Guidance

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.

 Valproate: In September 2024, the Medicines and Healthcare products Regulatory Agency (MHRA) published a Drug Safety Update on valproate use in men and their partners. Effective contraception (condoms, plus contraception used by the female sexual partner) is recommended throughout the valproate treatment period and for 3 months after stopping valproate. See the MHRA’s advice for healthcare professionals. NICE is assessing the impact of this alert on recommendations in this guideline.

Recommendations on valproate in this guideline are in line with the MHRA guidance on valproate use by women and girls and Drug Safety Update on the risks associated with valproate in men and women under 55. For more details see update information.

Last reviewed: 30 July 2024

We simplified the guideline by removing recommendations on general principles of care that are covered in other NICE guidelines (for example, the NICE guideline on service user experience in adult mental health). This is a presentational change only, and no changes to practice are intended.

This guideline updates and replaces NICE guideline CG38 (July 2006).

Next review: This guidance will be reviewed if there is new evidence that is likely to change the recommendations.

Recommendations

This guideline includes recommendations on:

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

How we develop NICE guidelines

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.

Your responsibility

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.