Long-Term Treatment in Bipolar Disorder

Bipolar disorder is a lifelong illness with a course that is usually chronic or recurrent. Severity ofcomplications is generally proportionate to the number of episodes, especially depression. In additionto potentially preventing episodes, effective treatment reduces mortality. This article reviews long-termtreatment strategies for bipolar disorder, focusing on depressive episodes, and discusses treatmentstudies, including problems in design. Treatment effectiveness, including reduction of suiciderisk, 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 obtainingsyndromal recovery in the acute episode, to functional recovery during continuation treatment, to stabilityduring maintenance treatment. Successful long-term treatment of bipolar disorder requires integratedpharmacologic and nonpharmacologic treatments combined with a therapeutic alliance that facilitatesa proactive, preventive approach to the illness.