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Treatment of Bipolar affective disorder

Treatment for bipolar disorder usually involves a combination of approaches:

  • Treatments to stabilise mood swings
  • Learning to recognise things that might ‘trigger’ an episode of depression or mania
  • Learning to recognise the signs of an approaching episode
  • Treatments for the main symptoms (depression and mania) if they do occur

Stabilising mood swings

A number of drug treatments are available that can help in stabilising mood swings.

  • Lithium carbonate: this is an older mood stabilising drug that is still widely used. It can have unpleasant side effects and regular blood tests are important as high levels of lithium in the blood can be dangerous
  • Anticonvulsant drugs (eg valproate, carbamazepine): Some anticonvulsant drugs also help to stabilise mood swings. They are sometimes used where the condition does not respond to treatment with lithium.

Sometimes anticonvulsant drugs may be combined with lithium to make them more effective.

Learning to recognise ‘triggers’

Over time it is possible to find out the kind of things that can trigger a manic or a depressive episode. Often the trigger may be stress, overworking or tiredness.

Although it is not possible to remove all stress from your life, you can take steps to keep it to a minimum. This might mean taking time for relaxation, taking regular gentle exercise, making sure you don’t work long hours too often and that you take regular holidays from work.

For your general wellbeing it is good to have a realistic balance between your life and work, to take regular exercise and eat a healthy balanced diet.

Learning to recognise signs of an approaching episode

If you have bipolar disorder, it is possible to learn to recognise the warning signs of a manic or a depressive episode. This will not stop the episode, but it will mean that you can get help in time and reduce the severity of the episode. This might mean you can get help and treatment early so that the episode is less severe. In practice this might involve making some changes to your treatment, perhaps adding an antidepressant or an antipsychotic drug to the mood stabilising drugs you are already taking.

Although it can be difficult to learn to recognise these warning signs, it can help you to manage the condition more effectively in the long-term.

Treatment for depression episodes

The depression episodes of bipolar disorder may be treated in a similar way to clinical depression. This includes the use of antidepressant drugs (see article on depression).

Common antidepressants include:

  • Selective Serotonin / Noradrenaline Reuptake Inhibitors (SSRIs / SNRIs). Eg fluoxetine, venlafaxine, reboxetine. These are newer drugs and have fewer side effects. However, SSRIs should not be prescribed to children and adolescents under the age of 18, with the exception of fluoxetine which can be prescribed if specialist advice is obtained.
  • Tricyclic drugs. Eg dothiepin, imipramine, amitryptyline. These are older drugs that may have unpleasant side effects
  • Monoamine Oxidase Inhibitors (MAOIs). Eg phenelzene, isocarboxazid. These are older drugs that can only be used with care
  • Sometimes non-drug treatments such as cognitive behaviour therapy (CBT) may also be used. CBT involves discussing your condition in detail with a trained therapist and it can help to find ways of coping with and managing your condition.


Treatment for manic episodes

The manic episodes of bipolar disorder are often treated using antipsychotic drugs (sometimes called neuroleptics). These drugs have a calming and soothing effect, but may have unpleasant side effects. Examples include risperidone, fluphenazine, sulpiride.

Making treatment decisions

You should be able to talk over your options for treatment with your GP and any specialist that you are referred to.

If you are taking any drugs or medicines, you should continue with the full course of treatment unless you agree with your doctor to make changes to the drug or dosage.  If you have any unpleasant side effects or are worried about your treatment, you should discus this with your doctor.