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Journal compilation \u00a9 2012 John Wiley &amp; Sons A\/S.<\/jats:p><jats:p><jats:bold>Objectives:\u2002<\/jats:bold> Many patients diagnosed with bipolar disorder (BD) respond incompletely or unsatisfactorily to available treatments. Given the potentially devastating nature of this prevalent disorder, there is a pressing need to improve clinical care of such patients.<\/jats:p><jats:p><jats:bold>Methods:\u2002<\/jats:bold> We performed a literature review of the research findings related to treatment\u2010resistant BD reported through February 2012.<\/jats:p><jats:p><jats:bold>Results:\u2002<\/jats:bold> Therapeutic trials for treatment\u2010resistant bipolar mania are uncommon, and provide few promising leads other than the use of clozapine. Far more pressing challenges are the depressive\u2010dysthymic\u2010dysphoric\u2010mixed phases of BD and long\u2010term prophylaxis. Therapeutic trials for treatment\u2010resistant bipolar depression have assessed anticonvulsants, modern antipsychotics, glutamate [N\u2010methyl\u2010D\u2010aspartate (NMDA)] antagonists, dopamine agonists, calcium\u2010channel blockers, and thyroid hormones, as well as behavioral therapy, sleep deprivation, light therapy, electroconvulsive therapy (ECT), transcranial magnetic stimulation, and deep brain stimulation\u2014all of which are promising but limited in effectiveness. Several innovative pharmacological treatments (an anticholinesterase, a glutamine antagonist, a calcium\u2010channel blocker, triiodothyronine, olanzapine and topiramate), ECT, and cognitive\u2010behavior therapy have some support for long\u2010term treatment of resistant BD patients, but most of trials of these treatments have been methodologically limited.<\/jats:p><jats:p><jats:bold>Conclusions:\u2002<\/jats:bold> Most studies identified were small, involved supplementation of typically complex ongoing treatments, varied in controls, randomization, and blinding, usually involved brief follow\u2010up, and lacked replication. Clearer criteria for defining and predicting treatment resistance in BD are needed, as well as improved trial design with better controls, assessment of specific clinical subgroups, and longer follow\u2010up.<\/jats:p>","DOI":"10.1111\/j.1399-5618.2012.01042.x","type":"journal-article","created":{"date-parts":[[2012,9,3]],"date-time":"2012-09-03T09:17:16Z","timestamp":1346663836000},"page":"573-584","source":"Crossref","is-referenced-by-count":52,"title":["Evidence\u2010based options for treatment\u2010resistant adult bipolar disorder patients"],"prefix":"10.1111","volume":"14","author":[{"given":"Shi Hui","family":"Poon","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kang","family":"Sim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Min Yi","family":"Sum","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carissa 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