Long-term treatment in bipolar disorder

Bipolar disorder is a lifelong illness with a course that is usually chronic or recurrent. Severity of complications is generally proportionate to the number of episodes, especially depression. In addition to potentially preventing episodes, effective treatment reduces mortality. This article reviews long-term treatment strategies for bipolar disorder, focusing on depressive episodes, and discusses treatment studies, including problems in design. Treatment effectiveness, including reduction of suicide risk, is enhanced if patients and physicians collaboratively recognize and treat prodromal symptoms, preventing the emergence of episodes. Strategies for treatment differ as one progresses from obtaining syndromal recovery in the acute episode, to functional recovery during continuation treatment, to stability during maintenance treatment. Successful long-term treatment of bipolar disorder requires integrated pharmacologic and nonpharmacologic treatments combined with a therapeutic alliance that facilitates a proactive, preventive approach to the illness.