What kind of treatments can help?

It has been suggested that the best treatment for bipolar disorder should include both ‘talking treatment’ and medication. The exact combination of treatments you are offered will depend on whether you are managing a current bipolar episode or managing your mental health in the long term.

“[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 are experiencing.

During depressive episodes

  • You are 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 proved to help with depression, such as cognitive behavioural therapy (CBT)

During manic or hypomanic episodes

  • You are likely to be offered medication – this might be new medication or adjusting your current medication
  • You are unlikely to be offered a talking treatment if you are currently experiencing a manic or hypomanic episode

What should my long-term treatment plan involve?

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 a community mental health team or your family doctor, although you should 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
  • A crisis plan, so you know what to do if you experience any of your early warning signs, 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 you experience

If you are receiving a talking treatment, you might set some of these goals with your therapist. You should share these goals with your family doctor. 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 hospitalised or sectioned, and [I’ve] done so well. My medication is working”

How can talking treatments help in the long term?

Talking treatments can help you:

  • Understand 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

Which talking treatments might I be offered?

There are several talking treatments you might be offered to help you manage your bipolar disorder in the long term. These include:

  • 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
  • Interpersonal and social rhythm therapy – this looks at any problems you have in communicating and interacting with other people, or relationship problems. It aims to help you balance your sleep cycle, work-life balance and daily routines
  • 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.

“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.”

Is ECT ever used to treat bipolar disorder?

Electroconvulsive therapy (ECT) should only be considered a treatment option for bipolar disorder in extreme circumstances. This could be if:

  • You are 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 are in this situation, your doctor should discuss this option with you in a clear and accessible way before you make any decisions.

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