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What is the gold standard treatment for bipolar disorder?

Bipolar disorder, formerly known as manic depression, is a mental illness characterized by extreme shifts in mood and energy levels. A person with bipolar disorder experiences alternating episodes of mania (elevated moods, increased energy and activity levels) and depression (low moods, low energy and activity levels).

Bipolar disorder is a chronic, lifelong condition with recurring episodes throughout a person’s life. It affects about 2.8% of American adults each year. The average age of onset is 25 years old, although it can occur at any age. Bipolar disorder often develops in the late teens or early adulthood.

There are four main types of bipolar disorder:

  • Bipolar I Disorder – defined by the occurrence of at least one manic episode, with or without depressive episodes
  • Bipolar II Disorder – defined by hypomanic (less severe mania) episodes and depressive episodes
  • Cyclothymic Disorder – characterized by cycling between hypomanic and depressive symptoms that do not reach full manic or depressive episodes
  • Other Specified and Unspecified Bipolar Disorders – symptoms cause clinically significant distress but do not meet the full criteria for bipolar I or II

Bipolar disorder is complex and often challenging to diagnose and treat effectively. It requires a comprehensive treatment plan that includes medication, psychotherapy, and healthy lifestyle changes.

What is the best treatment for bipolar disorder?

There is no single best treatment for bipolar disorder. The gold standard approach involves a combination of medications, psychotherapy, and lifestyle adjustments to help manage symptoms long-term.


Medications are the foundation of bipolar disorder treatment. They help regulate moods and prevent or reduce the severity of mood episodes. Commonly prescribed medications include:

  • Mood stabilizers – Lithium remains the gold standard mood stabilizer. Anticonvulsant medications like valproate (Depakote) and lamotrigine (Lamictal) are also commonly used.
  • Atypical antipsychotics – Antipsychotics like quetiapine (Seroquel), olanzapine (Zyprexa), risperidone (Risperdal), and aripiprazole (Abilify) can be added to mood stabilizers for more effective treatment of mania or depression.
  • Antidepressants – May be used cautiously alongside mood stabilizers to treat bipolar depression. Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac) and serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine (Effexor) are preferred.

Finding the right medications or combination of medications takes some trial and error. Most people need to take medications long-term to prevent relapses.


Different forms of psychotherapy or talk therapy provide important psychological and social support for people with bipolar disorder. Therapy helps patients better understand and manage their illness. It equips them with coping strategies to deal with symptoms and address relationship or work problems.

Some therapeutic approaches with strong evidence for bipolar disorder include:

  • Cognitive behavioral therapy (CBT) – focuses on identifying and changing negative thinking and behavior patterns
  • Interpersonal and social rhythm therapy (IPSRT) – aims to develop healthy routines and address relationship conflicts
  • Family-focused therapy – provides education and improved communication strategies for family members
  • Psychoeducation – teaches patients and families about bipolar disorder to empower self-management

Joining a support group can also provide great psychological benefits through shared understanding and experiences.

Lifestyle Management

Certain lifestyle habits and daily routines can help stabilize moods for people with bipolar disorder. Important lifestyle components include:

  • Following a regular sleep schedule – with 7-9 hours of sleep per night
  • Eating healthy and regular meals
  • Exercising regularly
  • Reducing work and life stress when possible
  • Avoiding alcohol and recreational drug use
  • Keeping a mood journal to track symptoms
  • Practicing relaxation techniques like yoga, meditation, or deep breathing

Making positive lifestyle changes empowers patients to take an active role in managing their health.

Complementary and Alternative Medicine

Some patients find benefits from incorporating complementary and alternative medicine (CAM) into their bipolar treatment plans. CAM therapies like yoga, meditation, massage, acupuncture, light therapy, and supplements may help enhance mood stability, reduce stress, and improve sleep when used alongside conventional treatment.

However, the evidence for most CAM bipolar therapies remains limited. Patients should discuss trying CAM approaches with their doctor first. Some supplements like St. John’s wort can interact negatively with medications. Most CAM therapies should be viewed as complementary adjuncts, not replacements for standard treatment.


In cases of severe mania or depression, or when there is a high risk of self-harm, hospitalization may be necessary. Hospitalization allows for immediate medical intervention in a supervised environment. Adjustments can be made to medications and intensive psychotherapy and monitoring provided until moods stabilize.

Electroconvulsive Therapy

For treatment-resistant bipolar cases, electroconvulsive therapy (ECT) may be considered. ECT involves passing electrical currents through the brain to induce a brief seizure. This alters brain chemistry to immediately treat severe depression or mania when other options have failed. ECT is a safe procedure but can cause short-term memory loss and confusion. It is typically only used for severe bipolar cases unresponsive to medications when rapid improvement is needed.

Self-Care Strategies

To supplement professional treatment, individuals can take certain self-care steps to help manage their bipolar disorder day-to-day:

  • Track moods and symptoms – Use a daily mood journal or app to monitor changes.
  • Stick to daily routines – Maintain regular sleep, meal, exercise, and work schedules.
  • Learn coping strategies – Try deep breathing, journaling, or meditation to relieve anxiety and racing thoughts.
  • Reduce stress – Make time for relaxing activities and avoid unnecessary stress when possible.
  • Join a support group – Connect with others facing similar challenges.
  • Communicate with loved ones – Share how you’re feeling and how others can help.
  • Avoid drugs and alcohol – Prevent destabilizing effects on moods.
  • Stay organized – Use calendars, lists, and reminders to help stay focused.

Implementing personalized self-care strategies makes it easier to manage the ups and downs of life with bipolar disorder.

Treatment Challenges

Despite effective treatment options being available, many barriers exist that can interfere with successful long-term treatment:

  • Failure to obtain an accurate diagnosis – Other mental health conditions have overlapping symptoms. Getting an accurate diagnosis can take years.
  • Lack of access to care – Many patients struggle to access or afford specialized psychiatry services and medications.
  • Medication side effects – Side effects like weight gain, drowsiness, and sexual problems often lead patients to stop taking medications.
  • Medication non-adherence – Even when feeling better, up to 60% of patients stop taking their medications which puts them at high risk of relapse.
  • Substance abuse issues – Around 50% of people with bipolar disorder also have problems with drug or alcohol abuse which interferes with treatment efforts.
  • Failure to make lifestyle changes – Patients may continue stressful, chaotic lifestyles that destabilize their moods.
  • Social stigma – Social stigma around mental illness may prevent patients from seeking help.

These challenges highlight the importance of comprehensive treatment plans tailored to each patient’s needs and active self-care. Ongoing communication with mental health professionals is key to optimizing and adjusting treatment strategies over the long-term.

Signs of Improvement

With effective, consistent treatment, many patients with bipolar disorder can achieve long periods of mood stability and live fulfilling lives. Signs that treatment is working well include:

  • Experiencing fewer, milder mood episodes that are easier to manage
  • Requiring lower medication doses to manage symptoms
  • Noticing episodes being triggered by external stressors rather than internally
  • Being better able to use self-care strategies to relieve symptoms
  • Having improved functioning at work, in relationships, and in day-to-day activities
  • Being able to identify prodromes (early warning signs) of oncoming episodes

Ongoing communication with a mental health team is important to monitor progress, provide support, and make treatment adjustments when needed.


In summary, the gold standard treatment approach for bipolar disorder involves:

  • Medications – Typically mood stabilizers, atypical antipsychotics, and sometimes antidepressants
  • Psychotherapy – Such as CBT, IPSRT, psychoeducation, and family therapy
  • Healthy Lifestyle Habits – Like regular sleep, exercise, stress management, and avoiding substance abuse

This comprehensive strategy provides both medical and psychological tools to help patients manage their symptoms and live full lives. However, challenges like lack of access to care, medication side effects, and treatment non-adherence are common. Ongoing communication with a specialized care team is essential to tailor and optimize treatment over the long run.

With proper treatment and self-care, many patients see substantial improvements in their mood stability and ability to function at work, in relationships, and in daily life. While bipolar disorder is a chronic condition, long-term treatment adherence provides hope for patients to live fulfilling and productive lives.