Treatment for bipolar disorders should include both pharmacotherapy and psychotherapy.  Because stressful life events are associated with increases in relapse rates, therapy should address the number and severity of stressors in an individual’s life.

Pharmacotherapy
The pharmacological treatment of bipolar disorders is divided into initial treatment to get the condition under control, and maintenance treatment. Treatment of bipolar disorders requires different strategies for the patient who is experiencing mania, hypomania, or depression. The primary treatment has been mood stabilizers (lithium, valproic acid (Depakote, Depakene), carbamazepine (Tegretol), oxcarbazepine (Trileptal), lamotrigine, antipsychotics (primarily atypical), and benzodiazepines. Each of these medications is associated with a unique side effect and safety profile, and no one drug is predictably effective for all patients. Often, a practitioner will try different medications before an optimal treatment is found.

For the treatment of acute mania, lithium carbonate is considered the typical mood stabilizer. But because it can take a while to be effective, it is usually supplemented in the early stages of treatment by atypical antipsychotics, mood-stabilizing anticonvulsants, or high-potency benzodiazepines.

For treatment of bipolar depression, lamotrigine, quetiapine, (Seroquel), or other mood stabilizers or atypical antipsychotic medication can be used either alone or in combination. A fixed combination of olanzapine and fluoxetine has been shown to be effective in treating acute bipolar depression for an 8-week period without inducing mania or hypomania. Other medications may be used when a patient does not respond to standard antidepressants.

Maintaining the treatment of bipolar disorder to prevent recurrence of mood episodes is the greatest challenge of managing this condition. Lithium, carbamazepine, and valproic acid, alone or in combination, are the most widely used drugs in the long-term treatment of patients with bipolar disorder. In addition, thyroid supplementation is often needed during long-term treatment.

Patients may be asked to keep a daily record of their mood patterns or other facts that could help in finding the right treatment.

Psychotherapy

Psychotherapy is a vital part of bipolar disorder treatment and can be provided in individual, family, or group settings. Several types of therapy may be helpful. These include:

• Interpersonal and social rhythm therapy (IPSRT). IPSRT focuses on the stabilization of daily rhythms, such as sleeping, waking and mealtimes. People with bipolar disorder may benefit from establishing a daily routine for sleep, diet, and exercise.
• Cognitive behavioral therapy (CBT). This type of therapy focuses on identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones. CBT can help identify what triggers a patient’s bipolar episodes. The patient can also learn effective strategies to manage stress and cope with upsetting situations.
• Family-focused therapy. Family support and communication can help you stick with your treatment plan and help you and your loved ones recognize and manage warning signs of mood swings.