Management
A suspected bipolar disorder diagnosis needs to be confirmed by a specialist mental health assessment. The specialist team should then treat the acute episode and establish a care plan before ongoing care can be provided in primary care.7
Management options include psychological interventions (cognitive behavioural therapy, interpersonal therapy or behavioural couples therapy) for severe depression.8
Medication will ordinarily be initiated in secondary care, with the aim of treating the acute episode and then establishing the long-term management plan. Antipsychotics will be used to treat mania episodes, antidepressants for depressive episodes, and a mood stabiliser for long-term management.7
Any antidepressant being taken as monotherapy should be stopped if the patient develops hypomania or mania, and an antipsychotic offered instead.8
GPs are advised not to start lithium to treat bipolar disorder in primary care for people who have not taken lithium before, except under shared‑care arrangements. Valproate should not be initiated in primary care.
Electro-convulsive therapy is only recommended for severe mania that has not responded to other interventions and/or when the condition is potentially life-threatening. Even then, it is used only to achieve rapid and short-term improvement.