Treatment for bipolar disorder aims to reduce the severity and number of episodes of depression and mania.
If you do not get treatment, episodes can last between 3 to 6 months. Episodes of depression tend to last longer, between 6 to 12 months.
With effective treatment, episodes usually improve within about 3 months.
Treatment can include:
- psychological treatment such as talking therapies
- lifestyle advice – to help you improve your diet and get more sleep
Your GP and psychiatrist will talk to you about the different options. Most people with bipolar disorder can receive most of their treatment without having to stay in hospital.
Hospital treatment may be needed if your symptoms are severe or you're being treated under the Mental Health Act. This is because 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.
Medicine for bipolar disorder
Several medicines are available to help stabilise mood swings.
These are called mood stabilisers and include:
- anticonvulsant medicines
- antipsychotic medicines
If you're already taking medicine for bipolar disorder and you develop depression, your GP or specialist will check the dose. If you are not taking the right dose, they may change it.
Episodes of depression are treated slightly differently in bipolar disorder. This is because the use of antidepressants alone may lead to a hypomanic relapse. If you are given antidepressants, these are often used alongside a mood stabiliser.
Lithium is the medicine most commonly used to treat bipolar disorder.
It is a long-term method of treatment for episodes of mania, hypomania (less severe mania) and depression. It's usually prescribed for at least 6 months.
You will need regular blood tests to monitor your kidney and thyroid while taking lithium. Your GP can help you.
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. They may also be used with lithium when the condition does not respond to lithium on its own.
Valproate is not usually prescribed for women of childbearing age.
This is because there's a risk of physical defects to babies, such as:
- spina bifida
- heart abnormalities
- cleft lip
There may also be an increased risk of developmental problems, such as:
- lower intellectual abilities
- poor speaking and understanding
- memory problems
- autistic spectrum disorders
- delayed walking and talking
Your specialist may use valproate if there's no alternative or if it's unlikely you'll respond to other treatments. They'll tell you about the risks and check you're using reliable contraception.
You'll need to visit your GP to have a blood count when you begin the medicine, and then again 6 months later.
Carbamazepine is usually only given by an expert in bipolar disorder. The dose will be low to begin with and then gradually increased.
Your progress will be carefully monitored if you're taking other medicine such as the contraceptive pill.
Your liver and kidney function will be checked when you start and after 6 months.
You'll also need to have a blood count at the start and after 6 months. You may also have your weight and height monitored.
You'll usually start on a low dose and gradually increase.
See your GP immediately 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.
If you're on the pill, talk to your GP about different methods of contraception.
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 also be used for long-term bipolar depression.
Antipsychotic medicines can be useful if symptoms are severe or behaviour is disturbed. The initial dose may be low, as they can cause side effects such as blurred vision, dry mouth, constipation and weight gain.
You'll need to have health checks at least every 3 months. These might be more often, particularly if you have diabetes. If your symptoms do not improve, you may be offered lithium and valproate as well.
It is also recommended for moderate to severe manic episodes in adolescents with bipolar disorder.
You may need both lithium and valproate if you experience rapid cycling. This is where you quickly change from highs to lows without a 'normal' period in between.
If this does not help, you may be offered lithium on its own. Or a combination of lithium, valproate and lamotrigine.
Pregnancy and bipolar disorder
The risks of taking bipolar medicines during pregnancy are not fully known.
If you're pregnant and you have bipolar disorder, a written plan for your treatment should be developed as soon as possible.
The plan should be drawn up with you, your partner, your obstetrician (pregnancy specialist), midwife, GP and health visitor.
Some medicines are not routinely prescribed for pregnant women with bipolar disorder, as they may harm the baby. These include:
- benzodiazepines (tranquillisers), such as diazepam (Valium) and lorazepam (Ativan)
If you become pregnant while taking medicine for bipolar disorder, do not stop taking it until you have discussed it with your doctor.
If bipolar medicine is prescribed for bipolar disorder after your baby is born, it may also affect your decision to breastfeed.
Your pharmacist, midwife or mental health team can give you advice based on your circumstances.
Stopping taking medicine
Your GP or psychiatrist may recommend you stop taking medicine for bipolar disorder. If so, the dose will be reduced over at least 4 weeks. It can be up to 3 months if you are taking an antipsychotic or lithium.
You may wish to gradually stop taking medicine. It is always best to do this with professional advice and support.
An advanced directive is very useful in this circumstance. This is when you make a written statement about the type of treatment you would prefer in case you can no longer communicate your decisions.
If you have to stop taking lithium for any reason, talk to your GP or specialist about taking an antipsychotic or valproate.
Some people find psychological treatment helpful.
This may include:
- psychoeducation – to find out more about bipolar disorder
- cognitive behavioural therapy (CBT)
- family therapy
- supportive psychotherapy (counselling)
- trauma informed psychotherapy
Talking with a trained therapist is an important part of treatment for bipolar disorder.
A therapist can help you deal with depression. They can also give you advice on how to improve relationships and address any unresolved trauma or emotional distress.
Psychological treatment usually consists of around 16 sessions. Each session lasts an hour and takes place over a period of 6 to 9 months.
Lifestyle advice can include information about:
- regular exercise
- planning activities you enjoy that give you a sense of achievement
- improving your diet
- getting more sleep
You can get lifestyle advice from your psychologist or community mental health team.
Learning to recognise triggers
You can learn to recognise the warning signs of an episode of mania or depression.
Someone close to you may be able to help you identify your early signs of relapse from your history. For example, a mental health professional, peer support worker, family member or friend.
Wellness Recovery Action Plans (WRAP) are very useful. Your local community mental health team can advise you on how to develop this plan.
This will not prevent the episode from happening, but it will allow you to get help in time.
This may mean making some changes to your treatment. Your GP or specialist can talk to you about this.
Content supplied by the NHS and adapted for Ireland by the HSE