Bipolar blogger Natasha Tracy offers exclusive insight into the world of bipolar disorder.See all posts »
What is Treatment-Resistant Bipolar Disorder?
Treatment-resistance exists for any disorder or disease. It’s simply the description of a disease not responding to treatment. However, what constitutes a “treatment-resistant” illness is up for debate, particularly in bipolar disorder. There is no standard definition.
Because there are three phases of bipolar disorder: acute mania, acute depression and maintenance, “treatment-resistance” may only apply to one phase. So, for example, once a person goes into acute mania and fails to respond to several treatments, that might be considered treatment-resistant bipolar mania.
Treatment-Resistance is the Rule in Bipolar Disorder
It’s important to remember though, to some extent with bipolar disorder, treatment-resistance is not the exception, but the rule. Many people with bipolar disorder do not respond to an initial treatment and many people require a combination of treatments in order to experience wellness so initial nonresponse to a treatment isn’t officially treatment-resistance.
The official designation of “treatment-resistance” then, needs more clarification.
Standard Bipolar Medications
There are many medications that are standard in bipolar disorder, depending on the phase of treatment. Common examples include lithium, divalproex, lamotrigine, and quetiapine. (See a complete list with evidence indications here.) These standard medications are FDA-approved for use in bipolar treatment. “Treatment-resistance” then should take into account how people respond to these standard treatments.
According to a Psychiatric Times article:
“Sachs suggested that the term ‘treatment-resistant bipolar disorder’ should be reserved for patients who do not respond to a combination of 2 standard medications in a specific period, such as 6 weeks for mania, and 6 months or 3 cycle-lengths for maintenance. Others have required multiple trials of combinations or that patients fail to respond to nonstandard treatments, such as antidepressants.”
And when a doctor says “fails to respond” what they mean is that the patient doesn’t respond to a medication given at an adequate does for an adequate amount of time, and in my experience, many medications are discontinued long before that marker for a variety of reasons like side effects.
What Does Treatment-Resistance Really Mean?
But it’s important to remember that just because a case of bipolar disorder may be treatment-resistant, that’s not the same thing as treatment-impossible. True treatment-resistance really only indicates to the psychiatrist that more novel routes of treatment are warranted. It’s critical, and I cannot stress this enough, not to think that treatment-resistance indicates that the patient, or the physician, should give up. I have been treatment-resistant for much of my bipolar life but that doesn’t mean that effective treatments weren’t later found.
What to do in Cases of Treatment-Resistant Bipolar Disorder
Next week I’ll be talking about the novel forms of treatment that can be considered in cases of treatment-resistant bipolar disorder.