Long-term Treatment of Bipolar Disorder

People who have had at least two episodes in five years (that is, at least two manic episodes, two depressive episodes, or one manic and one depressive episode) or three serious lifetime episodes will need to take medication over the long term, even when they experience no symptoms.

This can be difficult for people to accept once they stabilize and begin to feel well again. However, research clearly shows that bipolar disorder is a chronic, cyclic disease and that the consequences of going off medication can be tragic.

Treatment usually involves a mood stabilizer; other medications may be added on a short-term basis if depression or mania worsens or if symptoms such as impulsivity, irritability, or poor concentration develop. A person on long-term treatment for bipolar disorder will need periodic blood tests to monitor blood levels of the medication and to check for any serious side effects, such as liver, kidney, or thyroid problems.

Sleeping problems are common in people with bipolar disorder because mania can cause a reduced need for sleep and depression can cause insomnia. Benzodiazepines and certain neuroleptics may help promote sleep but are given only for short periods.

Sometimes a depressive episode occurs in someone who has been doing well with long-term treatment (known as breakthrough depression). When this happens, there are a number of treatment options.

Those who experience mild to moderate depression may be given a higher dosage of their mood stabilizer. (In some instances, however, the mood stabilizer may actually induce mild depression, and the doctor may choose to lower the drug dosage.) If depression is severe, the person may be given an SSRI or a second mood stabilizer. Rapid cycling between mania and depression despite long-term treatment precludes use of antidepressants.

Publication Review By: Karen L. Swartz, M.D.

Published: 03 Mar 2011

Last Modified: 20 Jun 2013