Treatment for mania or hypomania

Treatment for mania or hypomania

NICE recommends the treatments described in this section for adults aged 18 and over. Young people aged 13 and over may be offered a medication called aripiprazole (see other NICE guidance for details of our guidance on aripiprazole), or they may be offered one of the treatments for adults. Young people should not usually take antipsychotic medication for more than 3 months.

For more details about medication for young people and adults, see taking medication

Your care team should advise you not to make important decisions until you have recovered from mania or hypomania, and encourage you to stay in touch with your carer for support during an episode of mania.

Medication

If you have mania or hypomania you should be offered one of these antipsychotics:

  • haloperidol

  • olanzapine

  • quetiapine

  • risperidone.

If you're taking an antidepressant when the mania or hypomania starts, your doctor or nurse may advise you to stop taking the antidepressant.

If the first antipsychotic doesn't work

You should be offered a different antipsychotic from the list of antipsychotics above.

If the second antipsychotic doesn't work

You may be offered a medication called lithium to take together with an antipsychotic. If lithium doesn't help, you may be offered a medication called valproate instead, which you also take together with an antipsychotic.

Valproate can harm unborn babies. You should not take valproate if there is any possibility that you are or will become pregnant.

If you are already taking lithium or valproate when a manic episode starts

Your doctor or nurse should check whether you're taking the right dose of lithium or valproate. They may offer you an antipsychotic to take as well.

You should not be offered medication called lamotrigine to treat mania or hypomania (but you may be offered lamotrigine for depression).

If you have mania with symptoms of depression

You should be offered the same treatment as for mania.

When your mania has improved

Your care team should discuss with you whether to continue your medication for another 3 to 6 months.

Electroconvulsive therapy

Very rarely, a treatment called electroconvulsive therapy may be offered. See other NICE guidance for details of our guidance on electroconvulsive therapy.

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