Treatments for bipolar disorder aim to reduce the severity and frequency of the episodes of depression and mania so that a person can live life as normally as possible.
Treatment options for bipolar disorder
If they are not treated, episodes of bipolar-related mania can last for 3-6 months. Episodes of depression tend to last longer, for 6-12 months.
However, with effective treatment, episodes usually improve within about three months.
Most people with bipolar disorder can be treated using a combination of different treatments. The treatment may include one or more of the following:
- medication to prevent episodes of mania, hypomania (less severe mania) and depression – these are known as mood stabilisers and are taken every day, on a long-term basis
- medication to treat the main symptoms of depression and mania when they occur
- learning to recognise the triggers and signs of an episode of depression or mania
- psychological treatment such as talking therapy to help deal with depression and to give you advice about how to improve your relationships
- lifestyle advice such as doing regular exercise, planning activities that you enjoy and that give you a sense of achievement, and advice on improving your diet and getting more sleep.
Read more information about living with bipolar disorder.
Most people with bipolar disorder can receive most of their treatment without having to stay in hospital.
However, treatment in hospital may be required if your symptoms are severe, or if you are being treated under the Mental Health Act because there is a danger that you will harm yourself or others. In some circumstances, you may be able to have treatment in a day hospital and return home at night.
Medication
Several medications are available to help stabilise mood swings. These include:
- lithium carbonate
- anticonvulsant medicines
- antipsychotic medicines
If you are already taking medication for bipolar disorder and you develop depression, your GP will check that you are taking the correct dose and, if necessary, will adjust it.
Episodes of depression in bipolar disorder can be treated in a similar way to clinical depression. This includes using antidepressant medication. Read information about how depression is treated and antidepressants.
If your GP or psychiatrist recommends that you stop taking medication for bipolar disorder, the dose should be gradually reduced over a minimum of four weeks, and up to three months if you are taking an antipsychotic or lithium. If you have to stop taking lithium for any reason, see your GP about taking an antipsychotic or valproate (see below) instead.
Lithium carbonate
In the UK, lithium carbonate (often referred to as just lithium) is the medication that is most commonly used to treat bipolar disorder. Lithium is a long-term method of treatment for episodes of mania, hypomania and depression. It is usually prescribed for a minimum of six months.
If you are prescribed lithium, stick to the prescribed dose and do not stop taking it suddenly (unless told to by your doctor).
For lithium to be effective, the dosage must be correct. If the dose is incorrect, it may cause side effects, such as diarrhoea and vomiting. If you are taking lithium and you have side effects, tell your doctor immediately.
While taking lithium, you will need to have regular blood tests (at least once every three months) to ensure that your levels of lithium are not too high or too low. Your kidney and thyroid function will also need to be checked every two to three months if the dose of lithium is being adjusted, and every 12 months in all other cases.
While you are taking lithium, avoid using non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, unless they are prescribed by your GP. Your GP can advise you further about this.
In the UK, lithium is currently the only medication that is licensed for use in children who have bipolar disorder (who are aged 12 or over). However, in 2000, the Royal College of Paediatrics and Child Health stated that unlicensed medicines may be prescribed for children if there are no suitable alternatives, and where their use can be justified by expert agreement.
Anticonvulsant medicines
Anticonvulsant medicines include:
These medicines are sometimes used to treat episodes of mania. Like lithium, they are long-term mood stabilisers. Anticonvulsant medicines are often used to treat epilepsy, but they are also effective in treating bipolar disorder.
A single anticonvulsant medicine may be used or, where the condition does not respond to lithium on its own, they may be used in combination with lithium.
Valproate
Valproate is not usually prescribed for women of child-bearing age because there is a risk that it could damage an unborn child. However, if there is no alternative, your GP will need to ensure that you are using a reliable form of contraception.
If you are prescribed valproate, you will need to visit your GP to have a blood count when you begin the medication and then again six months later.
Carbamazepine
Carbamazepine is usually only prescribed on the advice of an expert in bipolar disorder. To begin with, the dose will be low before it’s gradually increased. If you’re taking other medication (including the contraceptive pill), your progress will be carefully monitored.
Blood tests to check your liver and kidney function will be carried out when you start taking carbamazepine and again after six months. You will also need to have a blood count (at the start and after six months) and you may also have your weight and height monitored.
Lamotrigine
If you are prescribed lamotrigine, you will usually be started on a low dose that will be increased gradually.
If you are taking lamotrigine and you develop a rash, see your GP immediately. You will need to have an annual health check, but other tests will not usually be required.
Women who are taking the contraceptive pill should talk to their GP about changing to a different method of contraception.
Antipsychotic medicines
Antipsychotic medicines are sometimes prescribed to treat episodes of mania or hypomania. Antipsychotic medicines include:
They may also be used as a long-term mood stabiliser. Quetiapine may be used for long-term bipolar depression.
Antipsychotic medicines can be particularly useful if symptoms are severe or behaviour is disturbed. As antipsychotics can cause side effects, such as blurred vision, dry mouth, constipation and weight gain, the initial dose will usually be kept low.
If you are prescribed an antipsychotic medicine, you will need to have regular health checks (at least every three months but possibly more often), particularly if you have diabetes. If your symptoms do not improve, you may be offered lithium and valproate as well.
Rapid cycling
If you have rapid cycling (you quickly change from highs to lows without a “normal” period in between), you may be prescribed a combination of lithium and valproate.
If this does not help, you may be offered lithium on its own or a combination of lithium, valproate and lamotrigine. However, you will not usually be prescribed an antidepressant unless an expert in bipolar disorder has recommended it.
Learning to recognise triggers
If you have bipolar disorder, you can learn to recognise the warning signs of an approaching episode of mania or depression.
This will not prevent the episode from occurring, but it will allow you to get help in time.
This may mean making some changes to your treatment, perhaps adding an antidepressant or antipsychotic medicine to the mood-stabilising medication you are already taking. Your GP or specialist can advise you about this.
Psychological treatment
Some people find psychological treatment helpful when used alongside medication in between episodes of mania or depression. This may include:
- psychoeducation to help you find out more about bipolar disorder
- cognitive behavioural therapy (CBT), which is most useful when treating depression
- family therapy, a type of psychotherapy that focuses on family relationships (such as marriage) and encourages everyone within the family or relationship to work together to improve mental health
Pregnancy
The management of bipolar disorder in women who are pregnant, or those who are trying to conceive, is complex and challenging. One of the main problems is that the risks of taking medication during pregnancy are not always that well understood.
The National Institute for Health and Clinical Excellence (NICE) recommends that the risks of treating or not treating women with bipolar disorder during pregnancy should be fully discussed.
NICE also recommends that specialist mental health services should work closely with maternity services. A written plan for managing the treatment of a pregnant woman with bipolar disorder should be developed as soon as possible. The plan should be drawn up with the patient, her partner, her obstetrician (pregnancy specialist), midwife, GP and health visitor.
The following medication is not routinely prescribed for pregnant women with bipolar disorder:
- valproate – there is a risk to the foetus and the subsequent development of the child
- carbamazepine – it has limited effectiveness and there is risk of harm to the foetus
- lithium – there is a risk of harm to the foetus, such as cardiac problems
- lamotrigine – there is a risk of harm to the foetus
- paroxetine – there is a risk of harm to the foetus, such as cardiovascular malformations
- long-term treatment with benzodiazepines – there are risks during the pregnancy and immediately after the birth, such as cleft palate and floppy baby syndrome
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