Bipolar disorder – recognising it and staying well
What mania and depression look like in bipolar disorder, why treatment continues between episodes, the monitoring some medicines need, and what to watch for.
Two directions, not just low mood
Bipolar disorder involves episodes of depression and episodes of elevated mood. It is often first mistaken for depression alone, because the depressed episodes are what bring people to a clinic — the elevated ones can feel good, or feel like finally being productive.
- In an elevated (manic or hypomanic) episode: much less need for sleep without feeling tired, racing thoughts, talking fast, unusual confidence, spending or risk-taking that is out of character, irritability, and sometimes losing touch with reality.
- In a depressed episode: persistent low mood, loss of interest, heavy fatigue, changes in sleep and appetite, difficulty concentrating, feelings of worthlessness, and thoughts of death or suicide.
- Between episodes many people are entirely well, which is part of why treatment gets stopped.
Treatment continues between episodes
Bipolar disorder is treated with mood-stabilising medicine taken continuously, not only when unwell. The point of it is to make episodes less frequent and less severe. Stopping when things are going well is the most common route back to hospital, and stopping some of these medicines abruptly carries its own risks.
Medicines used in bipolar disorder in South Africa:
Lithium Carbonate — Camcolit, Quilonum
Bipolar disorder (prophylaxis and acute mania); recurrent depression augmentation
Sodium Valproate / Valproic Acid — Epilim, Convulex, Depakote, Depakene
Epilepsy (generalised and focal); bipolar disorder; migraine prophylaxis
Lamotrigine — Lamictin, Epitec, Lamotrin, Elmendos
Epilepsy (focal and generalised); bipolar disorder (maintenance — depression prevention)
Quetiapine — Seroquel, Seroquel XR, Dopaquel, Mylan Quetiapine
Schizophrenia; bipolar disorder; major depressive disorder (adjunct); insomnia (low dose, off-label)
Olanzapine — Zyprexa, Adco-Olanzapine
Schizophrenia; bipolar disorder (acute mania and maintenance); treatment-resistant depression (with fluoxetine)
- Some of these need regular blood tests — to check the level in the blood, and to check the thyroid, kidneys or liver. Those appointments are part of the treatment, not an optional extra.
- Dehydration, some painkillers and some blood-pressure tablets can change the level of certain mood stabilisers in the blood. Tell every prescriber what you take.
- Some carry serious risks in pregnancy. If pregnancy is possible, discuss it before it happens rather than after.
- Alcohol and cannabis both destabilise mood and interact with treatment.
Staying well day to day
- Sleep is not a side issue. A regular sleep schedule is one of the strongest protections, and a few nights of little sleep is one of the most reliable early signs of an episode building.
- Learn your own early-warning signs and write them down while you are well. Ask someone close to you what they notice first — it is often different from what you notice.
- Agree a plan in advance for what should happen if those signs appear: who to call, what to do about work, who holds the bank card.
- Keep clinic appointments even when nothing is wrong. Those are the appointments where doses get adjusted before an episode instead of after.
Common questions
- Can I stop bipolar medicine when I feel well?
- No. Feeling well is what the medicine is doing. Stopping between episodes is the most common reason people relapse, and some of these medicines are dangerous to stop abruptly. Any change is planned with your clinician.
- Why do I need blood tests for my mood medicine?
- Some mood stabilisers need the blood level checked to stay in a safe and effective range, and some need thyroid, kidney or liver monitoring. Those appointments are part of the treatment.
- Can antidepressants make bipolar disorder worse?
- An antidepressant given on its own can trigger an elevated episode in someone with bipolar disorder. That is why it matters to tell a clinician about any past period of barely sleeping, racing thoughts or out-of-character behaviour.
Sources
- Adult Hospital Level Standard Treatment Guidelines and Essential Medicines ListNational Department of Health, South Africa
- Mental health support and crisis resourcesSouth African Depression and Anxiety Group (SADAG)
- Medicines Online Directory and approved patient information leafletsSouth African Health Products Regulatory Authority
- Clinical and public health guidanceWorld Health Organization
Last reviewed 11 August 2026.