Diet for bipolar disorder

Natural remedies for treating bipolar disorder

Counseling, cognitive behavioral therapy (CBT), and a range of lifestyle changes can help people with bipolar disorder to manage their symptoms and improve their overall quality of life.

Sleep

Share on PinterestRegular sleep is important for people with bipolar disorder.

Bipolar disorder can disrupt a person’s sleep. During a manic phase, an individual may sleep very little, but during a low phase, they may sleep for a long time.

Missing sleep can trigger a mood change, and getting enough sleep is essential to managing mood.

Good sleep hygiene can encourage people with the condition to have regular sleep.

Tips include:

  • going to bed and getting up at regular hours
  • making sure the room is comfortable
  • avoiding screen time and potentially stressful situations before bed
  • not eating a large meal too soon to sleeping
  • avoiding or limiting alcohol intake

People with bipolar disorder who have difficulty sleeping should speak to their physician.

Diet

A healthful diet is an important lifestyle habit for a person with bipolar disorder.

A 2011 study found that up to 68 percent of people seeking treatment for bipolar disorder have excess weight or obesity. People with bipolar disorder also had a higher risk of various other conditions, including diabetes, low bone density, and cardiovascular disease.

A healthful diet can help to reduce the risk of these conditions.

In 2013, another study found that people with bipolar disorder are more likely to engage in binge eating than the general population.

This may be a side effect of medication or due to overeating during episodes of depression.

Being overweight can complicate recovery and increase the risk of diabetes, high blood pressure, and anxiety.

Share on PinterestRegular eating habits can help people with bipolar disorder to stay healthy and avoid gaining excess weight.

Doctors do not know what causes bipolar disorder, but it may be due to an imbalance of chemicals in the brain. These chemicals, also called neurotransmitters, are noradrenaline, dopamine, and serotonin.

Serotonin can also affect appetite. It may be that when serotonin levels are low, people experience cravings for carbohydrates and sweet foods.

Tips for maintaining a healthful diet include:

  • keeping to regular eating times
  • ensuring that the diet is varied, well-balanced, and has plenty of fresh fruits and vegetables
  • making a meal plan for the week, preparing a list before going to the grocery store, and sticking to it

Learning and practicing new recipes during times of positive mood may help a person to establish these habits.

Exercise

Moderate and regular exercise can help to balance mood and prevent a number of health problems, such as obesity and cardiovascular disease.

There is a lack of evidence to show that physical activity can specifically help people with bipolar disorder, but some research suggests it may help to improve mood during a low phase.

A 2015 review of studies suggested that exercise “may be a viable and effective strategy to deal with the depressive phase of bipolar disorder.”

Another review, published in 2016, concluded that “generally, exercise was associated with improved health measures, including depressive symptoms, functioning, and quality of life.”

More studies are needed to find out how much exercise an individual should have, how often, and how intense the activity should be, especially as bipolar disorder involves a number of physical and psychological factors.

Practicing moderation

People with bipolar disorder have a higher risk of engaging in addictive behaviors.

One study found that 56 percent of people with the condition had at some time experienced addiction involving either alcohol or drugs.

Certain circuits in the brain play a role in pursuing rewarding experiences. One study has suggested that people with bipolar disorder have stronger activation in these circuits.

This may be what drives the person towards risky behavior.

The positive side of this, say the authors of the study, is that it encourages people to work with energy toward their goals and ambitions.

On the other hand, it may mean that an individual focuses fully on the short-term rewards of a decision while disregarding the possible long-term risks.

Tips for avoiding these problems include:

  • becoming more aware of any tendency to engage in risky — for example, addictive — behaviors
  • seeking help if there is already a problem
  • asking friends and loved ones to support any decisions to avoid destructive or addictive behaviors

Friends who are aware of the risks might, for example, suggest going to see a movie instead of a bar on a night out.

Managing a manic episode

It is not always possible to prevent a manic episode, but as the condition progresses, the individual and their friends and family may start to notice the signs of a mood change.

Here are some tips when this happens:

  • See a doctor, if it is the first time, if you have discontinued treatment, or if treatment is not working.
  • Follow the treatment plan and keep all medical appointments, as medications may need adjusting.
  • Try to keep to a regular sleeping pattern and avoid unnecessary stress when possible.
  • Eat a healthful diet and get enough exercise.
  • Avoid alcohol and other substances.
  • Keep track of your moods and feelings.

If you have people around you, try to share with them what is happening so that they can support you.

Diet and weight may affect response to bipolar disorder treatment

Bipolar Disorder (which used to be called ‘manic depression’) is characterised by episodes of mood swings, between being very up or very down with periods in between the two extremes. The fact that there are two opposite sets of symptoms means that finding an effective treatment is difficult. While current medications are useful, they are better at targeting mania symptoms (the ‘up’ phase), leaving a lack of effective treatment for people experiencing depressive episodes. Now a group of Australian, German and American scientists have shown those who have a high quality diet, a less inflammatory diet, and/or a low BMI (Body Mass Index) may respond better to an add-on nutraceutical treatment provided as part of a clinical trial.

“If we can confirm these results, then it’s good news for people with Bipolar Disorder, as there is a great need for better treatments for the depressive phase of Bipolar Disorder” said lead researcher Melanie Ashton of Deakin University in Australia.

A total of 133 participants were randomly assigned to take a combination of nutraceuticals (compounds derived from foods such as vitamins or minerals that treat or prevent a disease or disorder) including the anti-inflammatory amino acid n-acetylcysteine (NAC), or NAC alone, or a placebo (a dummy pill) for 16 weeks. Participants received the study medication in addition to any stable treatments they were already receiving. Researchers measured BMI at the beginning of the study, and then measured depression and how a person is able to function in their day to day life. Researchers also rated whether a participant was improving and, if so, how much, over the next 20 weeks. Participants filled in a questionnaire about what they usually eat over the year and researchers calculated a diet quality score, where good diets included a healthy diet with lots of fruit and vegetables, whereas poorer-quality diets had more saturated fat, refined carbohydrates and alcohol. These types of diets were then categorised as either anti-inflammatory or pro-inflammatory based on foods that affect inflammation.

Melanie Ashton continued, “We found that people who had a better-quality diet, a diet with anti-inflammatory properties, or a lower BMI, showed better response to add-on nutraceutical treatment than did those who reported a low-quality diet, or a diet including foods that promote inflammation, or who were overweight.

What this means, if these results can be repeated in a larger trial, is that treatment for Bipolar Disorder would need to take into account what a person eats and their weight.

There are some points we need to note about this study. This is a randomised, controlled trial, but what we found were exploratory outcomes; in other words, it wasn’t the main result that we were testing. Our result is statistically significant, but because the study wasn’t specifically designed to test the effect of diet quality,

inflammatory diets and BMI on drug response in general, it is necessary to see the work replicated in a larger study before any firm conclusions can be formed.”

Commenting, Professor Eduard Vieta (Barcelona) said:

“This is interesting work, which holds out the possibility that patients with Bipolar Disorder may benefit from a balanced diet. However, it is an early study, and we need more research before we can think whether this might affect clinical practice.”

Professor Vieta was not involved in this work, it is an independent comment.

The Facts About Lithium Toxicity

Lithium toxicity is usually caused by taking more than your prescribed dose of lithium, either at once or slowly over a long period of time.

There are three main types of lithium toxicity, each with different causes:

INSERT LONG LIST FORMAT:

  • Acute toxicity. This happens when you take too much lithium at once, either accidentally or on purpose.
  • Chronic toxicity. This happens when you take a little too much lithium daily over a long period of time. Dehydration, other medications, and other conditions including kidney problems, can affect how your body handles lithium. Over time, these factors can cause lithium to slowly build up in your body.
  • Acute-on-chronic toxicity. This can happen if you take lithium every day for a long period of time, but then suddenly take an extra pill one day, either accidentally or on purpose.

If you think someone is at immediate risk of self-harm, overdosing, or hurting another person:

  • Call 911 or your local emergency number.
  • Stay with the person until help arrives.
  • Remove any guns, knives, medications, or other things that may cause harm.
  • Listen, but don’t judge, argue, threaten, or yell.

If you or someone you know is considering suicide, get help from a crisis or suicide prevention hotline. Try the National Suicide Prevention Lifeline at 800-273-8255.

Sensitivities and interactions with lithium

Some people are more sensitive to lithium and may experience symptoms of lithium toxicity at lower levels than others. This is especially true in people who are older or dehydrated. It’s also more likely in people with cardiovascular and kidney problems.

Certain foods or drinks may also affect lithium concentrations in the body. It’s best to not adjust the following unless monitored by a doctor:

INSERT LONG LIST FORMAT:

  • Salt intake. Less salt can make your lithium levels rise, while increasing your salt intake can cause it to fall.
  • Caffeine intake. Caffeine found in coffee, tea, and soft drinks may have an effect on lithium levels. Less caffeine can cause your lithium levels to rise, while more can cause it to lower.
  • Avoid alcohol. Alcoholic beverages can have a negative effect on many medications.

In addition, taking lithium with other medications can also increase your risk of lithium toxicity. If you take lithium, make sure you talk to your doctor before using:

  • nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen (Motrin, Advil) or naproxen (Aleve)
  • indomethacin
  • selective cyclooxygenase-2 (COX-2) inhibitors, such as celecoxib (Celebrex)
  • acetaminophen (Tylenol)
  • metronidazole
  • calcium channel blockers such as amlodipine (Norvasc), verapamil (Verelan), and nifedipine (Adalat CC, Procardia XL)
  • angiotensin-converting enzyme (ACE) inhibitors, such as enalapril (Vasotec) or benazepril (Lotensin)
  • diuretics

A Dietary Treatment for Bipolar Disorder?

Bipolar disorder is a challenging illness with various clinical presentations. In “type one” people struggle with alternating symptoms of full blown mania, and most also have depressive episodes as well. In “type two,” depression is the primary state, with the occasional rare bit of hypomania. By mania, I mean increased energy, increased sexuality, racing thoughts, insomnia, feeling grandiose or very irritable, sometimes to the point where you detach from reality and become psychotic. Medication and specific kinds of therapies focused on monitoring symptoms, adjusting lifestyle and regulating sleep-wake cycles have been proven to be helpful in decreasing the number of manic and depressive episodes. Typically, the medications are also anti-seizure medicines, such as valproate, lamotrigine, and carbamazepine.

Ketogenic diets, which are low in carbohydrate and protein while high in fat have been used to treat epilepsy for a hundred years. Since anti-seizure medicines are clearly useful for bipolar disorder (notwithstanding many side effects), would a ketogenic diet that can control seizures be useful in bipolar disorder (1)?

In the literature for epilepsy, patients were encouraged to fast for 12-36 hours to promote ketosis, and then to follow a dietary plan with less than 20 g carbohydrate daily (or even lower, in most research ketogenic diets). In doing so their brains would be flooded with ketones, and promote having some excess protons floating around in the space between the cells. Critically, it seems that in order for a ketogenic diet to help control seizures, there must be reduced sodium molecules floating outside the cells as well. There are several seizure medicines (such as gabapentin) that don’t work well for bipolar disorder. When scientists look closely, they find that only the seizure medicines that promote a reduced extracellular sodium concentration are helpful in bipolar disorder. Ketosis does exactly that.

To really understand what is going on, we need to take a close look at how nerves work. It’s pretty cool, really, but involves a little science. Now a picture, courtesy the US Government and Wikipedia:

Nerve impulses and signals travel along the nerve fibers via electricity. How that happens is that the extracellular levels of ions and the intracellular levels of ions are maintained at a very different level. Inside neurons, the sodium concentration is about 10mM, but outside, it is 130mM or more – rather like there are a bunch of balls stored in a container on top of a hill. Open a little door on the side of the container, and the balls come pouring out and down the hill. Potassium is the opposite – levels are very high inside the cells, and quite low outside (3).

Neurons have plasma membranes like other cells in our bodies. Those membranes are somewhat like a tarp that has been oiled on both sides. Charged ions such as sodium and potassium can’t get through unless they go through special ion pumps that are located in the cell membranes. The sodium pump, in fact, may use up to 50% of the energy in the brain (4)!

The result of all these shenanigans is that our nerve cell membranes are left somewhat negatively charged (-75 mV, in fact). The neurotransmitters (such as serotonin, norepinephrine, dopamine, acetylcholine, glutamate, GABA, etc.) work by changing these membrane potentials in various ways. Neurotransmitters can open ion channels, allowing sodium to enter the cell and causing a wave of electrical impulse that travels along the neuron. Neat!

When the electrical impulse (or “action potential”) reaches the end of the neuron, the “presynaptic terminal,” neurotransmitters are released into the space between the nerve cells, called the synapse. At this part of the neuron, calcium is the important ion (though sodium plays a role too). The electrical impulse (originally mediated by sodium at the dendrite) that traveled down the nerve causes extracellular calcium to pour into the cell, which then leads to the release of the neurotransmitters into the synapse, which then can affect communication with the next neuron. Voila! Your neurons have now sent messages to one another. Yee haw. The sodium and calcium membrane potential craziness can be set back to baseline by the transport of potassium, so everything is all set for a new signal to be sent.

It’s Friday (at least when I am writing this article!). I know. But it’s important to understand the above to some extent to figure out why a ketogenic diet might change the ionic environment in our brains.

Before we get to a ketogenic diet, let’s look at lithium, carbamazepine, and valproate, all medications that have anti-seizure and mood stabilizing properties. Lithium is especially interesting, because it looks a lot like sodium, so much so that our kidneys can become confused between the two. Seems our brains can be confused as well. In rats treated with lithium, the lithium displaces the intracellular sodium in the neurons, and overall sodium is decreased. The changed sodium gradient may be central to the mood-stabilizing effects of lithium. (Any doctors out there will be squinting at me right now – hey, lithium isn’t an anti-seizure med! Well, actually, in the old days it was used as one. Lithium can be horribly toxic at levels high enough needed to control seizures, so it is never used for seizures now. Carbamazepine is a little mysterious, but one of its effects is to definitely inhibit the voltage-sensitive sodium channels. (Lamotrigine, another anti-seizure and mood stabilizing drug, does something very similar). Valproate has a whole load of actions, and can increase GABA, making it a pretty good anti-anxiety med. Another thing it does is to decrease the rapid-fire ability of the spazziest neurons, probably by inhibiting the sodium channels.

Get the picture here? All these meds can be life-saving if you have bad bipolar disorder or seizures, but they can all be pretty toxic and have a host of side effects. But all of them work (effectively) as insulators in the brain, decreasing the ability of the neurons to send out out-of whack sodium messages leading to neurotoxic calcium overload. This calcium overload is speculated to be the cause not only of seizures, but also migraines and bipolar symptoms, which is why anti-seizure meds can be used to treat all three conditions.

Enter the ketogenic diet. Ketogenic diets (severely carbohydrate restricted diets) result in ketone bodies (made from fat) being used by the brain as fuel in lieu of glucose. The ketone bodies, acetoacetate and beta-hydroxybutyrate, are acidic. That simply means that there will be extra H+ protons hanging out, compared to a non-ketotic brain. Well, protons can be pumped into neurons in exchange for sodium, acting a little bit like lithium. And a few extra protons outside the cell do all sorts of interesting things, such as reduce the excitability of the neurons and reduce the activity of the excitatory neurotransmitters. Protons seem to block the calcium channels at the NMDA receptors, for example (5). GABA (the inhibitory neurotransmitter and anti-seizure also) is increased in the brain in ketogenic diets, along with many other neurotransmitter changes (6).

Sounds good! Well, some intrepid doctors in Israel had a bipolar patient who didn’t respond that well to medication, and after discussion with the patient and family, it was decided to try a ketogenic diet (7). The patient fasted for 48 hours and began what is described as a “classic” ketogenic diet for two weeks. Oddly, she didn’t have any ketones in her urine, which is a reliable sign of being in ketosis, especially early on. After two weeks, the doctors added medium chain triglyceride oil, which can induce a more reliable ketogenic state. The patient was pretty gung-ho on the diet, and the doctors made note that her compliance was good for the month the diet was tried. She showed no clinical improvement, no loss of weight, no urinary ketosis, and no changes in liver function. Seems odd that she wouldn’t get ketosis or weight loss while fasting or on a strict ketogenic diet, but perhaps that’s why it didn’t work. I’ll discuss a second case below.

On the internet, one can find a number of anecdotes about people improving bipolar symptoms with ketogenic or low carb diets. But it is very important to understand that there are absolutely no systematic scientific studies, not even a small pilot trial. The last thing you would want to do is, all on your own, ditch your meds and try a home-made ketogenic diet without anyone’s help. Ketogenic diets can have pretty bad side effects – constipation, menstrual irregularities, elevated serum cholesterol (if you care) and triglycerides (not good), hemolytic anemia, elevated liver enzymes, kidney stones, and gallstones. Up to 15% of kids on a ketogenic diet will get changes in the heart conduction which puts them at higher risk for death (this is thought to be mediated via selenium deficiency). Valproate + ketogenic diet seemed to worsen the side effects (8).

Now some of these ketogenic diet studies were done at the height of the low-fat era, and likely designed by some pretty fat-hating nutritionists. And, like Atkins TM, many of the original ketogenic diets will have no regard for the omega6:omega3 ratio. Here’s a case where Atkins made manic psychosis a lot worse – I wonder about that, as arachadonic acid (omega 6 metabolite) administration has also been shown to worsen psychosis. In that case, the patient was on valproic acid also, and that may have been part of the problem. A natural sort of ketogenic diet (think Inuit in the winter) would probably have a lot fewer of these complications and side effects.

But it makes you think, doesn’t it? Many of our ancestors probably spent many a winter in ketosis, and other times lack of food or long fasts would have brought on brief periods of ketone body use in the brain too. Maybe our brains work better if we spend time in ketosis. Speculation, of course, but not an unimportant question to research further.

Foods to Eat & Avoid with Bipolar Disorder

If you’ve ever experienced heartburn or acid reflux following a meal, you know what you eat can have a big impact on how you feel. But did you also know that your diet can have repercussions on your mental health as well? Recent research suggests that certain foods might play a role in triggering mood swings in those with bipolar disorder.

What is bipolar disorder?

People with bipolar disorder suffer from dramatic mood swings characterized by episodes of extreme elation and major depression. These changes can occur gradually, over the course of several days or even weeks, or they can come on suddenly. In addition to an unusual shift in mood, episodes of bipolar disorder include problems with unclear thinking, distorted perception, and an inability to function socially.

How does food affect people with bipolar disorder?

According to a study in the Journal of Psychiatric Research, consuming certain foods could make mood swings worse in people with bipolar disorder. Eating a high-sugar, low-nutrient diet can cause dramatic fluctuations in blood sugar levels, which can affect mood. On the other hand, eating a diet of healthy, nutrient-dense foods has the potential to stabilize your mood and provides the body and brain with the nourishment necessary for proper functioning.

Foods to eat with bipolar disorder

✓ Fresh fruits, including apples, bananas, and berries

✓ Dark green, leafy vegetables such as spinach and kale

✓ Lean meats and cold-water fish, including chicken, turkey, and salmon

✓ Whole-grain products including bread, pasta, and cereal

✓ Eggs and soy products

✓ Low-fat dairy products

✓ Nuts and seeds, including almonds, walnuts, and chia seeds

✓ Legumes like beans, lentils, and peas

✓ Dark chocolate

Foods to avoid with bipolar disorder

X Fried, fatty foods like French fries and onion rings

X Caffeinated beverages like coffee, soda, and energy drinks

X Saturated fat found in cream, cheese, butter, and other whole-milk dairy products

X Sugary desserts and candy bars

X Products containing white flour, like pasta, bread, and bagels

X Red meat including beef, veal, pork, goat, and lamb

X Salt, which is found in bacon and ham, cheese, pickles, and soy sauce

X Processed foods, like chips, cookies, granola bars, fruit snacks, and frozen dinners

X Alcoholic beverages, including wine, beer and spirits

Do you suffer from bipolar disorder?

If you think you might be one of the 5.7 million Americans affected by bipolar disorder, the best thing you can do is seek help from a medical professional. While there are no laboratory tests to diagnose bipolar disorder, your doctor can advise you on a healthy diet and recommend other measures to make your symptoms more manageable.

At Synergy Research Centers in San Diego, we’ve been conducting clinical research trials on a variety of psychiatric conditions, including bipolar disorder research study, for more than 18 years.

Foods, Supplements and Drugs to Avoid When You Have Bipolar Disorder

Recently we examined how diet can influence those suffering from depression and with those suffering from bipolar disorder, the same can be true in some cases. Many bipolar patients have found some success through more exercise and better dietary choices, and in this light, here are some foods and drugs that should be avoided.

“NATURAL” DIETARY SUPPLEMENTS

Some supposedly “natural” dietary supplements can have a bad interactions with certain types of prescription medications, especially those taken in association with being bipolar. While they may seem innocent enough on the surface, they could cause other serious health problems and can also increase or enhance some bipolar symptoms. These three are of particular concern:

  • Ephedra
  • Androstenedione
  • Creatine

OTHER DANGEROUS DRUGS

While things like caffeine can be perfectly safe for most people, for many people with bipolar disorder, this type of stimulant can trigger manic episodes in some patients. Caffeine can inhibit sleep and this lack of sleep can contribute to bipolar mood swings and mania.

Alcohol is another hazard that those with bipolar disorder should steer clear from using. Not only are they more likely to become addicted to drinking or other forms of substance abuse, they can interact negatively with many types of medications.

SALT & SUGAR

Anyone who is choosing to live a healthier lifestyle will usually cut down their intake of sugar and salt. For those taking lithium to control their symptoms, monitoring salt intake can be tricky since these amounts can create a sudden increase or decrease in their sodium levels. People should consult with their physician to ensure they are getting the right amount of salt included in their diet, usually between 1,500 and 2,300 milligrams daily.

When it comes to sugar, people with bipolar disorder are at an increased risk of developing metabolic syndrome, a pre-diabetes condition that makes it difficult to manage blood sugar levels. Similar to caffeine, the rollercoaster ride of highs and lows with sugar consumption can wreak havoc with some symptomology.

Those with bipolar disorder should always consult with their doctor before making any changes to their diet. While there is no cure, prescription treatments with the right medication and better choices can offer some additional relief to those suffering from this condition.

Researched and written by Mark Kirkpatrick

To Supplement or Not to Supplement: That Is the Bipolar Depression Question

Many of our patients want to incorporate nutritional supplements into their pharmacologic regimen. They view psychotropics with skepticism1 and prefer natural products, which are more consistent with their values and beliefs toward life and health.2 For some, supplements represent a seemingly safe augmentation strategy. Others view nutritional supplements as a “natural” treatment option and hope such agents will replace their psychotropic regimen.

With the multitude of nutritional products available to patients via the Internet and health-food stores, psychiatrists need to be prepared to respond to questions from patients about the value of these supplements. With so few FDA-approved treatment options in bipolar depression, bipolar patients, in particular, are likely to ask whether these products will help eliminate their painful and recurring depressive symptoms.

Along with my co-author, Boadie W. Dunlop, MD, I recently reviewed the efficacy data of nutritional supplements for the treatment of bipolar depression.3 From the PubMed and Ovid MEDLINE databases, I identified all randomized clinical trials of nutritional supplements in bipolar depressed patients that met the following inclusion criteria: the subject sample included adult bipolar (I, II, or NOS) depressed or euthymic patients; were randomized controlled trials; reported changes in depressive symptoms or depressive episode recurrences; and were written in English. Studies that enrolled both non-bipolar and bipolar patients were included only if they reported the results for the bipolar patients separately. Supplements were organized into 3 categories: essential nutrients/minerals, non-essential nutrients, and combinations of nutritional products. The study design, and efficacy and adverse event data for each study were evaluated.

What the evidence showed

Among essential nutrients/minerals, omega-3-fatty acids had the strongest evidence of efficacy for bipolar depression, although some studies failed to find positive effects from this supplement. The interpretation of results from omega-3-fatty acid trials is complicated by the varying doses and ratios of eicosapentaenoic acid and docosahexaenoic acid—the 2 forms of omega-3-fatty acids used in trials of this supplement.

Weak evidence supported the efficacy of vitamin C, whereas no data supported the usefulness of folic acid and choline. However, folic acid’s role in prevention of birth defects, particularly among bipolar patients, is of great importance—regardless of its usefulness for bipolar disorder symptoms.4

Among the non-essential nutrients, the 2 studies of N-acetylcysteine produced unclear efficacy for treating acute depressive episodes relative to placebo. One study demonstrated its potential to improve depressive symptoms over time. The other, although nonsignificant, suggested it had a prophylactic effect against future depressive episodes.

Inositol is another nonessential nutrient for which the data were unclear. Although all but one of the studies of inositol failed to demonstrate efficacy, the negative studies were underpowered and indicated numerically positive effects. Cytidine was the least supported nonessential nutrient.

Medication is an essential component of treatment for anyone with bipolar disorder. Because people with bipolar disorder often experience rapid or extreme changes in mood, energy level, attention, and behavior, medication can help stabilize mood changes and reduce symptoms. Medication can also prevent future manic or depressive episodes from occurring and reduce their overall intensity.

Bipolar disorder medication is most effective when taken in combination with therapy and daily, healthy choices. If you’ve been diagnosed with bipolar disorder, here are some common types of medication you may be prescribed. Be aware that it may take several tries before you find the best combination that works for you.

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Mood Stabilizers

Mood stabilizers are prescribed to manage hypomanic or manic episodes and sometimes depressive episodes. Examples may include lithium, valproic acid, carbamazepine, lamotrigine, and divalproex sodium.1 Mood stabilizers sometimes can take several weeks to achieve their full effect, and if you take a stabilizer such as lithium, you may have to have regular blood tests to ensure the dosage is not toxic to your body.2

Antidepressants

Antidepressants are sometimes prescribed to treat depressive episode symptoms for people with bipolar disorder, but there is much debate about their efficacy. Antidepressants can trigger manic episodes when not combined with a mood stabilizer and can also potentially increase mood cycling. They may also cause increase suicidal thoughts, particularly among young people. Talk to your doctor about the benefits and risks of taking antidepressants to treat bipolar disorder.3

Antipsychotics

When mood stabilizers or antidepressants fail to curb symptoms, doctors may also prescribe antipsychotic medications. Examples include risperidone, olanzapine, aripiprazole, ziprasidone, quetiapine, asenapine, clozapine, and lurasidone. Antipsychotics are sometimes used in place of mood stabilizers or in combination with them. Talk to your doctor about the benefits and risks of antipsychotics.4

Other Medication

Doctors may prescribe other medication to treat symptoms of bipolar disorder. Anti-anxiety medication such as benzodiazepines may be prescribed to help with anxiety or insomnia. Thyroid medication may be used to treat low thyroid levels caused by mood stabilizers. If you are taking any other medications or supplements or are prescribed anything new, talk to your doctor about potential dangerous interactions effects.

Medication Management

Medication is most effective and least dangerous when you take it consistently and accurately. Here are a few tips for making sure you manage medication effectively.

  • Don’t take medication with alcohol or other illegal drugs. This can decrease their effects or increase unpleasant symptoms. People with bipolar disorder are at increased risk for substance use, so be aware of the risks.5
  • Set an alarm to remember to take your medication at the same time each day. If you forget to take a dose, follow the medications directions on what to do.
  • Use a pill organizer to ensure accuracy and to alert you to when you’re running low. Ask your pharmacy to send you reminders when your new prescription is available.
  • Alert your doctor to any side effects you may experience. It often takes a few changes before you can find the right combination of medications for you.
  • Don’t discontinue medication without consulting with your doctor first. If you feel better, that’s probably a sign that the medication is doing its job. Reducing dosage or stopping the medication altogether without consulting your doctor puts you at risk for relapse or increased mood cycling.

Healthy habits can also play a huge role in increasing the efficacy of medication. If you are eating healthy, exercising, getting consistent sleep, reducing caffeine intake and avoiding drugs and alcohol, then you are setting yourself up for fewer symptoms and greater mood stability. Many people find that participating in counseling or psychotherapy can help them build up healthy habits and overcome potential barriers to good mental health.

Where Do I Start?

If you think you might have bipolar disorder or are unhappy with your medication, talk to your doctor as soon as you can. Write down a list of questions, and don’t be afraid to share your concerns about side effects or past experiences. If you’re currently experiencing a manic or depressive episode, you may need to consult with your doctor at least once a week to assess the effects of the medication. If you are feeling suicidal or experiencing psychotic symptoms, you can go to the hospital or call a loved one for help. You can also call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or their TTY number at 1-800-799-4TTY (4889).

The more information you give your doctor, the better they can help you find the right treatment for your bipolar disorder. What steps can you take today to take the best care of your mind, mood, and body?

Article Sources Last Updated: Jun 6, 2019

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