Treatment Resistant Bipolar Disorder

This activity is designed for general, pediatric and geriatric psychiatrists, neurologists, nurse practitioners, physician assistants, nurses, psychologists, social workers, other mental health professionals and primary care clinicians who treat patients with bipolar disorder.

Supported by educational grants from:

Alkermes, Inc., and Sunovion Pharmaceuticals Inc.

Activity Information


Original Release Date: May 10, 2019
Expiration Date: May 10, 2020
Estimated Time to Complete Activity: 1.0 hour




Educational Needs

No treatments have been developed specifically for bipolar disorder. Drug development is difficult because the etiology and pathophysiology of bipolar disorder are not understood, and no animal models exist. The illness itself is complex and its presentation is heterogeneous, displaying mania, depression, mixed states, rapid cycling, periods of euthymia, and, in some patients, psychotic symptoms. The mainstay of treatment for bipolar disorder, lithium, was discovered serendipitously 7 decades ago. Other agents efficacious in bipolar disorder are drugs that were developed for other purposes, such as epilepsy and schizophrenia. The effects of these drugs in bipolar disorder are real but modest and adverse events are common. Finding a tolerable combination of drugs and appropriate doses is largely a matter of trial and error. Few comparative studies that can inform clinical decision making have been done. Likewise, there is little evidence to guide clinicians on the subsets of patients that may respond to particular agents.

But treatment for patients with bipolar disorder is critical. Bipolar disorder causes a substantial decrease in quality of life, and its comorbid medical disorders decrease life expectancy by 1 to 2 decades.

Some patients fail to respond adequately to the standard medications. Additional approaches, supported by a few small trials, may be appropriate for these patients. Clinicians would benefit from education summarizing additional treatment approaches for patients with treatment resistant bipolar disorder.

Learning objectives

At the conclusion of this program, participants should be better able to:

  • Use best available evidence to guide selection of pharmacotherapy for treatment resistant mania
  • Use best available evidence to guide selection of pharmacotherapy for treatment resistant bipolar depression


Mark A. Frye, MD
Department of Psychiatry and Psychology
Mayo Clinic College of Medicine
Mayo Clinic Depression Center
Rochester, Minnesota



Method of Participation

Participants should read the activity information, review the activity in its entirety, and complete the online post-test and evaluation. Upon completing this activity as designed and achieving a passing score on the post-test, you will be directed to a webpage that will allow you to receive your certificate of credit via email or you may print it out at that time.

The online post-test and evaluation can be accessed at

Inquiries about CME accreditation may be directed to the University of Cincinnati at or 513-558-3197.

Joint provider statements


This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the University of Cincinnati and Global Academy for Medical Education. The University of Cincinnati is accredited by the ACCME to provide continuing education for physicians.

Physician Credit Designation
The University of Cincinnati designates this Live Activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Physician Assistants Credit Designation
The American Academy of Physician Assistants (AAPA) accepts AMA PRA Category 1 Credit(s)™ from organizations accredited by the ACCME.

Disclosure Information

As part of their efforts to ensure balance, independence, objectivity, and scientific rigor, the joint providers of this CME/CE activity have required the faculty and all others involved in the development of the content to disclose any relationships they may have with commercial companies that have a product or service relevant to this activity.

Faculty Disclosures

In accordance with Accreditation Council for Continuing Medical Education (ACCME) Essential Areas and Policies, information about the relationships of presenters with commercial interests (if any) will be included in materials distributed at the conference.

Mark A. Frye, MD
Has indicated that he has received research grants from AssureRx Health Inc, Mayo Foundation, and Myriad Genetics Inc. Dr Frye has been a consultant for Janssen Pharmaceuticals Inc, Mitsubishi Tanabe Pharma Corporation, Myriad Genetics Inc, Neuralstem Inc, Otsuka America Pharmaceuticals Inc, Sunovion Pharmaceuticals Inc, and Teva Pharmaceuticals. Mayo Clinic has a financial interest in AssureRx Health Inc.

Planning Committee Members

Barbara Forney No Relevant Relationships
Bruce Gebhardt, MD No Relevant Relationships
Shirley Jones No Relevant Relationships
Ruth Kollmer No Relevant Relationships
Margaret McLaughlin, PhD No Relevant Relationships
Susan P. Tyler No Relevant Relationships

Resolution of Conflicts of Interest

In accordance with the ACCME Standards for Commercial Support of CME, University of Cincinnati will implement mechanisms, prior to the planning and implementation of this CME activity, to identify and resolve conflicts of interest for all individuals in a position to control content of this CME activity.

Off-Label Disclosure

The faculty have been instructed to identify investigational drugs or devices or discussion of drugs or devices that is outside of labeling currently approved by the US Food and Drug Administration.

Contact Information for Technical Questions

Please technical questions or concerns to Global Academy for Medical Education at 973-290-8225 or email

Copyright Statement

Copyright © 2019 by Global Academy for Medical Education, LLC, Frontline Medical Communications Inc., and its Licensors. All rights reserved. No part of this publication may be reproduced or transmitted in any form, by any means, without prior written permission of the Publisher. Global Academy for Medical Education, LLC, University of Cincinnati, Postgraduate Institute for Medicine, and Frontline Medical Communications will not assume responsibility for damages, loss, or claims of any kind arising from or related to the information contained in this publication, including any claims related to the products, drugs, or services mentioned herein.