Bipolar disorder is characterised by extreme mood swings. These can range from extreme highs (mania) to extreme lows (depression).
Episodes of mania and depression often last for several days or longer.
During a period of depression, your symptoms may include:
The manic phase of bipolar disorder may include:
If a person is not treated, episodes of bipolar-related mania can last for between 3 and 6 months.
Episodes of depression tend to last longer, often 6 to 12 months.
But with effective treatment, episodes usually improve.
Most people with bipolar disorder can be treated using a combination of different treatments.
These can include 1 or more of the following:
medicine to prevent episodes of mania and depression – these are known as mood stabilisers, and you take them every day on a long-term basis
medicine to treat the main symptoms of depression and mania when they happen
learning to recognise the triggers and signs of an episode of depression or mania
psychological treatment – such as talking therapies, which help you deal with depression and provide advice on how to improve relationships
Lifestyle advice – such as doing regular exercise, planning activities you enjoy that give you a sense of achievement, and advice on improving your diet and getting more sleep
Most people with bipolar disorder can receive most of their treatment without having to stay in hospital.
But hospital treatment may be needed if your symptoms are severe or you’re being treated under the Mental Health Act, as there’s a danger you may self-harm or hurt others.
In some circumstances, you could have treatment in a day hospital and return home at night.
Several medicines are available to help stabilise mood swings.
These are commonly called mood stabilisers and include:
If you’re already taking medicine for bipolar disorder and you develop depression, your GP will check you’re taking the correct dose. If you’re not, they’ll change it.
Episodes of depression are treated slightly differently in bipolar disorder, as taking antidepressants alone may lead to a relapse.
Most guidelines suggest depression in bipolar disorder can be treated with just a mood stabiliser.
But antidepressants are commonly used alongside a mood stabiliser or antipsychotic.
If your GP or psychiatrist recommends you stop taking bipolar disorder medicine, the dose should be gradually reduced over at least 4 weeks, and up to 3 months if you’re taking an antipsychotic or lithium.
If you have to stop taking lithium for any reason, talk to your GP about taking an antipsychotic or valproate instead.
In the UK, lithium is the main medicine used to treat bipolar disorder.
Lithium is a long-term treatment for episodes of mania and depression. It’s usually prescribed for at least 6 months.
If you’re 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 it’s incorrect, you may get side effects such as diarrhoea and getting sick.
Tell your doctor immediately if you have side effects while taking lithium.
You’ll need regular blood tests at least every 3 months while taking lithium. This is to make sure your lithium levels are not too high or too low.
Your kidney and thyroid function will also need to be checked, usually every 6 months.
In the UK, lithium and the antipsychotic medicine aripiprazole are currently medicines that are officially approved for use in teenagers with bipolar disorder.
But the Royal College of Paediatrics and Child Health says that other bipolar medicines may be prescribed for children if recommended by their doctor.
Anticonvulsant medicines include:
These medicines are sometimes used to treat episodes of mania. They’re also long-term mood stabilisers.
Anticonvulsant medicines are often used to treat epilepsy, but they’re also effective in treating bipolar disorder.
A single anticonvulsant medicine may be used, or they may be used in combination with lithium when bipolar disorder does not respond to lithium on its own.
Valproate is not usually prescribed for women of childbearing age because there’s a risk of physical defects in babies, such as spina bifida, heart abnormalities and cleft lip.
There may also be an increased risk of developmental problems, such as lower intellectual abilities, poor speaking, memory problems, autistic spectrum disorders, and delayed walking and talking.
In women, your GP may decide to use valproate if there’s no alternative or you have been assessed and it’s unlikely you’ll respond to other treatments.
They’ll need to check you’re using a reliable contraception and will advise you on the risks of taking the medicine during pregnancy.
Carbamazepine is usually only prescribed on the advice of an expert in bipolar disorder. To begin with, the dose will be low and then gradually increased.
Your progress will be carefully monitored if you’re taking other medication, including the contraceptive pill.
Blood tests to check your liver and kidney function will be carried out regularly.
You’ll also need to have regular blood count tests, and you may also have your weight and height monitored.
If you’re prescribed lamotrigine, you’ll usually be started on a low dose, which will be increased gradually.
See your GP straight away if you’re taking lamotrigine and develop a rash. You’ll need to have an annual health check, but other tests are not usually needed.
Women who are taking the contraceptive pill should talk to their GP about switching to a different method of contraception.
Antipsychotic medicines are sometimes prescribed to treat episodes of mania.
They may also be used as a long-term mood stabiliser. Quetiapine may also be used for long-term bipolar depression.
As antipsychotics can cause side effects, such as blurred vision, a dry mouth, constipation and weight gain, the initial dose will usually be low.
If you’re prescribed an antipsychotic medicine, you’ll need to have regular health checks at least every 3 months, but possibly more often, particularly if you have diabetes.
If your symptoms do not improve, you may be offered lithium or valproate as well.
You will be prescribed a mood stabiliser or combination of mood stabilisers if you experience rapid cycling, where you quickly change from highs to lows without a “normal” period in between.
But you will not usually be prescribed an antidepressant unless an expert in bipolar disorder has recommended it.