What Should I Look for in Outpatient Treatment Programs for Bipolar Disorder?

Summary: The two most important things to look for in outpatient treatment programs for bipolar disorder are a treatment center that provides a full psychiatric evaluation to establish an accurate diagnosis and clinicians with significant experience treating people with bipolar disorder.

Key Points:

• If you have think you have bipolar disorder, getting an accurate diagnosis can help you avoid months or even years of inappropriate and potentially counterproductive treatment based on inaccurate diagnoses.
• The symptoms of bipolar disorder often overlap with other mental health disorders, including depression, anxiety, and disorders with psychosis, which is why even experienced clinicians can misdiagnose bipolar disorder.
• Effective treatment for bipolar disorder hinges on the accuracy of the diagnosis and matching evidence-based treatment to your specific treatment profile.

Why is Bipolar Disorder a Challenge to Diagnose?

We’ll start with a definition of bipolar disorder provided by the  American Psychological Association (APA):

“Bipolar disorder is a serious mental illness in which common emotions become intensely and often unpredictably magnified. Individuals with bipolar disorder can quickly swing from extremes of happiness, energy, and clarity to sadness, fatigue, and confusion. All people with bipolar disorder have manic episodes, characterized by elevated or irritable moods that last at least a week and impair functioning. But not all become clinically depressed.”

That definition gives us an initial understanding of how the contrasting symptoms of bipolar disorder can complicate diagnosis. In addition, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there are three types of bipolar disorder:

Bipolar I (BD-I):

• Primary symptoms:
  • Manic episodes, depressive episodes, or mixed episodes.

Bipolar II (BD-II)

• Primary symptoms:
  • Manic episodes, depressive episodes, or mixed episodes that are less severe and disruptive than the episodes common in BD-I. The manic episodes in BD-II are called hypomanic.

Cyclothymic disorder:

• Primary symptoms:
  • Repeated, chronic depressive and hypomanic episodes that don’t rise to the level of those common in BD-I or BD-II.

Next, an understanding of the contrast between manic symptoms and depressive symptoms in bipolar disorder can illuminate the diagnostic challenge.

Symptoms of Mania in Bipolar Disorder

• Anger/outbursts/tantrums, all of which can be extreme
• Atypically fast speech/talking patterns
• Racing thoughts, often unwanted
• Atypically high levels of energy and activity
• Problems sleeping
• Difficulty concentrating
• High levels of enthusiasm/optimism
• Excess/over-multitasking
• Elevated sense of individual importance
• Risky/irresponsible behavior: driving, sex, spending money
• Aggression
• Hallucinations and delusions

Let’s compare those symptoms to the depressive symptoms in BD-I and BD-II.

Depressive Symptoms in Bipolar Disorder

• Persistent feelings of worthlessness and/or helplessness
• Excess, disproportionate response to rejection/disappointment
• Feeling hopeless/empty
• Frequent crying
• Low self-esteem/self-confidence/belief
• Sleep issues: difficulty sleeping, or sleeping too much
• Sudden change in appetite/eating patterns
• Anger/tantrums
• Loss of motivation
• Restlessness
• Difficulty sustaining concentration/following through on tasks

In an article published by the American Psychological Association (APA), Dr. Benjamin Goldstein of the University of Toronto describes the diagnostic challenge:

“Part of the problem is that with their diverse range of states and symptoms, bipolar spectrum disorders can look like major depression, anxiety, psychosis, substance use disorders, autism spectrum disorders, ADHD, personality disorders, or conduct disorders.”

That’s why the first thing we mention in this article is the importance of an accurate diagnosis. If you have undiagnosed bipolar disorder, or are misdiagnosed with a different mental health disorder, you may receive treatment that exacerbates the symptoms of bipolar disorder. This can lead to a number of negative outcomes, including a loss of belief that treatment can work, a loss of trust in mental health professionals, and a loss of hope for a better future.

With an Accurate Diagnosis, What Kind of Treatment Should I Expect?

When you look for outpatient treatment programs for bipolar disorder, the second most important thing to look for is whether the treatment center adheres to the conclusions of a recent expert review of treatment for bipolar disorder:

“Lithium should represent the first choice for the treatment of patients with bipolar disorder.”

That paper, published in 2023, confirms lithium is a mood stabilizer with decades of research proving its effectiveness in stabilizing the contrasting moods that characterize bipolar disorder. Another review of lithium, this one published in 2024, reaches a similar conclusion:

“Lithium is effective both in treating acute mania, as an adjunctive antidepressant, and as a maintenance treatment in bipolar disorder…[and] continues to be the mainstay treatment of mood disorders in general and in bipolar disorder specifically.”

 While an effective treatment plan for bipolar should be integrated, person-first, and holistic, and include – in addition to an effective mood stabilizing medication – psychotherapy, lifestyle changes, and complementary supports. In some cases, for people with treatment-resistant bipolar disorder, treatment with a brain stimulation approach may also be appropriate.

Evidence-Based Treatments for Bipolar Disorder

Medications for BD may include:

• Mood stabilizers, i.e. lithium
• Antipsychotics
• Antidepressants
• Ketamine (new and emerging treatment)

Psychotherapy for BD may include:

• Cognitive behavioral therapy (CBT)
• Diagnostic behavior therapy (DBT)
• Prolonged exposure (PE) therapy
• Cognitive remediation therapy (CRT)
• Acceptance & commitment therapy (ACT)
• Solution-focused brief therapy (SFBT)

Lifestyle adjustments for people with BD may include:

• Healthy eating
• Exercise
• Sleep hygiene
• Stress management

Effective complementary modalities for people with BD may include:

• Mindfulness
• Meditation
• Yoga/tai chi
• Expressive therapies (music, visual art, writing)

Brain stimulation therapies for people with BD may include:

• Electroconvulsive therapy (ECT)
• Transcranial magnetic stimulation (TMS)

Depending on the specifics of your diagnosis, your treatment plan will include a combination of support from each category above. Or rather, we can say that what you should look for in outpatient treatment programs for bipolar disorder is a center that collaborates with you to build a multimodal treatment plan that addresses all the factors that contribute to your symptom profile.

That means they offer a variety of ways to help you achieve goals you define yourself, with an awareness that lithium is the first line, most essential component of effective treatment for and management of the symptoms of bipolar disorder.

Benefits of Outpatient Treatment for Bipolar Disorder

Outpatient treatment means that you don’t live at or spend the night at your treatment center. Basic outpatient treatment is what most people think of when they hear the phrases going to therapy or I’m in therapy or I’m going to see my therapist.

Typical outpatient treatment occurs at a schedule that’s best for you:

• Once a month is common if you’ve been in treatment for a significant period of time, have robust coping skills, and are stable on their medication and have a solid handle on managing their symptoms.
• Treatment every two weeks is common if you have less time-in-treatment but have achieved a degree of stability on medication and have made progress developing robust distress tolerance and symptom management skills.
• Once-a-week visits are common if you’re early in treatment and need consistent support while achieving stability on medication and learning that treatment approaches and supporting modalities work best for you.

In some cases, you may attend outpatient treatment more than once a week, but if you’re at that level of need, an intensive outpatient program (IOP) may be what you need.

IOP Treatment Basics

• Treatment 3-5 days per week for around 3 hours per day, depending on the program.
• Participation in individual, group, and family therapy.
• Peer support groups.
• Daily/nightly treatment homework/assignments.

During IOP Treatment

• You live at home
• Have evenings and weekends free
• Can work and go to school

Additional Benefits of IOP Treatment

• Practicing what you learn in treatment in your daily life back home, at work, or at school.
• The ability to report back to your therapist and/or treatment peers about your progress back home, at work, or at school, i.e. this worked, that didn’t, and/or “how am I supposed to [fill in the blank] when [fill in the blank].”
• Receiving direct, immediate, practical feedback/responses/congratulations/suggestions about the things you report re. previous bullet point.

Those benefits also apply to individual outpatient treatment, with the exception of feedback from treatment peers during treatment sessions.

When Should I Look for Outpatient Treatment for Bipolar Disorder?

When you have any sort of persistent mental health challenge, we encourage you to seek professional support and consider the advice of a qualified psychiatrist, therapist, or counselor. A rule of thumb for symptoms:

If mental health symptoms like depressed mood or anxiety are present every day or almost every day for two weeks or more, then they’re likely more than passing moods or temporary tough patch. Regarding manic episodes in bipolar disorder, those that last at least a week meet criteria for diagnosis, while depressive episodes that last one to two weeks meet criteria for diagnosis.

If the symptoms you experience create disruption in your daily life, affect relationships, and impair your performance at school or work, and cause you to isolate yourself from friends, family, and social activities, we encourage you to seek a full psychiatric evaluation and consider the treatment options the assessing clinician recommends.

We’ll close with this maxim, which is important for anyone with a mental health disorder should understand: the earlier you get the evidence-based treatment you need, the better the outcome.