4.2.3.2 Maintenance treatment of bipolar disorder with mood stabilisers

Prescribing Notes

  • Therapy should be initiated by a psychiatrist and only following medical examination and careful assessment of risk/benefit.
  • See NICE CG 185 Bipolar disorder.
  • The Lithium Shared Care Guideline and Lithium Care Pathway should be consulted for advice on appropriate patient management including monitoring requirements and responsibilities.
  • The benefit of routine plasma drug level monitoring for valproate is not firmly established but may be helpful if side-effects are a problem, or non-compliance or non-response are suspected. See section 4.8.

Women of childbearing potential

  • Women receiving mood stabilisers must be warned to obtain pre-conception advice if they plan to become pregnant; the risk of relapse following withdrawal of mood stabilisers must be balanced against their established teratogenic potential which should be fully discussed with the patient. Psychiatric advice should be sought regarding the most appropriate management of individual patients. Advice is normally weighted towards stopping mood stabilisers and maintaining the patient on an antipsychotic if necessary.
  • Valproate medicines (Epilim▼, Depakote ▼) are contraindicated in women and girls of childbearing potential unless conditions of Pregnancy Prevention Programme are met. For further information see MHRA. All patients should be under the management of a specialist and have an annual review.