Introduction

This page is for anyone who wants to know more about bipolar disorder (sometimes called bipolar affective disorder or manic depression). It is especially helpful for anyone who has bipolar disorder, their friends and relatives.

This page describes:

• some of the treatments available.

Treatments

There are some things you can try to control mood swings so that they stop short of becoming full-blown episodes of mania or depression. These are mentioned below, but medication is still often needed to:

• keep your mood stable (prophylaxis);
• treat a manic or depressive episode.

Medications to stablise mood

There are several mood stabilisers, most of which are also used to treat epilepsy. However, Lithium (a naturally occurring salt) was the first effective mood stabiliser.

Lithium

Lithium has been used as a mood stabiliser for 50 years – but how it works is still not clear. It can be used to treat both manic and depressive episodes.

Treatment with Lithium should be started by a psychiatrist. The difficulty is getting the level of Lithium in the body right – too low and it won’t work, too high and it becomes toxic. So, you will need regular blood tests in the first few weeks to make sure that you are getting the right dose. Once the dose is stable, your GP can prescribe your Lithium and arrange the regular blood tests.

The amount of Lithium in your blood is very sensitive to how much, or how little, water there is in your body. If you become dehydrated, the level of Lithium in your blood will rise, and you will be more likely to get side-effects, or even toxic effects. So, it’s important to:

• drink plenty of water – more in hot weather or when you are active;
• be careful with tea and coffee – they increase the amount of water you pass in your urine.

It can take three months or longer for Lithium to work properly. It’s best to carry on taking the tablets, even if your mood swings continue during this time.

Side-effects

These can start in the first few weeks after starting Lithium treatment. They can be irritating and unpleasant, but often disappear or get better with time.

Blood tests

At first you will need blood tests every few weeks to make sure that you have the right level of Lithium in your blood. You will need these tests for as long as you take Lithium, but less often after the first few months.

Long-term use of Lithium can affect the kidneys or the thyroid gland. It is wise to have blood tests every few months to make sure that they are working properly. If there is a problem, you may need to stop Lithium and consider an alternative.

Taking care of yourself

• Eat a well-balanced diet.
• Drink unsweetened fluids regularly. This helps to keep your body salts and fluids in balance.
• Eat regularly – this will also help to maintain your fluid balance.
• Watch out for caffeine – in tea, coffee or cola. This makes you urinate more, and so can upset your Lithium level.

Other mood stabilisers

Although Lithium is probably still the most effective mood stabiliser, there are other medications that you can discuss with your psychiatrist.

• It is possible that Sodium Valproate, an anti-convulsant, works just as well, but we don’t yet have enough evidence to be sure. It should not be prescribed to women of child bearing age.
• Carbamazepine is slightly less effective. It is not usually suggested for bipolar disorder but, if it works for you, you don’t need to change it.

‘Atypical’ antipsychotic medications (such as Olanzapine) can also act as mood stabilisers.

What is the best treatment for me?

You need to discuss this with your psychiatrist, but some general principles are:

• Lithium, Sodium Valproate and Olanzapine will usually be recommended for long-term treatment.
• Carbamazepine may be suggested if you have faster and more frequent mood swings.
• A combination of drugs is sometimes needed.

Much depends on how well you get on with a particular medication. What suits one person may not suit another, but it makes sense to first try the medications for which there is better evidence.

What will happen without medication?

Lithium reduces relapse by 30–40%, but the more manic episodes you’ve had, the more likely you are to have another one.

As you get older, the risk of getting further episodes stays the same. Even if you have been well for a long time, you still risk having another episode.

When to start a mood stabiliser

After just one episode, it’s difficult to predict how likely you are to have another. You may not want to start medication at this stage – unless your episode was very severe and disruptive.

If you have a second episode, there is an 80% chance of further episodes – so most psychiatrists would usually recommend a mood stabiliser at this point.

For how long should a mood stabiliser be continued?

For at least two years after one episode of bipolar disorder, and for up to five years if there have been:

• frequent previous relapses
• psychotic episodes
• alcohol or substance misuse
• continuing stress at home or at work

If you continue to have troublesome mood swings, you may need to continue medication for longer.

More information about other mood stabilisers can be found in our page Medications for Mania.

Psychological Treatments

In between episodes of mania or depression, psychological treatment can be helpful. This should be around 16 one-hour sessions over a period of 6 to 9 months.

Psychological treatment should include:

• psychoeducation – finding out more about bipolar disorder;
• mood monitoring – helps you to pick up when your mood is swinging;
• mood strategies – to help you stop your mood swinging into a full-blown manic or depressive episode;
• help to develop general coping skills;
• cognitive behavioural therapy (CBT) for depression.