From the Guidelines
The management of bipolar affective disorder in the UK should prioritize a stepped-care approach combining pharmacological and psychological interventions, with first-line treatment involving mood stabilizers such as lithium or valproate, and psychological interventions like family-focused therapy, as supported by the most recent evidence 1. The management of bipolar affective disorder in the UK is a complex process that requires a comprehensive approach.
Key Components of Management
- Pharmacological interventions:
- Mood stabilizers such as lithium (starting at 400mg daily, titrated to achieve serum levels of 0.6-0.8 mmol/L for maintenance) or valproate (starting at 500mg daily, increased gradually to 1000-2000mg daily) are recommended as first-line treatment 1.
- Second-generation antipsychotics like quetiapine (300-600mg daily) or olanzapine (5-20mg daily) may be used for acute mania.
- Antidepressants (with caution due to switch risk) or lamotrigine (titrated slowly from 25mg to 200mg daily) may be added for depressive episodes.
- Psychological interventions:
- Family-focused therapy (FFT-A) has been shown to be effective in reducing mood severity, particularly depressive symptoms, and improving family relationships 1.
- Cognitive behavioral therapy and psychoeducation can also improve illness understanding and treatment adherence.
Monitoring and Maintenance
- Regular monitoring is essential, including:
- Mood charting
- Medication blood levels for lithium and valproate
- Screening for physical health complications
- Treatment is typically long-term, with maintenance therapy continuing for at least two years after an episode, often longer for recurrent illness 1.
Recent Evidence
- A recent study published in 2022 1 highlights the effectiveness of family-focused therapy in adolescents with bipolar disorder, demonstrating reduced manic symptom severity and improved family relationships.
- This study supports the use of psychological interventions, such as family-focused therapy, as a key component of the stepped-care approach to managing bipolar affective disorder in the UK.
From the Research
Management of Bipolar Affective Disorder (BPAD) in the United Kingdom (UK)
The management of BPAD in the UK involves a combination of pharmacological and psychosocial interventions.
- Treatment of bipolar disorder involves three therapeutic domains: acute mania, acute depression, and maintenance 2.
- Lithium has been a mainstay of treatment for some time, but antiepileptic drugs like divalproex, carbamazepine, and lamotrigine, along with novel antipsychotic drugs like olanzapine, risperidone, and quetiapine, alone or in combination, are increasingly being used successfully to treat acute mania and to maintain mood stability 2.
- Clinical practice guidelines (CPGs) consider lithium most robustly as a first-line intervention for maintenance treatment of bipolar disorder and strongly for the treatment of mania, with relatively modest support for the management of acute bipolar depression 3.
- The ideal lithium plasma concentration for maintenance and monitoring is 0.6-0.8mmol/L, along with the need for regular monitoring of renal and endocrine function 3.
- Antipsychotic and normothymic agents and/or anticonvulsants do not appear to have the same effects on each of the identifiable clusters of symptoms, mainly psychotic features 4.
- Carbamazepine and oxcarbazepine are also used in the treatment of bipolar disorder, with data from controlled clinical studies supporting the efficacy of carbamazepine in treating acute mania and as maintenance therapy 5.
- Other treatment options include Electroconvulsive therapy and transcranial magnetic stimulation, with psychoeducation and cognitive-behavioral therapy being the first-line psychosocial interventions 6.
Pharmacological Interventions
- Lithium is an effective mood stabilizer that is used principally for the management of bipolar disorder (BD) 3.
- Antiepileptic drugs like divalproex, carbamazepine, and lamotrigine are also used in the treatment of bipolar disorder 2, 5.
- Novel antipsychotic drugs like olanzapine, risperidone, and quetiapine are used to treat acute mania and to maintain mood stability 2.
- Antidepressant use is controversial, with guidelines suggesting their cautious use in combination with an antimanic agent 6.