ABSTRACT
Long-term management of bipolar disorder is complex and challenging, largely because of the inherent complexity of the disorder and the multitude of interacting psychosocial stressors and supports that interweave over time. Bipolar disorder comprises four to six behavioral/symptomatic domains, and each requires unique attention psychopharmacologically when present. Studies consistently report factors for depression, mania, irritability, anxiety, and psychosis. Impulsivity and affective/mood instability are the closest to a universal symptom complex in bipolar disorder, appearing to some degree in all phases of the illness and even in patients recovered with continuing care (1,2). No drug, neither a single lifestyle modification nor a form of psychotherapy effectively eliminates all symptoms. Because of the persisting expression of symptomatology of bipolar illness in even the best functioning individuals, treatment needs to be continued over the lifetime and periodically modified to target symptoms that may emerge during the course of long-term treatment. Tolerability and consequently adherence, factors that translate efficacious into effective treatments, should drive drug selection and continuation in maintenance treatment of bipolar disorder.
