Aims and approach to managing bipolar disorder

Most people with bipolar disorder require psychiatrist management. The general practitioner’s role includes facilitating the diagnosis of bipolar disorder, accessing specialist care and other services, and providing ongoing general medical care, monitoring and support to the patient. Shared care between the general practitioner and psychiatrist can improve health outcomes.

Other clinicians may be part of the multidisciplinary team depending on the patient’s needs, including a clinical psychologist, mental health nurse, occupational therapist and social worker. If available, an exercise physiologist and peer workers should be included in this team.

It is crucial for members of this team (particularly the primary clinician) to foster a therapeutic alliance with the patient to ensure continuity of care. Actively engage with the patient by listening attentively to their worries and concerns, and responding effectively and empathically.

Optimal management of bipolar disorder is multifaceted, and tailored to the type of mood episode (mania, hypomania or depression) and phase of the treatment (acute, maintenance or prophylactic therapy). Consider both the advice in this topic and the specific principles for:

• managing acute mania
• managing hypomania
• managing bipolar depression
• prophylaxis of bipolar disorder.

Multifaceted management of bipolar disorder involves:

• psychosocial interventions, started during the first episode and continued throughout treatment
• identification and treatment of comorbidities
• support for families, carers and significant others
• pharmacotherapy tailored to the episode:
  • acute mania, involving acute treatment followed by maintenance therapy for up to 12 months after the episode
  • hypomania
  • bipolar depression, involving acute treatment followed by maintenance therapy for up to 12 months after the episode
• pharmacotherapy for prophylaxis of bipolar disorder is often required to prevent future episodes and enhance resilience, for 3 to 5 years or indefinitely depending on patient factors
• if relevant, implementing measures to improve adherence.

Drug therapy for bipolar disorder is complex. Sequential trials of pharmacotherapy may be required until the best balance of effectiveness and adverse effects is achieved.

See also the additional considerations in managing bipolar disorder:

• in young people
• in females of childbearing potential
• during pregnancy
• during the postpartum
• for sodium valproate use in males of reproductive potential.

Patient resources include:

• Beyond Blue (1300 224 636)
• Black Dog Institute
• for young people, Headspace
• Head to health
• Lifeline (13 11 14)
• SANE Australia (1800 187 263)
• Suicide Call Back Service (1300 659 467).