If left untreated, episodes of depression or mania can last for 6-12 months. On average, someone with bipolar disorder will have five or six episodes over a 20-year period. However, with effective treatment, episodes usually improve within about three months.

The majority of people with bipolar disorder can be treated using a combination of approaches. These include:

• medicines to prevent episodes of mania, hypomania and depression; these are known as mood stabilisers and are taken every day, long-term,
• medicines to treat the main symptoms of depression and mania when they occur,
• learning to recognise things that trigger an episode of depression or mania, and
• learning to recognise the signs of an approaching episode.

Treatment for bipolar disorder

There are a number of drug treatments available that can help to stabilise mood swings. These include:

• Lithium carbonate is the most frequently used medication in the UK to treat bipolar disorder. It is a long-term method of treatment for episodes of mania, hypomania and depression, and is normally prescribed for a minimum of six months. If you are taking lithium, you need to ensure that you stick to the prescribed dose, and do not stop taking it suddenly. In order to be effective, it is vital that the dosage is correct. If the dose is incorrect, it can cause side effects, such as diarrhoea and vomiting. If you have side effects, you should inform your GP immediately. You will also need regular blood tests (at least every six months) to ensure that your levels of lithium are not too high or too low. Also, you should not usually take non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, unless they are prescribed by your GP.
• Anticonvulsant medicines include valproate, carbamazepine, and lamotrigine. These are sometimes used to treat episodes of mania. Like lithium, they are long-term mood stabilisers. Anticonvulsant medicines are often used to treat epilepsy, but have also been found to be effective in treating bipolar disorder. A single medicine may be used alone, but they are sometimes used in combination with lithium in cases where the condition does not respond to lithium on its own.

Women who are of child-bearing age are not usually given valproate because there may be risks to an unborn child. However, if there is no alternative, your GP should ensure that you are using a very reliable form of contraception. If you are prescribed valproate, you will also need to visit your GP to have a blood count when you begin the medication and again six months later.

If you are prescribed lamotrigine, you will usually be started on a low dose which will be increased gradually. If you are taking this medication, and develop a rash, you should seek medical help immediately. If you are taking the contraceptive pill, you should talk to your GP about changing to a different form of contraceptive. You will also need to have a yearly health check, but will not require any other tests.

Carbamazepine is usually only prescribed on the advice of an expert in bipolar disorder. The dose will be low to begin with, before being gradually increased. If you are taking other medication (including the contraceptive pill), you will need to be carefully monitored. You should have blood tests to check your liver and kidneys, when you start taking the medication, and then again after six months. You will also need to have a blood count (at the start and after six months), and may have your weight and height monitored.

• Antipsychotic medicines are sedatives used to treat an episode of mania or hypomania. They include olanzapine, quetiapine, and risperidone. Olanzapine may also be used long-term as a mood stabiliser and quetiapine for long-term bipolar depression. Antipsychotic medicines can be particularly helpful if your symptoms are severe, or your behaviour is disturbed. The initial dose is usually low, as they can cause side effects, such as weight gain. You will need to have regular health checks (at least every three months, possibly more often), particularly if you have diabetes. If your symptoms do not improve, you may be offered lithium and valproate as well.

If, for any reason, your GP or specialist advises you to stop taking medication for bipolar disorder, the dose should be gradually reduced over a minimum of four weeks, and up to three months, if you are taking an antipsychotic or lithium. If, for any reason, you have to stop taking lithium, you should see your GP about taking an antipsychotic or valproate instead.

If you have rapid cycling (quickly changing from highs to lows without a normal period in between), you may be prescribed a combination of lithium and valproate. If this does not help, you may be offered lithium on its own, or lithium, valproate, and lamotrigine. However, you will not usually be prescribed an antidepressant unless an expert in bipolar disorder has specifically recommended it.

Treating depression

If you are already taking medication for bipolar disorder, and you develop depression, your GP should check that you are taking the right dose and change it if necessary. Episodes of depression in bipolar disorder can be treated in a similar way to clinical depression. This includes the use of antidepressant medications.

Antidepressants are effective in about 70% of cases. However, it can take time (2-4 weeks) for them to take effect, so if you are prescribed a course of antidepressants, you need to be patient and persevere with them. There are several different types of antidepressants, and some have possible side effects. Some common antidepressants include:

• Tricyclic drugs for example, dothiepin, imipramine, and amitryptyline,
• Selective Serotonin Reuptake Inhibitors and Noradrenaline Reuptake Inhibitors (SSRIs and SNRIs) for example, fluoxetine, venlafaxine, and reboxetine, and
• Monoamine Oxidase Inhibitors (MAOIs) - such as phenelzene and isocarboxazid.

Learning to recognise triggers

If you have bipolar disorder, it is possible to learn to recognise the warning signs of an approaching episode of mania or depression. This will not prevent the episode occurring, but will enable you to get help in time. This might mean making some changes to your treatment, perhaps adding an antidepressant or an antipsychotic medicine to the mood stabilising medication that you are already taking. Your GP or specialist will be able to advise you about this.

Compulsory treatment

You should be able to receive the majority of your treatment without having to stay in hospital. However, if your symptoms are very severe, or you are being treated under the Mental Health Act because there is a danger that you will harm either yourself or others, you can be admitted to hospital. As an alternative, it may be possible for you to receive treatment in a day hospital and return home at night.

Other methods of treatment

You may also be offered psychological treatment that will help you to deal with your depression, your symptoms, and provide advice about how you can improve your relationships. Advice may include taking regular exercise and planning activities that you enjoy, and that give you a sense of achievement. You may also receive advice about your diet and how to ensure that you sleep well.

Future treatments

The development of new, better mood stabilising medicines is ongoing. There are also a number of other treatments currently being researched, such as transcranial magnetic stimulation and vagal nerve stimulation.