Long-Term Management of Bipolar Disorder Takes Teamwork

In my 20 years in psychiatry, I have worked with countless people navigating a bipolar I disorder (BD-I) diagnosis, some alone and others with the support of family or community. While my book knowledge—or theory knowledge—on the topic has remained consistent during this time, my applied practice and learned experience have helped me better understand how the disease may affect people over their lifetime. It also means that how I treat the disease, including BD-I symptoms such as mania and psychosis, has evolved considerably since I first began practicing medicine.

My hope is that this perspective is beneficial as I partner with those who experience BD-I to not just manage an initial diagnosis, but also to plan for and approach BD-I as a long-term treatment journey. I now take an ecosystem approach where I’ve moved beyond treating just “today’s symptoms,” to looking at their whole life, over decades.

I also include their families and loved ones in my treatment plan. Many of us are challenged to educate caregivers on the cycle and progression of the disease. We must also be educated by them—about what they need, what their goals are, and where they see their loved one’s quality of life in the years and decades to come.

Common Challenges in Managing Bipolar I

BD-I is a chronic disease that will, for many people, require lifetime management. Unfortunately, in my experience, the diagnosis of a serious mental illness, such as BD-I, is often followed by a similar pattern: First, treatment to bring an initial episode or specific symptoms under control, but then, as a person’s acute symptoms begin to improve, their motivation to stay the course and maintain treatment may eventually subside.

There are many reasons this can happen. Impacted individuals and their loved ones often want to move beyond each acute episode and return to “normal” life. However, “normal” may be short-lived as BD-I may only be entering a quiet period. Clinicians can help families or loved ones better understand and maintain their long-term view by educating them with crucial information about their loved one’s condition, providing all treatment options, and determining the next steps in the treatment pathway.

I have found that the best BD-I management takes commitment from a collective team. When those with BD-I and their families or loved ones form long-term partnerships with clinicians, they can create a shared vision for the future and work together to develop effective, long-term treatment plans.

The Need for Early Intervention in BD-I

One theory within the treatment community for those living with BD-I maintains that the longer a person living with the disorder goes untreated, the more severe their episodes—of depression or mania—can become.¹ According to the "kindling theory," brain pathways may go on aberrant detours, and the more those routes are reinforced, the easier it becomes for the brain to slide into familiar ruts. Therefore, early intervention, particularly at the first onset of disease, coupled with consistent treatment is critically important.

Because many families have little experience with conditions such as BD-I, they may not have a clear picture of their options and how those early decisions can impact an individual’s long-term mental health.

A clinician’s support can go a long way toward helping families assess their choices during these early episodes. While delaying treatment can lead to worsening symptoms, taking a proactive approach can fundamentally improve the quality of life for a person with BD-I—not only for a few months but potentially for years or even decades. Understandably, the road to treatment can often present difficult decisions for everyone involved; however, early interventions, when symptoms are relatively mild, can alleviate the long-term severity of manic episodes and relapse.² As clinicians, it’s always key to keep this in mind.

Identifying an effective therapeutic regimen is a great start, ensuring those with BD-I and their supporters must remain vigilant. It’s important that clinicians communicate these facts to individuals with BD-I, their family members, loved ones, and caregivers. Ensuring that everyone on the care team understands the big picture and shares the same treatment goals can help to improve long-term outcomes and provide the first steps in the ongoing disease management, given the chronic nature of BD-I.

Bipolar Disorder Essential Reads

What Being a Patient Taught Me About Being a Doctor

When Symptoms Overlap

Looking to the Future

While I don’t expect people to know exactly what their future holds, I do encourage those who manage BD-I to consider the possibilities of what their future may entail. Whether that means a treating clinician or the person who is diagnosed with BD-I and their caregiver or loved one, the advocacy in which the treatment journey is approached needs to be one of a long-term nature through teamwork from all parties. BD-I goes beyond today and tomorrow, and so should the approach to treating it.