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Compliance with treatment is a significant challenge for up to 60% of patients. A serious consequence of noncompliance is the high risk of relapse. Some of the reasons that bipolar patients may stop medications include:

• They feel that they are free of symptoms
• Patients may not believe they have a serious illness
• Patients may deny or minimize prior episodes and subsequent problems
• Side effects are too difficult to tolerate
• They crave the euphoric and productive feelings of hypomania

Research shows that stopping maintenance therapy almost always results in a relapse within weeks or months and that those episodes are often harder to treat. The APA notes that following remission from an acute episode, a bipolar patient may remain at high risk for relapse for up to 6 months. Some patients may experience low levels of mood changes, (e.g. residual depression or mania) between episodes. It is important to report any change in mood to a health care provider immediately so that medications can be adjusted to prevent an attack. Medication adjustments are a routine part of maintenance therapy.

Psychotherapy

The APA suggests that individual or group psychotherapy should be added to the drug treatment of bipolar disorder in order to address issues such as compliance with a treatment plan, lifestyle changes, self esteem, living with a chronic illness, and social/family relations. The APA notes that patients may also benefit from participation in support groups.

Electroconvulsive Therapy

This treatment modality should be considered as an option for people with mixed mania episodes, pregnant women, patients with refractory depression, and people with psychotic symptoms.