Is bipolar disorder considered a chronic, long-term, or permanent condition for FMLA forms and does it require multiple treatments?

Bipolar Disorder Classification for FMLA Forms

Bipolar disorder should be documented on FMLA forms as both a chronic/long-term condition AND a permanent condition that requires multiple treatments. 1, 2, 3

Nature of the Illness

Bipolar disorder is explicitly characterized as a lifelong illness with a chronic or recurrent course. 1, 3 The condition is generally considered permanent once diagnosed, as it represents a baseline pattern of mood dysregulation that persists throughout the individual's lifetime. 1

Key characteristics supporting this classification:

• Chronicity: The disorder presents as chronic difficulties regulating moods, emotions, and behavior, representing fairly stable baseline patterns rather than isolated episodes. 1
• Lifelong nature: Bipolar disorder is fundamentally a lifelong condition, with the general population prevalence of approximately 2.6% remaining stable because individuals do not "outgrow" the illness. 1, 4
• Recurrent course: The illness is characterized by recurrent episodes of depression and mania/hypomania that continue throughout the patient's life. 5, 2

Multiple Treatment Requirement

Bipolar disorder unequivocally requires multiple treatments, both acutely and long-term. 6, 2, 3

Pharmacological Requirements

• Long-term prophylactic treatment is mandatory, not optional, as bipolar disorder requires ongoing medication management to reduce frequency and intensity of episodes. 6, 3, 7
• Combination therapy is frequently necessary, with more than 50% of patients requiring multiple medications to manage symptoms across different phases of illness. 5, 2
• First-line treatments include mood stabilizers (lithium, valproate, lamotrigine) and atypical antipsychotics (quetiapine, aripiprazole, lurasidone, cariprazine). 2

Psychosocial Treatment Requirements

• Adjunctive psychotherapy is often necessary in addition to pharmacotherapy, including evidence-based approaches like interpersonal social rhythm therapy, family-focused treatment, and cognitive-behavioral therapy. 5, 8
• Treatment must address high rates of comorbid conditions including anxiety disorders, substance abuse, and personality disorders. 8

Duration and Prognosis

The chronic nature is further evidenced by:

• Approximately 75% of symptomatic time consists of depressive episodes or symptoms, indicating near-constant treatment needs. 2
• High relapse rates: Even with ongoing mood stabilizer therapy, 64% of patients relapse after recovery from an index episode. 1
• Reduced life expectancy by 12-14 years, with increased cardiovascular mortality and suicide risk (annual rate of 0.9% vs 0.014% in general population), necessitating continuous medical monitoring. 2

FMLA Documentation Recommendations

For FMLA forms, check all applicable boxes:

• ✓ Chronic condition: The disorder represents ongoing, persistent mood dysregulation. 1
• ✓ Long-term/permanent condition: It is a lifelong illness requiring indefinite treatment. 1, 3
• ✓ Requires multiple treatments: Both pharmacological and psychosocial interventions are necessary. 5, 2
• ✓ Requires continuing treatment: Long-term prophylactic medication and monitoring are mandatory to prevent episodes and reduce mortality. 6, 3, 7

Common pitfall: Do not classify bipolar disorder as a temporary or episodic condition simply because patients may experience periods of remission between episodes. The underlying disorder remains present and requires continuous treatment even during asymptomatic periods. 3, 7