Medication to prevent further bipolar disorder episodes
Some evidence – there is enough evidence to indicate that this can be a helpful treatment option.
It can be difficult to predict the risk of future episodes in young people, as you are in an early stage of the illness, and so balancing the benefits and risks of treatment to prevent future episodes is harder. Your doctor should discuss this with you and your parents or carers, and whether they would recommend using a longer-term medication.
There is less evidence on medication as a longer-term treatment for bipolar disorder in young people, and NICE do not make specific recommendations. The British National Formulary for Children (BNF-C) produces guidance for health professionals about medication for children and young people. They involve experts from organisations including the British Medical Association, the Royal College of Paediatrics and Child Health, and the Department of Health for England who work together on up-to-date recommendations. Unlike NICE, the BNF-C do make some recommendations about which medications should be considered. If your doctor does recommend a longer-term medication, the choices are similar to those for adults.
Mood stabilising medication to prevent further episodes
There is strong evidence for the effectiveness of lithium as a longer-term treatment in adults with bipolar disorder to prevent further episodes. Lithium can be used as a long-term treatment for episodes of mania and depression.
Atypical antipsychotic medication
If lithium or sodium valproate cannot be used, NICE recommend olanzapine as a longer-term treatment for bipolar disorder in adults. Quetiapine is also recommended as a longer-term treatment if you have found it to be effective during an episode of mania or bipolar depression.
There is also good evidence for sodium valproate as a longer-term treatment for bipolar disorder in adults. It is thought to be less effective than lithium, and usually your doctor would only prescribe it if you cannot take lithium. Sodium valproate tends not to be prescribed if there’s a chance you might become pregnant, because it can harm an unborn baby. If you are prescribed sodium valproate and there is a chance you could become pregnant, you should be given advice about contraception. Sodium valproate can also cause polycystic overy disease if used longer term.
Carbamazepine can be used as a longer-term treatment in bipolar disorder to prevent future episodes. It is commonly used to treat epilepsy in children and young people, and there is good evidence that it is safe in young people. There is less evidence however on its effectiveness in bipolar disorder.
Lamotrigine is used as a longer-term treatment in adults who have repeated episodes of bipolar depression, and there is evidence it is helpful. Lamotrigine is commonly used as a treatment for epilepsy in children and young people, and from that there is good evidence that it is relatively safe for young people. However, lamotrigine can cause a skin rash which can be serious. Lamotrigine is recommended if it has been effective for you in the treatment of an acute episode of depression, and if you have a pattern of repeated episodes of depression.
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.