What is bipolar disorder?
Bipolar disorder is a medical condition with many different treatment options. Medications are usually a central part of treatment and are often effective at stabilizing mood and managing other symptoms of the disorder.
How does my doctor know which medications to prescribe for bipolar disorder?
Before starting any medication, your doctor will assess your mental and physical health, which may involve doing blood tests. You will have follow-up appointments so that your doctor can monitor progress and check if there are adverse side effects.
It is very important to let your doctor know if there is a possibility that you may be pregnant.
How long will I need to take medications?
Most youth with bipolar disorder need to take medications for a long time. Usually, they start with low doses and then increase them gradually as needed.
Because the symptoms of bipolar disorder are quite complex, it is not unusual to need more than one medication to manage them. You may need to take a medication for several weeks or months to figure out if it works for you.
What types of medications are usually prescribed for bipolar disorder?
One or more of the following classes of medications are often prescribed to treat bipolar disorder in youth:
- mood stabilizers
- anticonvulsant medications
- atypical (second generation) antipsychotics
- antidepressants
You can discuss the options with your doctor.
Mood stabilizers
Lithium
Lithium is approved by Health Canada to treat and prevent symptoms of mania or hypomania in youths age 12 and older. Lithium can also act as an antidepressant and help prevent suicidal behaviour.
If you are prescribed lithium, you will need blood tests to monitor the amount of lithium in your blood. If the level is too low, lithium will not be effective. If it is too high, it can cause toxicity (poisoning), which is a medical emergency. Caffeine intake can affect the blood lithium level, and so can other over-the-counter and prescribed medications. Assuming the lithium level in the blood is within a safe range, most teenagers do not experience significant adverse or harmful effects. However, they do need regular blood tests to check for thyroid and kidney function, since lithium can affect these organs over longer periods of time.
Anticonvulsant medications
Anticonvulsants are sometimes used as mood stabilizers in bipolar disorder, but they were originally developed to treat seizures. These medications are not approved by Health Canada to treat bipolar disorder in children and teens. However, your doctor may prescribe these medications "off label", as they may work for some youth.
The most common anticonvulsant medications for bipolar disorder are valproic acid/divalproex sodium and lamotrigine.
Atypical (second generation) antipsychotics
Atypical antipsychotics are used more frequently than anticonvulsants to treat bipolar disorder in children and teens. They include:
- aripiprazole
- risperidone
- quetiapine
- olanzapine
- ziprasidone
- lurasidone
- clozapine
Some antipsychotics can cause significant weight gain and changes in metabolism, which can increase the risk of developing diabetes and high cholesterol. Your doctor should monitor your weight and the glucose and lipids levels in your blood.
Antidepressants
Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), are sometimes prescribed to treat depression in bipolar disorder. They are usually used at lower doses and for shorter periods of time in bipolar disorder than they are for depressive disorders.
If a doctor prescribes an antidepressant for bipolar disorder, they will often prescribe a mood stabilizer at the same time. This is to reduce the risk of switching to mania or hypomania.
For more information on the medical treatments mentioned here, please see the page Bipolar disorder: Treatment with medications, on AboutKidsHealth.ca.
Psychotherapy for bipolar disorder
Psychotherapy, also known as "talk therapy", involves a trained therapist working with an individual or a group of people on common objectives. Depending on the type of psychotherapy, the therapist can offer support, teach coping skills, or help you explore relationships.
Some psychotherapy treatments for bipolar disorder include:
- cognitive behavioural therapy (CBT)
- interpersonal and social rhythms therapy (IPSRT)
- family-focused therapy (FFT)
- dialectical behavioural therapy (DBT)
Cognitive behavioural therapy (CBT)
CBT has been well studied in children and teens with depression, and is particularly helpful for the depressive episodes in bipolar disorder.
Interpersonal and social rhythms therapy (IPSRT)
This type of psychotherapy originated from interpersonal therapy for depression, and was adapted for bipolar disorder.
IPSRT helps youth work on improving their relationships and managing their daily routines by using charts. Regular routines and sleep schedules may help prevent manic or hypomanic episodes or lengthen the time between them.
Family-focused therapy (FFT)
FFT involves a youth's family and focuses on enhancing the family's ability to cope with a depressive or manic/hypomanic episode and recognize new episodes earlier. FFT helps to improve communication and problem solving in the family.
Dialectical behavioural therapy (DBT)
DBT is a therapy that teaches youth skills to help them regulate their emotions and change maladaptive (unhelpful) behaviour.
Importance of patient/therapist relationship
Psychotherapy is more helpful when there is a good relationship between you and the therapist.
Lifestyle changes and general support
Youth with bipolar disorder may see their symptoms improve with following some general healthy routines.
These include:
- getting eight to ten hours of sleep a night
- eating a balanced diet, following Canada's Food Guide
- doing regular exercise in line with physical activity guidelines for youth
- obtaining peer support
- spending time doing healthy activities you enjoy
- taking time to see how you can reduce or remove unnecessary stressors
If your symptoms prevent you from following any of these suggestions, your health-care provider can offer advice.
