of talking therapies, including how to access them, see our pages on talking therapies.)
How can talking therapies help in the long term?
Talking therapies can help you:
- understand or make sense or meaning out of your bipolar disorder, and reflect on the impact it has had throughout your life
- identify early warning signs and symptoms
- develop strategies to cope with early symptoms, triggers and episodes
- make a crisis plan
- set goals and plans for staying well
“Bipolar disorder is one of those things that if you have it and it’s well controlled, you can use it productively… it’s in [my] best interest to take [my] meds, see [my] shrink regularly and stay well.”
What treatment can I get in a crisis?
If you start to feel very unwell, or if an episode of depression or mania is lasting for a long time and your regular treatment isn’t working, you may need to access crisis services to help you get through it. This may include:
- emergency support, such as going to A&E
- getting support from a crisis service if urgent help is needed
- hospital admission
(See our pages on crisis services for more detailed information about your options in a crisis, how to access services, and how you can plan ahead.)
Is ECT ever used to treat bipolar disorder?
Electroconvulsive therapy (ECT) should only be considered a treatment option for bipolar disorder in extreme circumstances. According to NICE guidelines, this could be if:
- you’re experiencing a long and severe period of depression, or a long period of mania, AND
- other treatments have not worked, or the situation is life-threatening.
If you feel like you’re in this situation, your doctor should discuss this option with you in a clear and accessible way before you make any decisions.
(See our pages on ECT for more information about this treatment and when it can be performed.)
