Is treatment for bipolar I different from treatment for bipolar II?

Answers from Daniel K. Hall-Flavin, M.D.

Treatment for bipolar disorder, formerly called manic depression, generally involves medications and mental health counseling (psychotherapy) — whether you have bipolar I or bipolar II. Bipolar II disorder is not a milder form of bipolar I disorder, but a separate diagnosis.

While the manic episodes of bipolar I disorder can be severe and dangerous, individuals with bipolar II disorder can be depressed for longer periods, which can cause significant impairment.

The types and doses of medications prescribed are based on your particular symptoms. Whether you have bipolar I or II, medications may include:

  • Mood stabilizers. You'll typically need mood-stabilizing medication to control episodes of mania or hypomania, which is a less severe form of mania. Examples of mood stabilizers include lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro) and lamotrigine (Lamictal).
  • Mood-stabilizing antipsychotics. If symptoms of depression or mania persist in spite of treatment with other medications, adding an antipsychotic medication such as olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris) may help. Your psychiatric care provider may prescribe some of these medications alone or along with a mood stabilizer.
  • Antidepressants. Your provider may add a certain type of antidepressant to help manage depression. Because an antidepressant can sometimes trigger a manic episode, it needs to be prescribed along with a mood stabilizer or antipsychotic in bipolar I disorder.
  • Antidepressant-antipsychotic. The medication Symbyax combines the antidepressant fluoxetine and the antipsychotic olanzapine. It works as a depression treatment and a mood stabilizer. Symbyax is approved by the Food and Drug Administration specifically for the treatment of depressive episodes associated with bipolar I disorder.

In addition to medication for bipolar disorder, other treatment approaches include:

  • Psychotherapy. As a key part of treatment, your psychiatric care provider may recommend cognitive behavioral therapy to identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones. Other types of therapy also may help.
  • Substance abuse treatment. Many people with bipolar disorder also have alcohol, tobacco or drug problems. Drugs or alcohol may seem to ease symptoms, but they can actually trigger, prolong or worsen depression or mania. If you have a problem with alcohol or other drugs, tell your provider so that both your substance use and bipolar disorder can be treated.
  • Treatment programs. Participation in an outpatient treatment program for bipolar disorder can be very beneficial. However, your provider may recommend hospitalization if your bipolar disorder significantly affects your functioning or safety.
  • Lifestyle issues. In addition to medications and other types of treatment, successful management of your bipolar disorder includes living a healthy lifestyle, such as getting enough sleep, eating healthy and getting enough physical activity. If you need advice in these areas, talk with your provider.

You may need to try different medications or combinations of medications to determine what works best. So it's important to regularly meet with your psychiatric care provider to see how well your treatment is working. If necessary, your provider may make periodic adjustments to your medication to keep symptoms and side effects under control.

Mar. 04, 2015