How can bipolar disorder be treated? Eleanor Segall for E Therapy

Bipolar disorder is a serious mental illness, a mood disorder, that affects 2% of the UK Population (Bipolar UK) and an estimated 4 million people according to the Mental Health Foundation. According to charity Bipolar UK,

‘Bipolar, sometimes known as manic depression, is a severe mental illness characterised by significant mood swings including manic highs and depressive lows.’

Bipolar disorder also has several types. Bipolar 1 disorder is severe and when untreated, means deep depression and the presence of a serious manic episode, which could in some cases require hospitalisation. Bipolar 2 disorder is characterised by lesser manic episodes called hypomania alongside the depression, but never full blown mania. There is also a form of the illness called Cyclothymia which is a lot milder and episodes do not become as heightened as the other forms.

In April 2018, singer Mariah Carey revealed to the world that she had been diagnosed with Bipolar 2 disorder and been dealing with it for decades. Quoted in the Guardian, she commented,

‘I’m hopeful we can get to a place where the stigma is lifted from people going through anything alone. It can be incredibly isolating. It does not have to define you and I refuse to allow it to define me or control me.

Carey believed she was experiencing a severe sleep disorder “But it wasn’t normal insomnia…. I was working and working and working … I was irritable and in constant fear of letting people down. It turns out that I was experiencing a form of mania. Eventually I would just hit a wall. I guess my depressive episodes were characterised by having very low energy. I would feel so lonely and sad – even guilty that I wasn’t doing what I needed for my career’

Carey is quoted as saying that she is well now on medication and therapy. This is true for the many millions of people with bipolar and this article will look at certain treatment options.

So how can bipolar disorder be treated?

There is a myth that bipolar disorder cannot be treated but in reality, many forms of treatment exist. While they may be trial and error for each person with bipolar, medicine has moved to a stage where most people with the condition can effectively manage it (and have more time between episodes), with the help of a GP or psychiatrist. However, there are forms of the illness that can be treatment resistant or more difficult to treat. There are also a plethora of psychological therapies that can help people with bipolar to manage their emotions and life difficulties.

What are the main medicines for bipolar disorder in the UK?

According to the NHS guidelines, there are several main medications that can help treat bipolar disorder. Although the cause of the illness is unknown, it is likely to be unusual changes in brain chemistry that cause the episodes. As such treatments have been developed to try and stabilise the mood changes.

The NHS says,

‘Several medications are available to help stabilise mood swings. These are commonly referred to as mood stabilisers and include:

  • lithium carbonate
  • anticonvulsant medicines
  • antipsychotic medicines
If you're already taking medication for bipolar disorder and you develop depression, your GP will check you're taking the correct dose. If you aren't, they'll change it.

Episodes of depression are treated slightly differently in bipolar disorder, as the use of antidepressants alone may lead to a hypomanic relapse.

… antidepressants are commonly used alongside a mood stabiliser or antipsychotic.’

As it says, anti psychotic medications help to prevent episodes of mania and psychosis, where your mind loses touch with reality. Anti depressants are often used in periods of depression but must be used alongside a mood stabiliser such as Lithium, to prevent a manic episode.

The NHS notes that the ‘gold standard’ drug in the UK for Bipolar disorder is Lithium carbonate, which is mainly taken orally, every day. They emphasise that Lithium is a long term level of treatment , prescribed for at least six months and can be taken for years as the illness is chronic. Lithium is a strong medicine, requiring blood tests as too much of it in the blood, is toxic. If dose is incorrect, you may feel sick or vomit, so its important to get it right, drink lots of water and have close monitoring. It can be highly effective but has some side effects.

Anti convulsant medicines such as carbamazepine and valproate may also be used to treat bipolar. These can help stabilise mood but as with any medication have side effects, so its important to be guided by a psychiatric expert. Lastly, if a manic episode is present, anti psychotic medications such as quetiapine or olanzapine can be used to return the brain to usual functioning. While good, they also have weight gain side effects.

When taking any medication its important to be guided by a qualified doctor and not to suddenly change or come off medicines, as this can make the illness worse.

There is also a lot of evidence that bipolar disorder can run in families and has a genetic component, although research is in its infancy. As a result, if you have a parent with it, you are more likely to have it yourself. This can be useful when deciding medicine treatment options.

What Psychological treatments help bipolar disorder?

The NHS recommends CBT (Cognitive Behavioural Therapy) which is a therapy that aims to change behaviour patterns and thoughts. It says it is most helpful during depressive episodes and should be done with a qualified therapist .

Mind, the mental health charity also recommends several other types of therapy. These include:

Interpersonal therapy – which focuses on your relationships with other people and how they can be bettered

Behavourial couples therapy- if you have a partner, focusing on any issues in your relationship to help heal

Group therapy for bipolar disorder- working with a therapist and a group of other people with bipolar to learn about self management of the illness

Family or talking therapy- if needed, working as a family to resolve issues that bipolar disorder may have caused. Additionally, talking therapy, unpacking emotions with a therapist can be very helpful to deal with your bipolar and life issues.

You can work with your GP or psychiatrist to find the right treatment for you and they can refer you, although there is a waiting list for NHS treatment.

What should someone with bipolar and their loved ones do in a crisis to get treatment?

There are various ways to get support. These can include phoning your psychiatry team and being referred to the crisis home team who may be able to visit you at home daily and provide mental health support. In an emergency if out of hours, you may need to go to A and E at a hospital for specialist care,. If you are very unwell, you may then be admitted to hospital either voluntarily or under a section of the mental health act.

Make sure you support your loved one with bipolar through this challenging time and try and get them to take their medication too, if safe to do so.

In summary, good care and treatment from a psychiatrist or GP, combined with finding the right medication and being compliant in taking it can really help improve the life of someone with bipolar disorder. Additionally, it’s really important to engage with counsellors or psychologists to help support emotional health and try different therapies to help. Group therapies and even arts therapies like art, writing or music can be very healing.

Make sure you seek support if you are in crisis and hopefully with the excellent treatment options that we have in the UK, you can recover again. There are long waiting lists and sometimes treatment on the NHS is not always readily available until you are acutely unwell. So, I would recommend speaking to the Samaritans helpline and practising self care methods like mindfulness and meditation to keep you well too, if you are able.

A diagnosis of bipolar disorder does not have to be the end of your life. Keep reaching for support and find the right treatment options for you.