The chronic, complex, and episodic course of bipolar mood disorder presents a formidable challenge to the clinician making a treatment plan. Although numerous therapeutic agents are reported to be efficacious for one or more aspects of bipolar illness, treatment is seldom completely effective and is never curative. The goal of treatment is to modify the symptomatic expression of the illness with the result that fewer, briefer, and milder episodes occur. In pursuit of this goal, the use of multiple medications, polypharmacy, is the rule rather than the exception. This article offers recommendations for treatment strategies based on the phase and stage of the illness. The strategies are organized into algorithms that emphasize the use of mood-stabilizing medications as initial steps in a systematic, iterative approach to treatment. Practical issues related to the use of mood-stabilizing therapies are discussed.
The authors and I are pleased to be able to present this collection of articles on key issues in the diagnosis and treatment of bipolar disorder. The authors and I gathered in Chicago for a 2-day meeting in July 1995 during which we discussed and debated the topics covered in this supplement. These articles, based on those discussions, have undergone extensive review and revision so that the most informative and current material as possible could be provided.
We would like to thank Abbott Laboratories for their generous support of this supplement.
The opinions expressed herein are those of the authors and do not necessarily reflect the views of the publisher, the editors, or the sponsor.
Clinical Psychopharmacology Unit, Massachusetts General Hospital, Boston, Massachusetts