Bipolar 1 disorder treatment

Long-term treatment

NICE says lithium is usually the first choice for long-term treatment to prevent episodes. If lithium does not suit you, other options include some antipsychotics or other mood stabilisers.

Lithium

• you will need regular blood tests, usually every 3 months in the first year and then less often
• drink plenty of fluids, especially in hot weather or if you are ill
• avoid anti-inflammatory painkillers like ibuprofen unless your doctor agrees

Valproate

Valproate (such as Depakote) can harm an unborn baby and may affect male fertility. It is not usually started in anyone under 55 unless two specialists agree there is no suitable alternative, and it must not be used in pregnancy.

Treating mania

Mania is usually treated with an antipsychotic medicine, such as olanzapine, quetiapine, risperidone or haloperidol. If you take an antidepressant, it is usually stopped. Some people need a short stay in hospital.

Treating depression

Bipolar depression is usually treated with medicines such as quetiapine, olanzapine (sometimes with fluoxetine) or lamotrigine. Antidepressants on their own can trigger mania, so they are used with care.

Psychological treatment

• psychoeducation, to understand bipolar and spot early warning signs
• CBT, interpersonal therapy or family therapy for bipolar depression and staying well

Your care plan

You should have a care plan and a crisis plan, including your early warning signs and who to contact. You should also have yearly physical health checks, as some medicines affect weight, blood sugar and cholesterol.

Next, read about living well with bipolar.