Medicines
Antipsychotics listed in the NICE bipolar disorder guidelines are:8
- haloperidol
- olanzapine
- quetiapine
Aripiprazole is included for up to 12 weeks’ use for treating moderate to severe manic episodes in bipolar I disorder in young people aged 13 and older.
If the first antipsychotic is poorly tolerated at any dose (including rapid weight gain) or is ineffective at the maximum licensed dose, then an alternative antipsychotic from this list can be tried. If this is not sufficiently effective at the maximum licensed dose, then lithium may be added, or sodium valproate if lithium is not suitable.
Sodium valproate for treating mania is off-label for some brands and contraindicated in women and girls of child-bearing potential. Other anti-epileptics that may help some people with bipolar are carbamazepine and lamotrigine.3,8
Recommended drug options for depression are:7
- quetiapine
- olanzapine on its own or with fluoxetine
Quetiapine may be preferred for patients who remain depressed between manic episodes. Lamotrigine may be a recommendation in bipolar II disorder (with hypomania) or bipolar depression but not mania.3