Bipolar disorder, which often has its onset in adolescence or early adulthood, is characterised by marked variations in mood, ranging from major depressive episodes to manic exacerbations. Compared to depressive episodes, manic recurrences are often brief and usually respond to anti-manic medications within a few weeks. Infrequently bipolar patients get badly affected by protracted manic symptoms that exhibit resistance to the usual anti-manic agents. As mania is a very disruptive condition with severe and adverse consequences for the patient, every effort should be made to bring it under control as soon as possible. Nonetheless, an occasional patient may require prolonged and persistent treatment to attain remission. In a case where manic symptoms are showing resistance, an evidence-based pharmacotherapuetic approach by the treating physician is essential. The provision of psychological and social support to the patient is vital in conjunction with biological measures for optimal management.
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