This guideline covers recognising, assessing and treating bipolar disorder (formerly known as manic depression) in children, young people and adults. The recommendations apply to bipolar I, bipolar II, mixed affective and rapid cycling disorders. It aims to improve access to treatment and quality of life in people with bipolar disorder.
MHRA advice on valproate: We have amended recommendations in line with the MHRA guidance on valproate use by women and girls. 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. The MHRA has published temporary advice on the valproate pregnancy prevention programme during the COVID-19 pandemic.
August 2023: The MHRA issued new safety advice on risks associated with valproate for the under 55s in December 2022. We will review our recommendations on long-term pharmacological interventions for adults in secondary care once further advice from the MHRA is available. People currently taking valproate should not stop taking it unless they are advised by a specialist to do so.
This guideline includes recommendations on:
- recognising and managing bipolar disorder in adults in primary care
- assessing suspected bipolar disorder in adults in secondary care
- managing mania, hypomania and bipolar depression in secondary care
- managing bipolar disorder in the longer term in secondary care
- promoting recovery and return to primary care
- recognising, diagnosing and managing bipolar disorder in children and young people
Who is it for?
- Healthcare professionals
- People working in occupational health, social services and the independent sector
- Children, young people and adults with bipolar disorder
- Families of and people who care for children, young people and adults with bipolar disorder
Guideline development process
This guideline updates and replaces NICE guideline CG38 (July 2006).
This guideline was previously called bipolar disorder: the assessment and management of bipolar disorder in adults, children and young people in primary and secondary care.
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.