Putting it All Together in Bipolar Disorder: Novel Treatment Options Focused on the Whole Patient

Bipolar disorder (BD) is a serious mental illness and a notoriously challenging disease for healthcare professionals to accurately diagnose and manage. As a result, high rates of undertreatment and nonadherence generally result in very poor outcomes among these patients. Because the burden among individuals living with BD is significant—approximately 83% of individuals with BD describe serious impairment—optimal management is essential. However, the adverse effect (AE) profiles associated with many treatment options, which include metabolic disruptions that can lead to unwanted weight gain and associated comorbidities, play a considerable role in nonadherence. While off-label therapies have been found to lessen antipsychotic‐related weight gain/obesity, gastrointestinal AEs are common and can be a barrier to dose escalation and tolerability. Although newer/novel agents have the potential to address the cardiometabolic burden of BD without sacrificing treatment efficacy or introducing intolerable Aes, data reveal that psychiatry and allied clinicians may not be optimally implementing these critical updates in patient care. Clinicians must, therefore, recognize the ongoing challenges related to metabolic outcomes in patients with BD and understand the potential role of novel therapies with diverse mechanisms of action as they enter the treatment paradigm. Furthermore, psychiatry and allied clinicians must be prepared to apply tactics such as shared decision-making into routine care in order to optimally identify and address burdens and unmet treatment needs and initiate personalized care.