Overcoming Challenges to Bipolar Disorder Treatment

January 26, 2015
Jeannette Y. Wick, RPh, MBA, FASCP

The approximately 4% of American adults with bipolar disorder face a litany of challenges, from unpredictable recurrences of hypomanic/manic or depressive episode to poor impulse control.

The approximately 4% of American adults with bipolar disorder (BPD) face a litany of challenges, from unpredictable recurrences of hypomanic/manic or depressive episodes, to poor impulse control, to difficulty maintaining relationships. Clinicians also come across those issues as they care for bipolar patients, and the constant and chronic fluctuating nature of the disorder often requires frequent medication changes and multiple medicines.

A recent review article provided a comprehensive overview of BPD and its medical, societal, and personal burdens. Drawing upon medical literature published from 1994 through 2014, the author covered delays in BPD diagnosis and evidence on the clinical effectiveness of available pharmacologic therapies.

Patients with BPD I or BPD II experience symptomatic depression at least 3 times more frequently than symptomatic mania or hypomania. For that reason, many patients with BPD are incorrectly diagnosed with depression.

Bipolar patients also experience psychiatric comorbidities such as anxiety and alcohol or drug dependence more often than people who do not have BPD. Additionally, BPD patients are more likely to develop other medical conditions, including diabetes, cardiovascular disease, obesity, migraine, and hepatitis C virus infection.

According to the review author, mood stabilizers remain the foundation of BPD treatment, but atypical antipsychotics are just as effective. Individual drugs have different efficacies dependent upon the patient’s phase (mania or depression), and some prevent relapse better than others.

While lithium therapy has been available for BPD for more than 60 years, the more recent availability of atypical antipsychotics has significantly enhanced clinicians’ approach to BPD care. Regardless, treatment outcomes remain inadequate.

Despite the apparent simplicity of BPD treatment guidelines, the review author noted that applying the recommendations is challenging when considering the variety of possible drugs and treatment combinations, drug interactions, and side effects. Furthermore, patient adherence is a substantial barrier to BPD treatment, as 75% of bipolar patients take their medication less than 75% of the time.

In the United States, the direct health care costs of BPD are estimated at $30.7 billion annually, with indirect costs estimated at more than $120 billion annually. Thus, the review author indicated that the health care system should assess its clinical management programs for BPD continuously.