Harvard Mental Health Letter

Improving outcomes in bipolar disorder

Psychosocial therapies augment medication, but challenges remain.

Although bipolar disorder is diagnosed largely on the basis of whether a manic or hypomanic episode has occurred, the condition's most painful burden may be depression and disability. In fact, bipolar disorder is the sixth leading cause of disability worldwide.

Disability is partly a consequence of the high rate of relapse for episodes of both mania and depression. For example, in a study of people with bipolar disorder type 1, characterized by episodes of mania (rather than hypomania) with or without depression, researchers followed patients after they suffered a manic or depressive episode. They found that 37% of patients experienced a recurrence of mania or depression within a year, 60% within two years, and 73% within five years.

Full recovery from a manic or depressive episode — if it is achieved — may take months, even years. One study of patients who had been hospitalized for a manic episode and were then followed after discharge found that 48% of patients recovered from symptoms by the end of a year, but only 24% returned to normal life functioning. Another study found that aftereffects of a manic episode continued to affect work, social, and family relations as long as five years later.

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