December 2023: We amended recommendations on valproate in line with MHRA safety advice that valproate must not be started for the first time in people (male or female) younger than 55 years, unless 2 specialists independently consider and document that there is no other effective or tolerated treatment, or there are compelling reasons that the reproductive risks do not apply.
February 2020: We amended recommendations on valproate in line with the MHRA guidance on valproate use by women and girls. The MHRA states that valproate must not be used in women and girls of childbearing potential (including young girls who are likely to need treatment into their childbearing years), unless other options are unsuitable and the pregnancy prevention programme is in place. We did this by:
moving cautions and links to the MHRA's latest advice on valproate into the recommendations
adding information about valproate use to recommendations rather than relying on cross-references to other recommendations in the guideline.
February 2016: The MHRA has produced a toolkit to ensure female patients are better informed about the risks of taking valproate during pregnancy. Healthcare professionals are advised to use the NICE guideline in conjunction with the latest MHRA advice and resources. Information has been added to the guideline to link to the MHRA's latest advice and resources.
April 2015: Recommendations 1.5.5, 1.5.8 and 1.7.6 have had links to section 1.10 added. Recommendations in section 1.10 related to valproate have been reordered, and a new recommendation on withdrawal of valproate in women of childbearing potential added. These changes are in line with the revised MHRA warning on valproate.
January 2015: The MHRA has strengthened its warnings on the use of valproate in women of childbearing potential.
Minor changes since publication
August 2023: We updated information about the December 2022 MHRA safety advice on valproate to clarify that the relevant recommendations in this guideline will be reviewed once further advice from the MHRA is available.
December 2022: We added links to new MHRA safety advice on risks associated with valproate for the under 55s.
June 2022: We updated the advice on choice of psychological intervention for bipolar depression, to link to the information in the new NICE guideline on depression in adults: treatment and management.
December 2021: Following a surveillance review we have updated recommendation 1.2.12 to say that either glycosylated haemoglobin (HbA1c) or fasting blood glucose may be used to test for diabetes, and 1.10.8 to clarify that the test is of fasting blood glucose.
March 2020: Cross reference to NICE's guideline on supporting adult carers added to recommendation 1.1.13.
November 2017: Information for some recommendations was updated with current UK marketing authorisations and MHRA advice. Links to other guidelines have also been updated. Some recommendations for research have been stood down.