The Rationale of Prophylactic (preventative) Treatment in Bipolar disorder(manic depressive illness)
Updated: Feb 16
Bipolar disorder is a chronic and a highly recurrent mood disorder that is characterised by many presentations. It also has many different developmental stages that require different treatments.
The prophylactic (preventative) stage of treatment may also be the most valuable one, and it is also the treatment that will help a bipolar patient to achieve long term balance and recovery from a bipolar disorder.
Nevertheless, many bipolar patients and relatives, and even professionals pay far more attention to the treatment during a crisis.
Even though the bipolar crises are really important to be treated with promptness and great care, this is not a stage of treatment that one should wish to keep on engaging.
A disorder that is defined by its recurrence, which also gets worse with its recurrence, can only be treated if the treatment stops the relapses.
The actual episodes and crises of a bipolar disorder sooner or later will heal. What usually does not end without proper treatment is its relapsing course. This is what really matters when it comes to the treatment of bipolar disorder.
This can only be accomplished through the rationale of prophylactic treatment.
When one is treating the disorder with that rationale in mind, many things are done differently.
The patient needs to continue his medication treatment even when well, and when there are no active symptoms.
The patient is engaged in a systematic psychological treatment that will help him to better learn his bipolar disorder, and to better cope with any impending signs of relapse.
The prophylactic stage of treatment is also a phase where many other comorbid (additional) problems can be treated with much greater safety (e.g. anxiety disorders, addictions, difficult personality traits). It is also a phase where one can focus on improving the functioning and the well-being of a bipolar patient.
As time goes by and with the all the treatment advances, we are blessed with even more effective treatments, with fewer side effects. These treatments also start earlier in the course of bipolar disorder. As this happens the next generation of bipolar patients will only be maintained under prophylactic treatments that will keep them well forever. In a sense we are starting to witnessing the first generations of bipolar patients where the nightmares of a highly relapsing bipolar disorder become a nightmare of the past.
There is nothing worse really than a bipolar disorder that has become chronic, and has led to treatment resistance, and long term functional impairment. Unfortunately, we still have an older generation of bipolar patients where continued relapses have become the default reality.
There is nothing better than a young bipolar patient who early on accepts and understands that after his first episode he needs to engage in specialist and intensive prophylactic treatment that will ensure a future with no relapses.
The rationale of Prophylactic treatment and its early practice and adoption are golden keys for a bipolar disorder that will cease to be a disorder, and will have a good course.
If we put an end to the relapses, then one can continue to develop with all the benefits of a creative, productive and highly intelligent self that is usually characteristic of patients with a bipolar disorder.
All our treatment decisions at BipolarLab are based, and guided by the rationale of prophylactic treatment. This is what we preach, practice and teach. This is what keeps our patients well.
Dr Yanni Malliaris is a clinical psychologist, Doctorate of the Institute of Psychiatry, King's College London), Founder and Clinical Director of BipolarLab.com and EDO the Hellenic Bipolar Organisation. He is also Greece's only Beck Institute CBT Certified Clinician (BICBT-CC). He grew up along side his father's bipolar illness, and thanks to him he became a bipolar disorder specialist. He helps his bipolar patients to befriend their bipolar disorder, to remain well, and to excel.