Medication for manic bipolar disorder episodes

Some evidence – there is enough evidence to indicate that this can be a helpful treatment option.

There are only a small number of studies of treatment of mania in young people, however there is a strong evidence base for the treatment in adults, and there are reasons to believe that bipolar mania in young people is similar to that in adults.

Antipsychotic medication

The first medication your professional is likely to suggest is called aripiprazole, which is a type of medication called a second-generation antipsychotic. You can find more information on aripiprazole here. 

If you cannot have aripiprazole for some reason, or it hasn’t been helpful, your professional might prescribe medications such as olanzapine, risperidone or quetiapine. These are also types of antipsychotic medication which are safe and effective, but are not used as often for young people. You can find more information about medications here. 

Medication is usually started at a low dose and gradually increased depending on how you respond to it (whether you are improving, and whether you are experiencing any side-effects). If the first antipsychotic medication you try has not helped enough, your doctor may offer you a different one. With treatment, episodes of mania should improve in about 3 months.   

Mood stabilising medication

You might be offered a mood stabiliser such as lithium. Sodium valproate is another mood stabiliser which can be offered, but it tends not to be prescribed if there’s a chance you might become pregnant, as it can harm an unborn baby, and can also cause polycystic ovary disease.

Sedative medication

If you have high risk manic symptoms you may need to be admitted to hospital, and in the short-term you may require additional sedative medication (e.g. lorazepam).

Stopping medication and preventing future episodes

NICE recommend that if you’ve been taking antipsychotics to treat mania, in most cases it should be stopped after about 12 weeks. Your doctor is likely to recommend stopping the medication gradually, by first reducing the dose.

Within 4 weeks of recovery from an episode of mania your doctor should discuss with you how to prevent future episodes. This might include using a longer term-medication (such as lithium or sodium valproate), as well as a psychological intervention and social supports. You might also be offered antipsychotic medication for longer than 12 weeks for the prevention of future episodes.

Treatments outlined on these webpages may not be available in every local area. It’s important that you discuss with your GP or mental health professional the treatment options available to you. You can also search for services near you on our Youth Wellbeing Directory and find out more about referral processes here.

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