Frequently Asked Questions

Patience, reassurance and support are really important. Many people with bipolar disorder find it a difficult diagnosis to accept and it can sometimes take years for this to happen. Avoid confrontation and just try to support them in a consistent way until they feel ready to accept the diagnosis.

Lithium is a highly effective medication for bipolar disorder but does have side-effects and some longer-term effects (this is why regular monitoring of kidney function and thyroid function are needed). Sometimes concern about kidney-related side effects leads to people stopping lithium but in most cases this can be managed by just reducing the dose and monitoring kidney function carefully. The most obvious effect of lithium is that it reduces the risk of relapse (for both depression and mania) and it has an anti-suicidal effect.

This is understandable – no one wants to take medication unless absolutely necessary. I think it is the job of clinicians to emphasise that many treatments (such as lithium) are effective over very long periods of time but only continue to be effective if taken when well.

I always recommend “Bipolar Disorder for Dummies” by Dr Candida Fink. Despite the title, it is the best book I have found for supporting individuals and family members with bipolar disorder.

I think things are slowly improving in terms of knowledge about diagnosis and I think this long lag time between onset and diagnosis will improve gradually.

I view the current diagnostic criteria for bipolar disorder as useful for clinical practice but they don’t capture the clinical and everyday complexity that most people with this diagnosis experience. I also view these criteria as ‘works in progress’ that need to be constantly updated as we gather new information.

In the last two years there have been major advances in terms of discovering genetic risk factors for bipolar disorder. We now know that bipolar disorder is caused by the effects of many hundreds of common genetic variants and we are starting to understand how these genetic risk factors interact with environmental factors (such as sleep problems) and cause mood problems. This research is also important for discovering new treatment approaches.

I am part of the large global genetics research community who are discovering the genetic basis of bipolar disorder but more recently I have been doing work in two main areas: the importance of sleep and circadian rhythms in bipolar disorder, and testing a new treatment called the ketogenic diet (see https://www.bipolarketostudy.com/). I hope to do more work soon on discovering how lithium works in bipolar disorder, eg, we think it might be effective because it helps to stabilise sleep and circadian rhythms.

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