An international team of experts argues that better care for people experiencing their first manic episode is urgently needed and that more research needs to go into treatment solutions for bipolar disorder.
In a new paper, published in The Lancet Psychiatry journal, the authors describe patchy and inconsistent care, widespread failure to detect bipolar disorder early enough, and a lack of guidance on how to treat people experiencing mania for the first time.
For the study, researchers from the National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre reviewed current evidence regarding the prevalence and health burden of bipolar disorder, the typical progression of illness, evidence for a range of interventions and the content of international guidelines.
Calling for clearer treatment guidelines and targeted care within existing services, the authors describe how people experiencing first episode mania have been overlooked by health services, despite evidence for effective treatments. They also assert that care is inconsistent and that few trials have examined interventions specifically for people who have had a first manic episode.
People with bipolar disorder are 50 times more likely to self-harm compared to the general population, and at least 12 times more likely to take their own lives (higher than the rate for people with schizophrenia).
Analyses suggest that close to 50 percent of people with bipolar show symptoms before the age of 21, and a recent review of 27 studies suggested an average delay of almost six years between first symptoms of bipolar disorder and targeted treatment.
“Bipolar illness can have serious effects on the health of a young person, their family and society in general,” said Dr. Sameer Jauhar, consultant psychiatrist for people experiencing first episode psychosis and Senior Research Fellow at the NIHR Maudsley Biomedical Research Centre.
“By identifying people who have had a first episode, and offering them appropriate treatment at an early stage, we can help them get on with their lives and prevent relapses.”
“As a consultant psychiatrist, this is something I see again and again,” Jauhar said. “People who are identified early and get effective treatment quickly are able to avoid further episodes and achieve extraordinary things, while others who the system doesn’t serve so well can get stuck for years.”
“Another really important factor is research — we need long-term studies to help guide future treatments and make sure we keep people well in the longer term,” said Jauhar.
The new findings highlight a lack of high-quality evidence for interventions in first episode mania, as well as gaps in guidelines on how to treat people experiencing mania for the first time.
“First episode mania can have a devastating impact on people living with bipolar and their families,” said Simon Kitchen, CEO of Bipolar UK.
“During the mania they might have racked up massive debts, damaged their careers and relationships with reckless behaviour or engaged in promiscuous activities that make them feel embarrassed. Post-mania requires rebuilding and often coming to terms with a life-changing diagnosis. It is vital that people are not left to go through this process alone.”