Bipolar disorder in adults

Patients with bipolar disorder attempting to recover from an acute episode should avoid situations or stressors known to trigger strong, negative emotions, based on their experience. Unhealthy relationships, poor living conditions, or stressful jobs may easily overwhelm their fragile state of recovery. Similarly, they should avoid alcohol and all illicit drugs. Reaching out to supportive friends and family members helps avoid isolation and creates an extended early relapse detection system. Remembering to take medications as prescribed is critical; some patients need reminders or pill-boxes to organise and structure their efforts at adherence. Patients should maintain a healthy sleep routine and schedule, eat properly, and exercise moderately. National Institute of Mental Health: bipolar disorder Opens in new window Advice and support with smoking cessation may be required; approximately 45% of people with bipolar disorder smoke tobacco.[299]Jackson JG, Diaz FJ, Lopez L, et al. A combined analysis of worldwide studies demonstrates an association between bipolar disorder and tobacco smoking behaviors in adults. Bipolar Disord. 2015 Sep;17(6):575-97. http://www.ncbi.nlm.nih.gov/pubmed/26238269?tool=bestpractice.com

Joining and participating in community organisations and patient advocacy groups, such as the National Alliance for Mental Illness or the Depression Bipolar Support Alliance, can foster recovery for the patient and their family. Depression and Bipolar Support Alliance Opens in new window

Patients taking lithium require education on the signs of lithium toxicity, with advice to consult a health professional immediately if suggestive symptoms (e.g., acute nausea, vomiting, diarrhoea, polyuria, polydipsia, confusion, or somnolence) occur.

Ideally, women of childbearing age with bipolar disorder should be referred for specialist pre-conception advice.[300]Public Health England​. Preconception advice for women with serious mental illness. Mar 2021 [internet publication]. https://www.gov.uk/government/publications/preconception-advice-for-women-with-serious-mental-illness ​ Do not start valproate treatment for female patients of childbearing potential, unless alternative treatments are not suitable; females of childbearing potential must follow a pregnancy prevention programme while on treatment with valproate medications. For European Union countries, the European Medicines Agency states that this programme should include:[199]European Medicines Agency. New measures to avoid valproate exposure in pregnancy endorsed. Mar 2018 [internet publication]. https://www.ema.europa.eu/en/documents/referral/valproate-article-31-referral-new-measures-avoid-valproate-exposure-pregnancy-endorsed_en.pdf European Medicines Agency: valproate medicines pregnancy prevention programme materials Opens in new window

• An assessment of a patient’s potential for becoming pregnant

• Pregnancy tests before starting and during treatment as needed

• Counselling about the risks of valproate treatment and the need for effective contraception throughout treatment

• A review of ongoing treatment by a specialist at least annually

• A risk acknowledgement form that patients and prescribers will go through at each annual review to confirm that appropriate advice has been given and understood

Precautionary measures may also be required in male patients owing to a potential risk that use of valproate in the three months leading up to conception may increase the likelihood of neurodevelopmental disorders in their children. Regulations and precautionary measures for female and male patients may vary between countries and you should consult your local guidance for more information.