Treating Depression in Bipolar Disorder

Written by Madeline Laguaite
Medically Reviewed by Smitha Bhandari, MD on September 14, 2024

Treatment for bipolar disorder has come a long way. Today, mood stabilizing drugs are a mainstay treatment for bipolar disorder. Doctors may prescribe lithium, an antimanic drug, or an antipsychotic drug — or a combination of both — in order to alleviate symptoms of depression without triggering a manic episode.

With bipolar disorder treatment, there’s not a “one size fits all” solution that works for everyone. 

But if you have bipolar and you’re not already on longterm medication, your doctor may recommend options such as:

Your doctor may also recommend a combination treatment. That may include:

If you have an episode of depression but you do take a longterm medication, the treatment plan may be different. For example, your doctor may change the dose of your existing medications.

While antidepressants are effective treatment for people with major depressive (unipolar) disorder, they are not always as effective for bipolar depression, and generally should not be given alone (monotherapy) in people with bipolar I disorder. When antidepressants are given alone to someone with bipolar disorder, there's a risk the drug might ignite a manic episode in some patients. Knowing this, most doctors may avoid using antidepressants as monotherapy for bipolar depression.

A very large randomized study sponsored by the National Institute of Mental Health (NIMH) called the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) showed that mood stabilizers alone produced a stable improvement only in about 1 in 4 people with bipolar depression, and surprisingly, adding an antidepressant to the mood stabilizer did not boost improvement further. The STEP-BD study underscored the need to find treatments other than mood stabilizers or antidepressants for bipolar depression.

Studies have shown that some antipsychotic drugs can also treat bipolar depression. These medications work by affecting receptors (called neurotransmitters) for chemicals in the brain that help regulate mood and behavior.

Your doctor will weigh the pros and cons of the available medications to help you get relief from bipolar without the risk of mania or drug interactions.

Central nervous system (CNS) depressants, which include benzodiazepines, act on neurotransmitters to slow down normal brain function. CNS depressants are commonly used to treat anxiety and sleep disorders and may be an effective alternative or adjunctive therapy in some people with acute mania.

Some commonly used benzodiazepines include: 

But these drugs all can be addictive and they can cause sluggish thinking. Generally, they should only be used to treat agitation or sleep problems during the acute phase of the condition and not as longterm medications. They typically should be tapered off rather than stopped abruptly, in order to minimize the risk of drug withdrawal.

Guidelines from the American Psychiatric Association suggest that ECT is an appropriate and sometimes preferred treatment for people with bipolar who have psychotic symptoms or a very high risk for suicidal behavior. In addition, ECT may benefit women who are pregnant and suffer with serious depression or mania.

Along with medications for bipolar depression, you may benefit from ongoing psychotherapy. This one-on-one therapy combines interpersonal psychotherapy with behavioral techniques to help you learn how to manage interpersonal problems more effectively. Therapy can also help you stay on your medications and normalize lifestyle habits. 

The STEP-BD study found that, in addition to medications, adding a structured therapy — such as cognitive behavioral therapy, interpersonal/social rhythm therapy, or family-focused therapy — can speed up treatment response in bipolar depression by as much as 150%.

Add WebMD as a Preferred Source to see more of our trusted content across Google Search, AI Overviews, and AI Mode