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Bipolar Disorder: The Management of Bipolar Disorder in Adults, Children and Adolescents, in Primary and Secondary Care

Bipolar Disorder: The Management of Bipolar Disorder in Adults, Children and Adolescents, in Primary and Secondary Care

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK)

Version: 2006


This chapter is based around the first-hand experience of people with bipolar disorder, family members and carers. It aims to relate Chapter 4 and the chapters on treatment and process and provision of care to a service user and carer context. The experiences are presented in three ways: by testimonies (both full and excerpted), by excerpts from interviews and from a survey conducted by MDF The BiPolar Organisation, formerly the Manic Depression Fellowship (MDF) (2004). The views represented here are illustrative only and are not intended to be representative of the experience of all people with bipolar disorder and their carers.


Long-term treatment aims to prevent the occurrence of future episodes of bipolar disorder and is important due to the recurrent nature of bipolar disorder. Aspects of long-term treatment include helping patients recognise signs of early relapse, avoiding triggers for episodes and employing pharmacotherapy. The long-term nature of treatment in bipolar disorder makes establishing a positive therapeutic alliance between patient and staff crucial. Patients require long-term medication to prevent a recurrence of both depression and mania. The relative importance of these two aims will be determined by the past history, that is, how many previous depressive and manic episodes have occurred and their severity. Lamotrigine is thought to have a specific effect in reducing the risk of recurrence of bipolar depression. Drugs that are thought predominantly to reduce the occurrence of mania include valproate, lithium and olanzapine, though each of these may also have significant effects in reducing the likelihood of depressive relapse. On average, people with bipolar disorder spend more time suffering from depressive symptoms than from manic symptoms. This is particularly the case in bipolar II disorder in which, in one study (Judd et al., 2003), the ratio of time depressed to hypomanic was 37 to 1 compared with 3 to 1 in bipolar I disorder (Judd et al., 2002). It could therefore be argued that the amelioration of depression is a key aim for most bipolar patients. Tolerability will often be a bigger concern for patients during long-term treatment than during acute treatment.

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