There is growing consensus that a major obstacle to good outcome among individuals with bipolar disorder (BD) is premature discontinuation of medications. Risks associated with discontinuation of medication among individuals with BD are well documented and include manic and depressive relapse, re-hospitalization and more lengthy hospital stays. A relatively limited, but growing literature suggests that it is possible to enhance treatment adherence among patients with BD. The most positive evidence for the improvement of medication adherence among patients with BD comes from specific psychosocial interventions used in conjunction with pharmacotherapies. It has been suggested that improved treatment adherence is at least a partial component of the observed positive outcomes of psychoeducational approaches among bipolar populations.

Recent data suggests that particularly common barriers to optimal medication adherence among individuals with BD are inadequate or incorrect knowledge of BD and BD treatments, comorbid substance abuse, poor communication with care providers and difficulty with medication routines. Approaches that are tailored or "customized" towards vulnerabilities in maintaining adherence may be particularly fruitful.

A collaborative care model in which individuals are active participants in their own care decisions can potentially optimize adherence. The use of Peer Educators to assist in adherence modeling may be particularly useful in the case of individuals with BD and medical comorbidities such as diabetes. There is an urgent need for greater understanding of interventions that can be implemented in real-world settings that address patient, provider/system, and environmental/social factors that are critical to treatment adherence.