Bipolar Disorder — NZ Condition Guide | KiwiMeds

What is Bipolar Disorder?

Bipolar disorder is a mental health condition characterised by extreme mood swings — episodes of mania or hypomania (elevated mood, energy, and activity) alternating with episodes of depression. It affects around 1–2% of New Zealanders.

Overview

Bipolar I disorder involves full manic episodes (lasting at least 7 days or requiring hospitalisation) and depressive episodes. Bipolar II involves hypomania (less severe elevated mood) and depressive episodes. Cyclothymia involves milder mood swings over at least 2 years. Mania symptoms include elevated or irritable mood, decreased need for sleep, racing thoughts, increased activity, grandiosity, poor judgement, and risky behaviour. Depressive episodes mirror major depression. Between episodes, mood may be normal.

Treatment in New Zealand

Bipolar disorder requires long-term management. Mood stabilisers are the cornerstone: lithium (funded by Pharmac) is the most evidence-based for preventing manic and depressive episodes; valproate (funded) and lamotrigine are alternatives. Antipsychotics (quetiapine, olanzapine, aripiprazole) are used for acute episodes. Antidepressants alone can trigger mania and are used cautiously. Psychotherapy (CBT for bipolar, psychoeducation) helps people recognise early warning signs and maintain stability.

NZ-Specific Information

Mental health services in NZ are accessible through GPs and community mental health teams. The Mental Health Foundation NZ provides support. Lithium requires regular blood monitoring — your GP or psychiatrist will arrange this. The Balance NZ website (balance.org.nz) provides peer support.

Frequently Asked Questions

Is bipolar disorder a lifelong condition? Yes, but with proper treatment, most people with bipolar disorder live fulfilling lives. Can people with bipolar disorder work? Yes — many people with well-managed bipolar disorder work and have successful careers. Is bipolar hereditary? There is a strong genetic component — risk is 4–6 times higher if a first-degree relative has bipolar disorder.

Supplements That May Support Management

⚠️ Important: The supplements listed below have varying levels of clinical evidence. They are not a substitute for prescribed medications and should only be considered as adjunctive support under the guidance of a qualified healthcare professional. Always inform your GP or pharmacist before commencing any supplement, as interactions with prescribed medicines are possible.

• Omega-3 Fatty Acids (EPA-dominant) — Multiple meta-analyses support adjunctive omega-3 supplementation in bipolar disorder for reducing depressive episode frequency and severity. EPA at ≥1.5 g/day shows the strongest signal. Benefits for manic episodes are less established. Omega-3 is considered safe as an adjunct to mood stabilisers.
• N-Acetylcysteine (NAC) — NAC at 2 g/day has demonstrated in randomised controlled trials reductions in depressive symptoms and improved functioning in bipolar depression when used as an adjunct to standard mood stabiliser therapy. Mechanisms include antioxidant activity and glutamate modulation.
• Vitamin D — Vitamin D deficiency is more prevalent in bipolar disorder and is associated with worse mood outcomes. Supplementation is recommended where deficiency is confirmed.
• Magnesium — Magnesium modulates lithium transport and supports neuronal stability. It should be monitored and supplemented as needed given that lithium therapy can affect electrolyte balance.
• CAUTION: St John’s Wort — St John’s Wort (Hypericum perforatum) is CONTRAINDICATED in bipolar disorder. It can trigger manic episodes and dangerously interacts with lithium, reducing lithium levels. Never use without specialist advice.

Relevant Vaccinations

Individuals living with bipolar disorder may benefit from the following vaccinations. Please discuss your vaccination status with your GP or practice nurse, as eligibility and funding through the New Zealand National Immunisation Schedule may apply.

• Influenza (annual) — Illness and disrupted routine can trigger mood episode relapse. Annual vaccination supports stability.
• COVID-19 — COVID-19 and post-COVID neuropsychiatric complications can destabilise bipolar disorder. Maintaining vaccination is recommended.
• Hepatitis B and HPV (if eligible) — Preventive health vaccination is important as people with bipolar disorder may have reduced engagement with routine healthcare.

Dietary Guidance

Evidence-based dietary modifications play a meaningful role in the management of bipolar disorder. The following foods are generally recommended as part of a balanced, condition-appropriate diet. A referral to a registered dietitian may be beneficial for personalised nutritional planning.

• Consistent meal timing and regular balanced eating — Circadian rhythm disruption is central to bipolar mood cycling. Regular mealtimes support circadian stability alongside sleep hygiene. Skipping meals causes blood glucose instability that can worsen mood.
• Omega-3 rich foods (oily fish, walnuts, flaxseed) — Dietary EPA/DHA intake supports mood stabilisation through neuroinflammation modulation and serotonin receptor maintenance.
• Mediterranean anti-inflammatory dietary pattern — Associations exist between Mediterranean dietary adherence and reduced bipolar disorder episode frequency, likely via anti-inflammatory and neuroprotective mechanisms.
• Limit: alcohol and caffeine — Alcohol can trigger depressive episodes, interact with mood stabilising medications, and disrupt sleep. Caffeine can precipitate hypomania and disrupt sleep architecture — both important bipolar triggers.
• Sodium-consistent diet (on lithium) — Sodium intake significantly affects lithium excretion. A consistent sodium intake is essential on lithium therapy. Sudden sodium restriction (crash dieting, extreme exercise) raises lithium levels to potentially toxic concentrations.

Related Conditions & Medications

Related medications: Lithium. Related conditions: Depression, Anxiety.