Clinical Review

Bipolar disorder

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e8508 (Published 27 December 2012) Cite this as: BMJ 2012;345:e8508
  1. Ian M Anderson, professor of psychiatry1,
  2. Peter M Haddad, consultant psychiatrist and honorary reader in psychiatry12,
  3. Jan Scott, professor of psychological medicine34
  1. 1Neuroscience and Psychiatry Unit, University of Manchester, Manchester M13 9PT, UK
  2. 2Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
  3. 3Academic Psychiatry, Wolfson Unit Campus for Vitality and Ageing, Newcastle University, UK
  4. 4Fondation Fondamental and Universite-Paris-Est-Creteil, Paris, France
  1. Correspondence to: I M Anderson ian.anderson{at}manchester.ac.uk

Summary points

  • Bipolar disorder is characterised by recurrent episodes of elevated mood and depression, together with changes in activity levels

  • Elevated mood is severe and sustained (mania) in bipolar I disorder and less severe (hypomania) in bipolar II disorder

  • Depression is usually more common and longer lasting than elevated mood, and—together with inter-episode milder symptoms—contributes most to overall morbidity

  • Other psychiatric disorders, such as anxiety disorder and alcohol and drug misuse, are common

  • Risk of death from suicide and from natural causes, most often cardiovascular disease, is increased

  • Treatment is with drugs and supplemental psychotherapies; for both acute episodes and maintenance, treatment is guided by whether mania or depression predominates

Bipolar (affective) disorder, originally called manic depressive illness, is one of the most challenging psychiatric disorders to manage. Although it has been associated with creativity, it has a negative impact on the lives of most patients and more than 6% die through suicide in the two decades after diagnosis.1 Organisational change means that specialist services mostly treat acute episodes, leaving primary care with long term management. This review summarises current best practice in the diagnosis and management of bipolar disorder, signposting areas of uncertainty.

Sources and selection criteria

As well as searching the Cochrane Library, we searched Medline for reviews, systematic reviews, and meta-analyses published since 2007 using the terms “bipolar disorder”, “mania”, and “bipolar depression”. These references were used to update and supplement those obtained from recent evidence based guidelines on treating bipolar disorder, including ones from the National Institute for Health and Clinical Excellence, the British Association for Psychopharmacology, the Canadian Network for Mood and Anxiety Treatments, and the International Society for Bipolar Disorder. We also used our personal reference libraries. High quality systematic reviews, meta-analyses, and large randomised controlled trials were selected where possible and lower quality evidence and guideline recommendations when …

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