Mayo Clinic Health Library

Question

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

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

Updated: 03-23-2012

Answer

Bipolar treatment generally involves taking medications and going to mental health counseling (psychotherapy) — whether you have bipolar I or bipolar II. Both bipolar I and bipolar II disorders have several subtypes.

The types and doses of medications prescribed are based on your particular symptoms. Medications may include:

  • Mood stabilizers. Whether you have bipolar I or II, you'll typically need mood-stabilizing medication to control manic episodes. With bipolar I, unmanaged manic episodes can lead to irrational thinking, inappropriate decisions, and dangerous or out-of-control behavior. A less severe type of mania (hypomania) occurs with bipolar II, but it can still cause problems. Examples of mood stabilizers include lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, others) and lamotrigine (Lamictal).
  • 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) or asenapine (Saphris) may help. Your doctor may prescribe some of these medications alone or along with a mood stabilizer.
  • Antidepressants. For either type of bipolar disorder, a mood stabilizer or antipsychotic alone may be enough to control depression. If not, your doctor may add an antidepressant. Because an antidepressant can sometimes trigger a manic episode, it's usually prescribed along with a mood stabilizer or antipsychotic. Examples of antidepressants used for bipolar disorder include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil) and bupropion (Wellbutrin).

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

  • Mental health counseling (psychotherapy). As a key part of treatment, your doctor may recommend individual, group or family counseling.
  • Substance abuse treatment. According to a national survey, about half of people with bipolar disease also abuse alcohol, significantly increasing the risk of life-threatening complications. If you have a problem with alcohol or other drugs, tell your doctor so this can be part of your treatment plan.
  • Hospital treatment. This can include an inpatient hospital stay or participation in an outpatient treatment program. Because bipolar I is generally more severe than bipolar II, the need for urgent outpatient treatment or hospitalization is more common with bipolar I.
  • Lifestyle changes. Successful management of your bipolar disorder includes living a healthier lifestyle, such as getting more sleep, eating healthier and getting more physical activity. If you need help in these areas, ask your doctor for advice.

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 doctor to see how well your treatment is working. If necessary, your doctor may make periodic adjustments to your medication to keep symptoms and side effects under control.

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