Long-term plan
Around four weeks after an initial acute episode has resolved, the specialist team should draw up a long-term management plan to prevent relapses. In addition to psychological therapies, options include:7
- continuing the current treatment for mania; or
- starting long-term lithium treatment; or
- adding valproate to lithium treatment if the lithium is not effective; or
- using either valproate or olanzapine alone if lithium is poorly tolerated.
A mood stabiliser should typically be taken for at least two years after an episode of bipolar disorder, but at least five years if there have been frequent previous episodes, or there were psychotic episodes.
Longer treatment may also be needed if alcohol or substance misuse is a feature, or if the patient is exposed to ongoing stress in their home or work-life.3
Ideally, the person’s physical and mental health, as well as the effects of antipsychotic drug treatment, will be monitored in secondary care for at least the first 12 months, or until the person's condition has stabilised.7