Bipolar disorder in oncology: Considerations for the psychiatrist

Bipolar disorder confers elevated cancer morbidity and mortality compared to the general population, yet bipolar disorder remains under-studied in oncology settings.

This narrative review aimed to synthesize key considerations for psychiatrists and oncologists treating people with co-occurring bipolar disorder and cancer.

A narrative review was performed to examine literature related to bipolar disorder in oncological care, focusing on outcomes, treatment-emergent mood symptoms, psychopharmacological interactions, and supportive interventions.

Bipolar disorder may adversely affect cancer care through reduced treatment engagement, diagnostic delays, and lower receipt of guideline-concordant oncologic therapy. Bipolar disorder is associated with increased risks of self-harm and suicide, as is receiving a cancer diagnosis. Cancer-related neurological conditions and treatments, including corticosteroids, antineoplastics, and interferon-alpha, may precipitate or worsen mood episodes. Mood stabilizers and antipsychotics carry clinically relevant risks including organ toxicity, electrolyte disturbances, cardiac effects, and immunosuppression. Nonpharmacologic strategies, particularly psychotherapy and maintenance of sleep stability, are essential care components.

Bipolar disorder has important implications for cancer treatment, while cancer and its therapies can destabilize mood and complicate psychiatric care. Early psychiatric care, close collaboration between oncology and psychiatry, careful medication selection and monitoring, attention to suicide risk and sleep, and psychosocial support are essential to improving care outcomes in this high-risk population. Future research addressing bipolar disorder as a distinct category within psycho-oncology rather than categorized under broader severe mental illness classifications will help further elucidate disorder-specific best practices.