Diagnosing bipolar disorder can be a long process. Physicians may only see a patient on days when they are in a low mood, and they may only catch the depressive part of the disorder. Likewise, if a physician only sees the mania in the patient, they may mistake the disorder for anxiety or another mental heath issue. Once a successful diagnosis has occurred, the patient may struggle to receive the right treatment. Each case can present unique symptoms or circumstances, along with co-morbidities with other mental disorders that make treatment complicated. As a result, many bipolar disorder patients may be on multiple medications at once. An article appearing in Clinical Psychiatry News highlights the results of a study that illustrates the complicated nature of effectively treating bipolar patients. The findings show that nearly one-third of patients diagnosed with bipolar disorder I had been prescribed at least four psychotropic medications when they were admitted to a psychiatric hospital. Bipolar disorder is characterized by alternating periods of low mood, or depression, and periods of mania. During the depressive phase of the disorder, a patient may feel lonely, sad and hopeless. They may experience insomnia and a lack of motivation. During the manic phase, the patient may exhibit pie-in-the-sky aspirations, high levels of energy and a decreased need for sleep. Bipolar disorder may be categorized according to the length of the phases of the symptoms. The disorder can severely affect quality of life, particularly if the patient struggles to find adequate treatment strategies to address the symptoms. Conversely, a patient may experience symptom relief with a particular therapy that can lose its effectiveness over time as symptoms change in intensity or duration. The study was led by Dr. Lauren M. Weinstock of Brown University, who teamed up with researchers at Butler Hospital in Providence Rhode Island. The researchers say that the findings are an indication of the challenge of managing a complicated set of symptoms. Weinstock told Clinical Psychiatry News that there is a balance between help and harm that physicians must manage. Monotherapies for bipolar disorder are often not an effective way to treat the symptoms. The researchers looked at the charts for 218 adults admitted to a single psychiatric hospital and used a computer algorithm to compare data. The patients\u2019 average age was 42, with a range of 18-77 years of age. Fifty-eight percent of the participants were female. About one-third of the patients (32 percent) were taking a minimum of four psychotropic medications when they were admitted. This level of medication prescription was associated with a higher level of comorbid anxiety disorder, depression and a history of suicide attempts. Females were also more likely to be taking multiple medications. Women were also more likely to be taking benzodiazepines, antidepressants and stimulants, even after the data was controlled for depressed mood. The researchers note that the results may indicate an increased risk of experiencing adverse side effects, as well as drug interactions. There may also be an increased risk for medication errors and a failure to adhere to the treatment prescribed. The researchers also expressed concern for the cost associated for both patients and the health care system in a situation with a complex polypharmacy. In the study, researchers stressed the need for additional research that can examine outpatient prescribing for bipolar disorder, including evaluating potential risks, especially for women, when iatrogenic complications occur without any indication of potential benefits. The researchers note that the findings may be limited by the design of the study. The researchers did not supplement their methods to examine the chart data and were unable to distinguish between recent changes to treatment strategies and long-standing prescriptions. In addition, 94 percent of the participants were white and had health insurance, so the findings may not be applicable to other segments of the population.