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learn: bipolar symptoms

Treatments

Guidelines, Advice, and Responsibility

The National Institute for Health and Care Excellence (NICE) provides evidence-based guidelines on how healthcare professionals should treat various conditions, including bipolar disorder.

Doctors and other practitioners don’t have to follow these guidelines in every case, but if they choose not to, they should have a clear, justified reason for doing so. As a patient, it’s always okay to ask your healthcare team why a particular treatment plan is recommended and how it aligns with these guidelines.

Recommended Medications

Mood stabilisers are commonly used to help manage the highs of mania or hypomania, as well as depressive symptoms.

Lithium
Certain antipsychotics
Certain anticonvulsants
Certain benzodiazepines

Your doctor will tailor medication choices to your specific symptoms and needs, and adjustments may be needed over time to find what works best for you.

Medication is important but it won't work on it's own...

Symptom Care

Depression and Anxiety

Depressive symptoms are eased with Antidepressant or Anticonvulsant medication.

Psychological Treatments

Medication alone won’t fix Bipolar Disorder, sufferers need mental and emotional support

Mania and Hypomania

Successful treatment normally includes Mood Stabiliser or Antipsychotic medication

learn: treating bipolar

Depression and Anxiety

There is no single “wonder drug” for bipolar disorder. Your doctor will work with you to find the right medications, dosages, and combinations that best manage your symptoms. This approach applies to all aspects of bipolar disorder, including both highs and lows. When first diagnosed, your doctor should discuss options for treating depressive symptoms as part of your overall care plan.

You may be offered the following medications:

Fluoxetine
Quetiapine
Olanzapine
Lamotrigine

Fluoxetine is an antidepressant, and Lamotrigine is an anticonvulsant.

Sometimes, a single medication isn’t enough to manage all symptoms. If this happens, your doctor may recommend adding other medications to your treatment plan to help stabilise your mood and address different aspects of bipolar disorder.

Lithium, or
Sodium Valproate

Sodium Valproate is an anticonvulsant that can be effective for bipolar disorder. However, it is not recommended for young women who may become pregnant. Your preferences and concerns should always be taken into account when your doctor discusses treatment options with you.

learn: treating bipolar

Mania and Hypomania

You should be offered a mood stabiliser to help manage episodes of mania or hypomania. Doctors may sometimes call these “antimanic” medications. If you are currently taking antidepressants, your doctor may advise you to taper or stop them, as they can sometimes worsen symptoms.

Initially, you will often be offered an antipsychotic medication. Common antipsychotics used to treat bipolar disorder include:

Haloperidol
Olanzapine
Quetiapine
Risperidone

Not every medication works the same for everyone, so your doctor may suggest alternatives if needed. Similar to depression treatment, if an antipsychotic alone isn’t sufficient, you might be offered Lithium or Sodium Valproate to use alongside.

Doctors will adjust dosages and combinations based on what works best for you. Remember, Sodium Valproate is not recommended for young women who may become pregnant, and your personal preferences and concerns should always be taken into account.

learn: treating bipolar

Psychological Route

If you have an episode of depression, you should be offered medication and a high intensity talking therapy

If you experience a depressive episode, you should be offered both medication and a structured, high-intensity talking therapy. Examples include:

Interpersonal Therapy
(IPT)

Interpersonal therapy is a talking therapy focusing on you & relationships with other people.

Cognitive Behavioural Therapy
(CBT)

CBT is a therapy for managing your problems by changing the way you think & behave.

What psychological care is recommended?

You should be offered a psychological therapy specifically designed for bipolar disorder. This may be delivered individually or in a group setting.

The goal of therapy is to help prevent future episodes, also called relapse. A good therapy program should support you in learning how to:

Understand your condition
Consider how your thoughts and behaviours affect your mood
Monitor your mood, thoughts, and behaviours
Identify risks and sources of distress
Make plans to stay well
Prepare plans for when you start to feel unwell
Be aware of how you communicate
Manage day-to-day challenges effectively

If you live with your family or have close contact with them, you should also be offered family intervention.

Family intervention involves working together with mental health professionals to improve understanding, communication, and relationships within your family. It is offered to those you live with or see regularly.

The support provided will depend on your family’s specific challenges and preferences. This could include group sessions or individual family sessions. Typically, families receive support for 3 months to 1 year, with at least 10 planned sessions to ensure meaningful progress.

learn: coping mechanisms

Mental Training

Interpersonal Therapy (IPT)

Interpersonal Therapy (IPT) is a type of psychotherapy that helps relieve symptoms by improving how you relate to others. Unlike some therapies that focus on childhood or developmental issues, IPT addresses current problems and relationships. Therapists are active, supportive, and hopeful, offering practical strategies for change.

  • Structured and goal-oriented therapy
  • Time-limited, typically 12–16 weeks for the active phase
  • Focuses on interpersonal relationships and communication
  • Emphasises present, “here-and-now” relationships
  • Aims to strengthen social support and improve daily interpersonal functioning

IPT can be delivered individually or in a group setting, depending on your needs and preferences.

The average IPT program lasts about 16 sessions. Your doctor may recommend IPT alongside medication or other therapies to provide a well-rounded approach to managing bipolar disorder.

IPT Can Help Manage Bipolar Disorder

Research shows that medication alone may not fully manage bipolar disorder, highlighting the importance of psychosocial interventions. IPT is especially useful as a complementary treatment alongside medication and CBT.

At the heart of IPT is the idea that psychological symptoms often arise in response to challenges in your current relationships and daily interactions with others. By addressing these issues, IPT helps improve both mood and interpersonal functioning.

4 Areas of Focus

IPT helps you address key areas affecting your mood and wellbeing:

Conflict causing tension and distress
Grief and loss experiences
Challenges in relationships
Life changes affecting self and others

Learning practical strategies for these challenges often improves symptoms and helps you feel more in control of your mood and relationships.

Understanding exactly how life events effect me should help...

There’s No Hard or Fast Rule

The time needed to see results can vary from person to person. On average, research shows that an IPT program includes around 16 sessions.

The Structure of IPT

Opening Sessions (1–3) – These sessions focus on gathering information and deciding which areas of your relationships to focus on. Together with your therapist, you create an “interpersonal inventory,” listing key relationships in your life and grouping them into the four main problem areas.

Middle Sessions (4–14) – During this phase, you work on improving the selected problem areas with your therapist’s support. You and your therapist develop practical strategies, which you then try out between sessions to address real-life challenges.

Final Sessions (15–16) – The last sessions focus on wrapping up therapy, reflecting on progress, and managing any feelings about the therapy ending. You review the relationships and issues identified in your interpersonal inventory and celebrate the improvements you’ve made.

There’s no fixed length for IPT, as it depends on factors like the severity and type of bipolar disorder, as well as individual circumstances. Some people notice improvements after just a few sessions, while others may benefit from several months of therapy.

Interpersonal and Social Rhythm Therapy (IPSRT)

IPSRT helps reduce the erratic nature of daily routines, which can affect mood in bipolar disorder. It focuses on stabilising:

Meal schedules
Sleep-wake cycles
Balance between rest and activity

At the same time, IPSRT works to improve how you perform in key social roles and enhance the quality of your relationships. A 2020 clinical trial with 44 participants showed promising improvements in symptoms, though further research is needed.

Family-Focused Therapy (FFT)

FFT is designed for adults and children with bipolar disorder and their family members or supporters. It provides education about the condition and training in problem-solving and communication skills.

A 2016 review of eight clinical trials found that combining FFT with mood stabiliser medication can offer benefits over shorter psychoeducation programs. Benefits included faster recovery, reduced symptom severity, fewer mood episodes, and fewer recurrences.

So… What now?

Interpersonal therapy (IPT) for bipolar disorder starts with education about the condition and follows with sessions to collect information, assess that information, then plan and implement solutions.

A central idea in IPT is that psychological symptoms can be understood as a response to current difficulties in everyday relationships with other people.

The average number of IPT sessions is around 16.

Other psychotherapies may also be helpful alongside or instead of IPT. These include cognitive behavioural therapy (CBT), interpersonal and social rhythm therapy (IPSRT), and family-focused therapy (FFT). While research is still limited, these approaches have shown potential benefits for managing bipolar disorder and supporting long-term wellness.

Questions to ask

The following are helpful questions to ask your doctor or healthcare provider about IPT:

How many IPT therapy sessions might I need?
What realistic results can I expect from therapy?
If IPT isn’t effective, what alternative therapies are available?
What is the cost per therapy session?
Can I attend therapy sessions remotely or online?