Bipolar Disorder – Therapy

The aim of the treatment is to reduce the severity and frequency of the disease phases and their consequences. A combination of medication and psychotherapy should be used.

On the one hand, medication should be used to treat the current symptoms of the disease (acute therapy), on the other hand, this condition should be maintained if possible (maintenance therapy) and relapses should be prevented (phase prophylaxis).

Acute drug therapy

In acute therapy, mood-stabilizing drugs are always used, regardless of whether a depressive or manic episode is currently present. Among the most important mood stabilizers are lithium, carbamazepine, valproate and lamotrigine as well as modern atypics – especially quetiapine, aripiprazole, risperidone and olanzapine. In order to minimize side effects, these drugs must be precisely dosed and therapies must therefore be closely monitored, especially at the beginning.

In addition to mood stabilizers, so-called neuroleptics (antipsychotics) are used in acute treatment. In cases of severe agitation, other sedative drugs can also be used. In the acute therapy of a depressive episode, antidepressants are mainly used. However, there is a danger that the antidepressant treatment will quickly turn the depression into a mania – experts call this a “switch”.

Medicinal maintenance therapy & phase prophylaxis

After the symptoms have subsided, all patients should undergo maintenance therapy for at least one year – with the same mood stabilizers as in acute therapy. In most cases a long-term, possibly lifelong phase prophylaxis is necessary. As a rule, phase prophylaxis is also based on those mood stabilizers that have already achieved good results in acute and maintenance therapy.

Just as important as lithium, valproate and lamotrigine are some modern atypical neuroleptics (atypics such as aripiprazole or olanzapine). Studies with olanzapine as monotherapy have been very successful, as well as with quetiapine and aripiprazole.

For some time it has been investigated whether the combination of these atypical neuroleptics with certain epilepsy drugs (antiepileptic drugs) works even better than taking an atypical neuroleptic alone (monotherapy). Although this has not yet been sufficiently proven in studies, attempts are still being made to improve therapeutic success by combining two active substances if monotherapy is not sufficient for phase prophylaxis.


In addition to the administration of medication, psychotherapy should also be sought. Various psychotherapeutic methods can be used. At present, there are no definite indications that a particular method should be preferred in the treatment of bipolar affective disorders. Since the bipolar disorder is sometimes a very serious illness, it should be treated by therapists who are as experienced as possible.

Other supporting forms of therapy

In the treatment of a bipolar disorder, other forms of therapy can be used in addition to medication and psychotherapy. Ergotherapy, art therapy, dance therapy and music therapy as well as relaxation techniques and movement therapy can be used in addition.

In severe depressive phases, wake therapy, in which the patient is not allowed to sleep for a certain period of time, can alleviate the symptoms. In the case of strong manic phases, dark therapy, in which the affected person stays in a dark room for a certain period of time, is being tested. Brain stimulation procedures, in which the function of the nerve cells in certain areas of the brain is influenced by electric current or electromagnetic waves, and electroconvulsive therapy are only used in the treatment of severe bipolar diseases.

What can affected persons do themselves?

If you have already noticed the symptoms described above, you should definitely consult a psychiatrist. A self-test can provide information on how likely it is for you to have a bipolar affective disorder. Avoid alcohol and drugs or medications that are not prescribed by your doctor. These substances are often used for “self-therapy”, but can have a negative effect on the course of the disease.

In addition to medication and psychotherapy, you can also find support in self-help groups. Among other things, they can help you acquire knowledge about your illness, recognize signs of a relapse in good time and develop suitable strategies against it. You can exchange experiences with other sufferers, establish contacts and get to know other offers of help for you and your relatives.

So-called mood calendars, in which you can enter the type and extent of mood swings, have also proved their worth. In this way, the attending physicians gain an additional insight into the course of the disease and can adapt the drug therapy if necessary.