Bipolar Disorder Managing the Ups & Downs of a Complex Illness- Pharmacist
Bipolar disorder, sometimes referred to as manic-depressive illness, may be misidentified by health care practitioners as major depression, an anxiety disorder, attention deficit hyperactivity disorder, or even schizophrenia because of the wide range of clinical presentations. 1 National screening studies estimate that the lifetime prevalence of bipolar disorder is approximately 4%, which is higher than schizophrenia at 1% 2 and lower than major depressive disorder at almost 17%.3-5 Medications used to treat bipolar illness are as wide-ranging as the symptoms. Lithium, anticonvulsants, antipsychotics, benzodiazepines, and antidepressants all have a place in the treatment of individuals with bipolar disorder.6,7 The challenge is finding the right combination of medication and psychosocial intervention for a given individual. Barriers to Stabilization Lack of insight into the illness and high rates of nonadherence (40-60%) are primary barriers to the stabilization of bipolar illness.8,9 Up to 60% of those with bipolar disorder abuse drugs and alcohol.10 This greatly contributes to mood instability and nonadherence. The use of antidepressants without mood stabilizers (eg, lithium, valproate) or second-generation antipsychotics (SGA) has been shown to increase the frequency of mood episodes in bipolar illness and lead to mood destabilization.6,11 The Role of the Community Practitioner The role of the community practitioner is threefold: 1) to recognize symptoms of bipolar disorder and encourage appropriate drug therapy; 2) to counsel patients on bipolar disorder as a highly treatable illness that requires lifelong medication and psychosocial interventions; and 3) to provide medication education and monitoring to ensure maximum therapeutic benefit, prevent drug interactions, and help patients manage medication side effects.