Bipolar Disorder Treatment: Choosing the Right Treatment

Jan 30, 2022

Have you ever come across a person diagnosed with bipolar disorder? They experience moments of manic or hypomanic episodes and depression. There are three types of bipolar disorders[1], namely Bipolar 1 disorder, Bipolar 2 disorder, and Cyclothymic disorder.

  • Bipolar 1 disorder: a person with bipolar 1 disorder will experience at least one manic episode in their life. It’s diagnosed as an ICD 10 code for bipolar disorder.
  • Bipolar 2 disorder: a person will experience a depressive episode lasting at least two weeks. In addition, they get a hypomanic episode lasting a few days.
  • Cyclothymic disorder: a person will experience excessive mood swings characterized by extreme highs and lows.

All three are treatable, and there are different ways to treat the ailment in all people. This includes pregnant women and children. This article teaches the warning signs and symptoms of bipolar disorder and how to treat it.

Bipolar Disorder Symptoms

Bipolar disorder affects mental health and can be quite a devastating illness. Sadly, it has no age limit and can affect children, teens, and adults. One way to tell if a child, teen, or adult has this mental health condition is by noting their symptoms.

Symptoms In Children

Children can suffer from mental health conditions such as bipolar disorder[2]. Older children often receive the diagnosis, but there have been cases of young children having the illness. They have extreme mood disorders characterized by severe lows followed by bouts of hypomania[3].

Hypomania is a state in which the child displays excessive energy. This is in the form of behavior, activity, or mood. The child can feel sad, happy, angry, and have their emotions all over the place.

But, when these emotions are magnified, this is a cause for concern. When they become entirely uncontrollable and have continuous incidences  [4] over a short period, you should get some help.

The symptoms of bipolar disorder in children to watch out for include:

  • Your child can’t sleep or may have a serious shift  [5] in their sleeping patterns. One time they may not seem to want to get out of bed. Next, they sleep for hours on end and seem quite sad.
  • One of the main symptoms of bipolar disorder is extreme mood swings  [6], even in children. You start to notice a huge difference in their mood states.
  • With time, your child can’t seem to help themselves when engaging in risky and reckless behavior [7]. No amount of punishment or correction seems to turn things around for the better.
  • It’s normal for any child to see themselves as capable of achieving anything. Bipolar disorder presents as the child acting out a grand sense of self[8]. They keep boasting about their abilities even when it’s clear they fall short and cannot perform at the level they present.
  • As a child suffering from bipolar disorder advances to pre-teen, they may start to experience suicidal thoughts  [9]. If not treated, they might try at some point to take their own lives.

Symptoms In Teens

Teens experience lots of changes in their bodies as they go through puberty. They experience mood swings making it essential to distinguish between borderline personality disorder and bipolar.

However, the behavior isn’t as extreme. Only when suffering from bipolar disorder do they present extreme mood swings  [10].

Some of the symptoms of bipolar disorder in teens are:

  • They tend to express suicidal thoughts and can go as far as attempting to end their life. It’s why you have to pay attention to what they say and get them help as soon as possible.
  • It becomes harder for a teen to believe in their self-worth and feel valuable to the world. The worse the case of low self-esteem[11], the higher the chance they’ll attempt suicide.
  • The mood swings of a teen with bipolar disorder are extreme. They shift from terrible lows (depression) to highs (manic episodes[12]). Each mood shift can last up to a week.
  • They can’t seem to focus or concentrate on anything. It even becomes hard for them to sit still in school, which shows their productivity, which tends to take a nosedive. They can even develop Attention Deficit Hyperactivity Disorder[13] (ADHD).

Symptoms In Adults

Like in children and teens, bipolar disorder presents warning signs and symptoms. These can help get a positive diagnosis and begin the treatment for bipolar disorder.

The signs and symptoms are:

  • There are extended moments of happiness that are expressed openly to every person around them. This is followed by extreme moments of sadness as they enter a state of bipolar depression.
  • Bipolar disorder in adults is characterized by extreme insomnia  [14]. You have poor sleep patterns and tend to remain active throughout the night. It can even be brought on by post-traumatic stress disorder.
  • Talking fast  [15] and having racing thoughts are more warning signs to watch out for. It includes shifting from one topic to another without any relation whatsoever.

Only with treatment can children, teens, and adults with mental disorders get the help they need.

Borderline Personality Disorder Vs. Bipolar Disorder

The difference between the two is that people with borderline personality disorder(BPD) experience extreme emotional pain, and they tend to feel hopelessness, emptiness, and loneliness. On the other hand, people with bipolar disorder feel depression and mania.

Understanding Bipolar Disorder Treatments

People with bipolar or related disorders require treatment  [16] for them to feel better. Different treatment options consist of both traditional and complementary medicine. These include:

  • Standard, traditional treatment
  • Psychotherapy such as cognitive behavioral therapy
  • Alternative treatment such as supplements, CBD oil, ECT (Electroconvulsive Therapy), and TMS (Transcranial Magnetic Stimulation)

Standard Treatment

Bipolar disorder treatment is achievable by taking a specific mood-stabilizing medication. These bipolar disorder medications help with mood stabilization and help bring both manic and depressive symptoms under control.

But, ensure to get a prescription before taking any of them.


Lithium is a medication for people with bipolar disorder. Its primary role is to help bring mania under control by reducing its severity. It’s an effective medication in helping you get out of bipolar-related depressive episodes.

However, lithium can have side effects such as weight gain, excessive urine, excessive thirst, and vomiting. Therefore it’s no longer used as frequently as in years past.

When you start taking lithium[17], it interacts with the nervous system. For it to work, you have to take it for several weeks. You also need your blood levels frequently tested until you are in therapeutic range to avoid damage to the kidneys.

But, it’s to do so under a doctor’s supervision because lithium can affect your body function. Continuous intake affects the kidneys and thyroid.

Also, there’s an increasing decline[18] in lithium prescriptions, with practitioners becoming more reluctant to prescribe it due to patients’ non-compliance and side effects.

Summary: “Lithium works for any of the 3 types of bipolar disorder.”

SGAs (Second-Generation Antipsychotics)

SGAs continue to be prescribed as the ideal treatment for people with bipolar disorder. These medications are quite effective when seeking a fast solution to extreme manic behavior[19].

As you go through an extreme mood shift, the best treatment is to control symptoms first. It helps to bring the manic symptoms under control. But, there isn’t a definitive duration for how long you should take SGAs.

However, these mental disorder medications are known to have side effects  [20]. This is crucial to note, especially during the maintenance phase of bipolar disorder treatment. You can experience side effects such as extreme weight gain or extrapyramidal symptoms.

Summary: “SGAs are effective in managing bipolar depression episodes and work best for bipolar 1 disorder.”

Mood Stabilizers

Mood stabilizing  [21] medication is another example of medicine to manage bipolar disorder. The medication treats the highs and lows that you experience because of this illness.

Basically, it’s a way to help keep your mood stable so that you can go about your day. The mood-stabilizing bipolar disorders medication that a doctor can prescribe to you are valproic acid, Depakote (Divalproex Sodium), and Carbamazepine. These are known as anticonvulsants because they are also used to treat seizures.

However, it’s worth noting that each has a different effect on your mental health condition.

Summary: “The treatment works for any of the three types of mental illnesses: Bipolar 1 disorder, Bipolar 2 disorder, and Cyclothymic disorder.”


Antidepressants are medications used in treating bipolar disorder and extreme episodes of bipolar depression.

The goal of the drugs is to correct the brain’s neurotransmitters. These transmitters are in charge of your mood and general behavior.

There are five main types of antidepressants including:

1. SSRIs (Selective serotonin reuptake inhibitors)

Among the most common antidepressants for bipolar are SSRIs. They work well for bipolar patients suffering from depression  [22]. The excellent new SSRIs have fewer side effects.

Their role is to prevent the reuptake of serotonin in the brain. That way, your brain’s cells can easily send and receive messages. Once you begin to take SSRIs, your mood may elevate.

Some examples of SSRIs are Cipramil, Prozac, Lustral, and Faverin. These treat patients with bipolar 2 disorder.

2.  SNRIs (Serotonin and noradrenaline reuptake inhibitors)

Bipolar patients with extreme depression and mood swings respond better to SNRIs [23]. It can also be quite effective in treating ADHD and OCD (Obsessive Compulsive Disorder), extreme anxiety, and fibromyalgia.

SNRIs are effective in raising serotonin levels in the brain, plus norepinephrine. These are two essential brain transmitters responsible for mood elevation.

Examples of SNRIs are Pristiq, Fetzima, and Cymbalta.

3. TCAs (Tricyclic Antidepressants)

TCAs have a three-ring chemical structure hence the name. These are quite effective in treating patients[24] with depressive episodes. Apart from depression, TCAs can help with chronic pain and anxiety.

Examples of TCAs are Tofranil, Surmontil, Elavil, and Vivactil.

4. MAOIs (Monoamine oxidase Inhibitors)

MAOIs are rarely prescribed today due to their high risk for side effects and food/drug interactions.MAOIs are most often tried when other antidepressants don’t work.

The role of this antidepressant is inhibiting monoamine oxidase (a brain enzyme) action. This brain enzyme is responsible for breaking down  [25] neurotransmitters such as serotonin.

As a result, having less serotonin causes bouts of mood swings. Therefore, inhibiting the action of the enzyme is the best way to stabilize your mood.

Examples include Nardil, Parnate, and Marplan.

5. NASSAs (Noradrenaline and specific serotonergic antidepressants)

NASSAs are a form of medication effective in treating[26] extreme depression and personality disorders.

Examples are Avanza and Tolvon.

Summary: “The treatment is best for Bipolar 1 disorder, Bipolar 2 disorder, and Cyclothymic disorder”

Additional thoughts on drug therapy:

The National Institute of Mental Health (NIMH) did a large randomized study called Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD).  This study showed that mood stabilizers alone helped only 1 in 4 people with bipolar depression, and adding antidepressants offered no additional benefit. The STEP-BD study highlights the need for additional treatments that go beyond drugs for managing bipolar depression.


Several forms of depression therapy can be effective in treating bipolar disorder, such as:

  • Cognitive therapy
  • Social rhythm therapy
  • Behavioral therapy
  • Interpersonal therapy

You can also be part of a support group of people facing the same challenges as you while engaging in family-focused therapy. Here, you learn from other people’s experiences and gain helpful coping skills.

It’s possible to feel better knowing you aren’t alone in this and also be encouraged.Psychotherapy  [27] is best for Cyclothymic and Bipolar 2 Disorder.

But, ensure you consult with a therapist certified by the American Psychiatric Association. They’re best suited for proper mental health services administration.

Summary: “Psychotherapy is best for Bipolar 2 disorder and Cyclothymic disorder.”

Alternative Treatment

Treating bipolar disorder involves helping you get a better hold of your moods. There are complementary and alternative medicines that you can try as you strive to feel better.

Alternative treatments may work, but it’s best to consult your doctor first before using them.

The Ketogenic Diet as metabolic therapy

Metabolic disturbances in the brain are seen in persons with bipolar disorder, and the illness is comorbid with other metabolic disorders such as obesity, diabetes, and cardiovascular disease. The metabolic dysfunction results in impaired energy production, neurotransmitter imbalances, increased oxidative stress, and inflammation in the brain (28).  These metabolic disturbances are pathophysiologically linked to bipolar and other psychiatric diseases and likley responsive to metabolic-based therapies.

The ketogenic diet is a metabolic therapy which acts directly on this metabolic dysfunction, and effects and restores many mechanisms in the brain. The ketogenic diet provides an alternative fuel for the brain (ketone bodies) and thereby improves the brain’s energy production. It also reduces oxidative stress and inflammation in the brain, and improves neurotransmitter imbalances (29).

With a ketogenic diet the dietary composition is expected to result in a ketogenic metabolic state (ketosis). Most of the dietary energy comes from fat, protein content is moderate, and carbohydrate intake is minimal (30).

The ketogenic diet has been used since the 1920s to treat drug-resistant epilepsy (31). Anticonvulsant drugs used to treat epilepsy are commonly used in the treatment of bipolar disorder and there is significant comorbidity between the conditions. Mood disorders are common in epilepsy patients and epilepsy is common in patients with mood disorders (32,33). It therefore makes sense that a diet therapy that has been successful in treating drug-resistant epilepsy for 100 years has great potential in the treatment of bipolar disorder.

Clinical research with the ketogenic diet as a treatment for bipolar disorder is still in its infancy. There are several smaller case studies showing improvement of bipolar symptoms on the ketogenic diet (28,34,35). There is a large community of bipolar patients in forums online, following a ketogenic diet and sharing their experiences and supporting each other. An observational study of online reports, show a significant mood stabilization or remission of symptoms, improved mental clarity and increased energy (36). Human studies using the ketogenic diet are currently in progress, including a study entitled “Impact of a Ketogenic Diet on Metabolic and Psychiatric Health in Patients With Schizophrenia or Bipolar Illness” ( Identifier: NCT03935854).

Many of the medications given to treat bipolar disorder have side effects that result in metabolic disorders such as obesity, diabetes, and metabolic syndrome. Antipsychotic and antidepressant medicines are known to cause increased appetite and rapid weight gain. The ketogenic diet helps normalize and suppress appetite and can therefore help or reverse drug-induced metabolic side effects.

The ketogenic diet can, especially in the beginning of the diet, increase symptoms of hypomania, mania, and psychosis, which in most cases will stabilize with time. Therefore, a nutritionist and psychiatrist (working together) need to be consulted before initiating a ketogenic diet therapy in the treatment of bipolar disorder.

Exogenous ketone supplements

The metabolic state of ketosis can be achieved by exogenous ketone supplements, such as ketone esters or ketone electrolyte salts. Exogenous supplemental ketones generate nutritional ketosis rapidly, which can be dose-dependently sustained in those following the ketogenic diet or even a standard diet. Exogenous ketone supplements can be used to increase and sustain higher ketone levels, which further augment the therapeutic benefits of nutritional ketosis. Currently there are no human studies showing the effects of exogenous ketone supplements in bipolar disorder, but pre-clinical animal models show that exogenous ketone supplements may potentially be an effective treatment either as a primary or an adjunctive therapy. Ketone supplementation elevates blood levels of the ketone bodies: D-β-hydroxybutyrate (βHB), acetoacetate (AcAc), and acetone. These compounds, either directly or indirectly, beneficially affect the mitochondria and many cellular processes (glycolysis, neurotransmitter levels, activity of free fatty acid receptor 3/FFAR3, hydroxycarboxylic acid receptor 2/HCAR2, and histone deacetylase, as well as functioning of NOD-like receptor pyrin domain 3/NLRP3 inflammasome and mitochondrial uncoupling protein/UCP expression). Such cellular and molecular changes reduce the pathophysiology associated with various psychiatric disorders. We can conclude that ketone supplement-induced nutritional ketosis leads to metabolic changes and improvements, for example, in mitochondrial function and inflammatory processes, and suggest that development of specific adjunctive ketogenic protocols for psychiatric diseases [46]should be actively pursued.


Some people take brain supplements such as Omega 3 fatty acids in place of bipolar disorder medications. While these aren’t a proven form of treatment, supplements[38]can help with symptoms of the illness.

For instance, taking brain-boosting nootropics, Omega 3 fatty acids can help you with focus and concentration. Persons with Bipolar 1, 2, and Cyclothymic can take these supplements.

Summary: “Supplements work best for Bipolar 1 disorder, Bipolar 2 disorder, and Cyclothymic disorder.”


So far, healthcare research[39] shows CBD oil can be quite effective in treating mental disorder symptoms such as mania. The oil helps you calm down and be more stable for a specific duration.

However, there’s a need for further studies on this when treating bipolar disorder. You can take CBD under the supervision of a health care provider with Bipolar 1, 2, and Cyclothymic

Summary: “There is weak evidence that CBD works for bipolar disorders, and more research is needed.”

Electroconvulsive Therapy (ECT)

For many decades now, ECT has been used to treat people with bipolar disorder. It gained quite a bad reputation due to misuse, but ECT is an effective form of treatment [40]. But it has to be done in the right and safe way.

Summary: “ECT is more effective for Cyclothymic bipolar characterized by a major depressive episode.”

Transcranial Magnetic Stimulation (TMS)

TMS is an effective form of alternative treatment  [41] for bipolar disorder. But, this form of treatment requires a close eye on parameters at all times.

Summary: “TMS is quite effective for Cyclothymic bipolar where one undergoes extended periods of depressive symptoms.”

The Safest Treatments For Pregnant And Children

For pregnant women  [42], avoiding medication is the best way to keep their unborn child safe. This means they have to seek alternative treatments for people with bipolar disorder. By far, the best and safest treatment is ECT to treat bipolar disorder in females.

As for children who have bipolar disorder, a combination of depression therapy and mood stabilizers is better. They can take the mood stabilizers[43] under the supervision of a parent or guardian. Also, the parents or guardians become their support during cognitive behavioral therapy sessions.

Managing Bipolar Disorder With Healthy Lifestyle

Once you begin treatment, there are other steps you can take to improve your quality of life. Despite having bipolar disorder, you can live a better and healthier life.

This entails taking good care of yourself through proper nutrition, healthy foods  [44], and improving your mental health.

Some of the steps you can take include:

  • Getting ample sleep (it is important to track sleep to identify sleep disruptors)
  • Creating and sticking to a workout routine
  • Eating a diet that optimizes metabolic health biomarkers (glucose, insulin, inflammation)
  • Avoiding drugs and alcohol
  • Sticking to your therapist appointments
  • Joining a support group
  • Getting out in nature
  • Having an active social life

The minute you find a treatment that works, the next crucial step is learning how to manage bipolar. This takes effort and a lot of time to accomplish. You can seek help from a mental health professional along the way and have a bipolar support alliance around you.

Is Bipolar Disorder Genetic?

Genetic disposition to bipolar is possible. Up to 80% of all cases of bipolar disorder are inherited  [45] and require proper management from an early age. If a parent is bipolar, there’s a chance their child will also experience the same condition.

An early diagnosis can help kick off effective treatment and management of the mental health condition. Either parent can pass on bipolar disorder to their child.

Celebrities Who Live With Bipolar Disorder?

Kanye West

The world learned some time back that Kanye West is bipolar. This is after he made some fiery statements and sent out tweets that had people worried. Among his most famous comments was ‘slavery was a choice.’ Many people with bipolar experience periods of extreme depression. However, Kanye goes high. He was first diagnosed with bipolar in 2016, and his ex-wife Kim Kardashian has, in the past, explained the struggles Kanye faces in her Insta-stories.

Kanye has described that when he’s on a high, he gets into a state of hyper-paranoia. He doesn’t trust anyone, even those closest to him. He doesn’t take standard medication for the illness. Instead, Kanye admitted to seeking alternative treatment methods. He also takes strides to bring more awareness to mental health issues and help tackle the stigma.

Catherine Zeta-Jones

Catherine Zeta-Jones has bipolar and once checked herself into a facility to get treatment. She was facing bipolar 2 disorder after a challenging time in her life. Over the years, the famous actress has been quite outspoken about her medical condition.

Catherine’s main trigger was stress, and with treatment, she’s managing the condition.


Bipolar disorder is a mental health condition that can affect anyone at any stage in life. Children, teens, and adults can get from bipolar, and it’s usually characterized by a high (mania) and lows (depression). Gladly, there is a prescription medication for treating bipolar disorder.

Bipolar patients can take standard treatment, which includes antidepressants and mood stabilizers. On top of that, you can also attend cognitive behavioral therapy sessions. Also, there are alternative forms of treatment such as the ketogenic diet and exogenous ketone supplements, CBD oil, supplements, TMS, and ECT. All these must be under the supervision of a health care provider.

Besides these treatment options, maintaining a healthy lifestyle can help you gain more control over bipolar disorder. Eat healthy meals, exercise, optimize sleep, be social, and get a support group. This will help you feel better and can work wonders for your mood.

Unfortunately, bipolar disorders can be passed down from a parent to their child. It’s why early diagnosis is crucial to help manage it effectively with the help of a healthcare provider.

Frequently Asked Questions

What is the most common treatment for bipolar?

Mood stabilizers such as lithium or other anticonvulsants are the most common treatments for bipolar. They are quite effective in bringing mania under control and helping you out of depressive episodes.

Can bipolar disorder be cured?

Up to date, there is no known cure for bipolar disorders, and all you can do is treat mania and depressions then manage the condition. Still, living a healthy and normal life is quite possible, even with bipolar disorders.

What is the difference between bipolar disorders and depression?

With bipolar disorder, you experience episodes of high (mania) and lows (depression) – the two alternate from time to time. With depression, you are sad all the time, and there are no “highs” or optimistic times.

This is an updated and modified version of an article. The original article can be found here.

Written by Mitchelle Morgan (Health Writer) and Maria Edwards (MSc Clinical Nutrition, NEXS, University of Copenhagen).
Reviewed by Kathy Shattler, MS, RDN and Dr. Dominic D`Agostino

Health Canal avoids using tertiary references. We have strict sourcing guidelines and rely on peer-reviewed studies, academic researches from medical associations and institutions. To ensure the accuracy of articles in Health Canal, you can read more about the editorial process here

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