When bipolar disorder is left untreated, the severity and duration of manic episodes increases. This is true with most illnesses, physical and mental. It is important for patients to consider this as early in treatment as possible because the disorder can be devastating to relationships, careers and unfortunately may cost them their life.

The treatment plan for bipolar disorder usually involves medication and psychotherapy. Including the family in treatment is best and recovery at home is most desirable. Keeping a consistent treatment regimen going even when things are going smoothly is essential. After the illness has stabilized, reducing the episodes of mania and depression is the heart of the work.

A tool that seems to be helpful for averting and reducing the number of manic episodes is called prodrome detection. It was developed by Dr. Perry and her colleagues and involves identifying the early warning signs that led up to the previous episodes. Asking the patient to identify what he or she was doing just prior to the last episode is a good way to begin.

For many, a lack of need for sleep, racing thoughts, and increased activity are prodromes for mania. Depression prodromes can include ruminating thoughts, and interrupted sleep. Once the prodromes are identified, they are written on a laminated card and carried by the patient at all times. A copy is given to the therapist, primary care physician, social worker, and any other treatment team members. A plan of action is agreed upon and a contractual agreement is made to implement the plan immediately at the first emergence of prodrome symptoms. In addition, a journal is kept with increased writing assignments around the time leading up to the first symptoms.

Episodes frequently occur suddenly with little or no warning. This makes it difficult but no less important to gain as much insight as possible into what was going on prior to the episode. With information, the patient and his or her family may be able to avert hospitalization or long periods of unemployment. Episodes can be expensive and embarrassing. Moreover, full recovery may take months or years.

Getting to the doctor immediately is critical. Part of the action plan that is agreed upon in advance may be to have an emergency medication pack to take. This has to be worked out with the doctor and taken as directed.

One of the challenges to treatment compliance is the elation that some patients feel when in a manic episode. It is difficult to give this up. The feeling is drug-like and seductive. Unfortunately, the highs are followed by horrible lows that are extremely painful and at times unbearable. Finding a balance between feeling good and still being functional may take some fine tuning. Unfortunately, some of the medications that are used to treat the illness may have a flattening affect on mood. It is important to work on a solution with the doctor so this side effect can be managed effectively.

Many people stop their medication abruptly as soon as they feel better. The reasoning goes something like, “why do I need medication when I feel good?” The reality is they feel good because they have been taking their medication, reducing their stress load, exercising regularly, thinking rationally, and maintaining good sleep hygiene.