Priority 11 from the Bipolar PSP

UNCERTAINTY: Can bipolar be managed effectively without medication and if so how, and what are the long term outcomes? (JLA PSP Priority 11)
Overall ranking	11
JLA question ID	0041/11
Explanatory note	Not available for this PSP
Evidence	None identified
Health Research Classification System category	Mental Health

Extra information provided by this PSP
Original uncertainty examples	For full examples, see Category ID M2 on spreadsheet. Are different treatments (non pharmacological) effective in predominantly depressive vs predominantly manic pattern of illness? ~ Are there other forms of therapeutic treatments such as emotion regulation or guided self help strategies which can help a person manage their mood effectively if they are reluctant to take medication such as olanzapine and lithium? ~ Support appears to be adherence to medication, that in turn causes side effects, those 'afraid' of side effects will stop medication. Why does a patient feel pressured into medication or no support. Ending up in lying about taking their meds. What else can you do as a patient. ~ Some "alternative gurus" suggest that Bipolar Disorder is an over-medicalised condition, and that psychotropic meds are part of the problem, not part of the solution - that we should "just try harder" to personally manage our own mood swings and not rely on prescription drugs or other people. How much merit is there in that school of thought? ~ Can mindfulness or Mindfulness based CBT reduce the number of episodes (even without medication) in bipolar or does it only work in unipolar recurrent depression.
Submitted by	Patients x 323 ~ Carers x 151 ~ Health Professionals x 36 ~ Others x 26

Extra information provided by this PSP

Original uncertainty examples

For full examples, see Category ID M2 on spreadsheet. Are different treatments (non pharmacological) effective in predominantly depressive vs predominantly manic pattern of illness? ~ Are there other forms of therapeutic treatments such as emotion regulation or guided self help strategies which can help a person manage their mood effectively if they are reluctant to take medication such as olanzapine and lithium? ~ Support appears to be adherence to medication, that in turn causes side effects, those 'afraid' of side effects will stop medication. Why does a patient feel pressured into medication or no support. Ending up in lying about taking their meds. What else can you do as a patient. ~ Some "alternative gurus" suggest that Bipolar Disorder is an over-medicalised condition, and that psychotropic meds are part of the problem, not part of the solution - that we should "just try harder" to personally manage our own mood swings and not rely on prescription drugs or other people. How much merit is there in that school of thought? ~ Can mindfulness or Mindfulness based CBT reduce the number of episodes (even without medication) in bipolar or does it only work in unipolar recurrent depression.

Submitted by

Patients x 323 ~ Carers x 151 ~ Health Professionals x 36 ~ Others x 26

PSP information
PSP unique ID	0041
PSP name	Bipolar
Total number of uncertainties identified by this PSP.	363 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	14 June 2016