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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 these were lacking.
What is bipolar disorder?
Bipolar disorders are characterised by recurrent episodes of elevated mood and depression, which are accompanied by changes in activity or energy and associated with characteristic cognitive, physical, and behavioural symptoms (fig 1 ). The term mania is used when elevated mood is severe and sustained or associated with psychotic symptoms, leading to marked disturbance of behaviour and function. Hypomania refers to less...