Bipolar disorder is being better understood each day. There is also ongoing research into its treatment.
But successfully treating bipolar disorder can involve several medication trials, and it can take years to achieve remission. Even if remission is attained, recurrence is the rule — not the exception. It’s not uncommon for all first-line treatments to be exhausted.
People in this situation may be considered by mental health professionals to be treatment-resistant. Luckily, there are treatments that can be tried when first-line, and even second-line, treatments for bipolar disorder fail.
What is Treatment Resistance?
There is no consensus among clinicians and researchers on one definition of treatment resistance. Generally, patients in an acute state (manic, depressed or mixed) whose symptoms do not improve after at least two evidence-based medication trials are considered treatment-resistant in research studies. In the maintenance phase, patients are considered treatment-resistant if they continue cycling despite several adequate medication trials.
In some studies additional criteria must be met in order to truly be considered treatment-resistant. These include functional measures of remission.
Dr. Prakash Masand, psychiatrist and founder of Global Medical Education argues, however, that “Treatment-resistance is more common than most clinicians think since a sustained response to treatment rarely includes an assessment of functioning. When functioning and residual depression are taken into consideration, far more patients would be considered treatment-resistant.”
First-Line Treatments for Bipolar Disorder
First-line treatments for bipolar disorder have been shown to be the most reliable. They are approved by the Food and Drug Administration (FDA). First-line treatments vary, depending on the phase of bipolar disorder the patient is in.