Bipolar treatment: Are bipolar I and bipolar II treated differently?

Treatment for bipolar disorder, which used to be called manic depression, usually involves medicines and talk therapy. This is true for both bipolar I and bipolar II disorders, which are two different types of a like condition. These conditions also are called bipolar 1 and bipolar 2.

People with bipolar I can have severe and even dangerous manic episodes. People with bipolar II have hypomanic episodes that are not as emotionally high as manic episodes but can have just as big of an effect. In both bipolar I and bipolar II, the depressive episodes happen more often than manic or hypomanic episodes and can severely affect daily life.

The types and doses of medicines needed are based on your symptoms. Medicines for both bipolar I and bipolar II may include:

• Mood stabilizers. These medicines are usually part of bipolar I and bipolar II treatment. Mood stabilizers help control episodes of mania or hypomania. Examples include lithium (Lithobid), valproic acid, divalproex (Depakote), carbamazepine (Tegretol, Equetro, others) and lamotrigine (Lamictal).
• Antipsychotics. These may be given alone or along with a mood stabilizer. Examples of medicines taken by mouth include olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lumateperone (Caplyta), lurasidone (Latuda), cariprazine (Vraylar) and asenapine (Saphris). Also, there are some brands that can be given as an injection.
• Antidepressants. These help manage depression and anxiety. But some can trigger mania, so in bipolar I they're given along with a mood stabilizer or an antipsychotic. In bipolar II they may sometimes be used alone.
• Antidepressant-antipsychotic. The medicine Symbyax includes the antidepressant fluoxetine and the antipsychotic olanzapine. It helps treat depression that's part of bipolar I.

Other treatments used with medicines include:

• Talk therapy, also called psychotherapy. As a key part of treatment, your mental health professional may recommend cognitive behavioral therapy, also called CBT, to identify negative thoughts, beliefs and behaviors and replace them with healthy, positive ones. Another talk therapy option is interpersonal and social rhythm therapy, which keeps a regular routine to help manage mood. Family therapy may be part of treatment. Therapies such as dialectic behavioral therapy, a type of CBT, and acceptance and commitment therapy also have been shown to help in bipolar disorder.
• Treatment for use of alcohol or other drugs. Many people with bipolar disorder also use alcohol, tobacco or drugs. Alcohol or drugs may seem to ease symptoms, but they can trigger, prolong or worsen depression or mania. Talk with your mental health professional about your alcohol, tobacco or drug use so that, if needed, both your substance use and bipolar disorder can be treated.
• Treatment programs. Outpatient treatment programs for bipolar disorder can be very helpful. But sometimes a hospital stay is needed if symptoms are severe and affect functioning or safety.
• Self-management strategies. Learn about your bipolar condition and how to take care of yourself. A healthy lifestyle, such as getting enough sleep, eating a healthy diet and being physically active, can help manage bipolar symptoms. Keeping to a regular schedule, having social activities and joining a support group also may help.

You may need to try different medicines or a mix of medicines to find what works best for you. Meet regularly with your mental health professional to talk about how your treatment is working and to make changes if needed. 

• Bipolar medications and weight gain