How Common Is Recovery From Bipolar Disorder?

Bipolar disorder can be a devastating and disabling psychiatric illness that often begins in young people and then runs an episodic clinical course. Do individuals with bipolar disorder get better? What does "getting better" mean? These questions are addressed in a study recently published in the Journal of Affective Disorders Reports by Melanie Katz, Ishnaa Gulati, and Esme Fuller-Thomson.

Individuals with bipolar disorder have “severe mood disturbances and significant shifts in energy, activity levels, quality of life, and the ability to carry out daily tasks, with recurrent episodes of mania and depression.” Those with bipolar I disorder experience more severe and disruptive highs and lows than those with bipolar II disorder. The combined prevalence of bipolar I and bipolar II disorder is about 2 percent of the general population.

Katz and colleagues analyzed data from the 2012 Canadian Community Health Survey-Mental Health, a representative sample of over 25,000 individuals. After excluding participants with incomplete data, there were 555 adults (20 years old and above) who reported that they had been diagnosed with either bipolar I or bipolar II disorder during their lifetimes.

The authors examined three outcome measures: 1) absence of bipolar disorder during the previous year; 2) absence of bipolar disorder and absence of depressive episodes, anxiety disorders, alcohol or drug dependence, and suicidal ideation during the previous year; 3) complete mental health, which they defined as the absence of psychiatric disorders during the previous year, emotional well-being (high level of happiness or life satisfaction), and social and psychological well-being. Well-being was ascertained by responses on a survey instrument.

Characteristics of the Samples

The mean age of the 555 people with a lifetime history of bipolar disorder was lower than the group without a history of bipolar disorder (40.3 years vs. 48.0 years). More participants with a history of bipolar disorder had experienced adverse childhood events such as exposure to chronic parental domestic violence, sexual abuse, or physical abuse (56 percent vs. 29 percent).

Certain psychiatric conditions were more common in those with a history of bipolar disorder, for example, a lifetime history of generalized anxiety disorder (45 percent vs. 8 percent) and a lifetime history of drug and/or alcohol use disorder (52 percent vs. 21.5 percent).

Outcomes

About 44 percent of those with a prior history of bipolar disorder no longer had enough symptoms to qualify for a current (preceding year) diagnosis of bipolar disorder. Furthermore, about 34 percent of those with a prior history of bipolar disorder were free of both bipolar disorder and other psychiatric disorders in the preceding year. In comparison, 93 percent of the group without a history of bipolar disorder were free of psychiatric disorders during the previous year.

About 23 percent of the individuals with a lifetime diagnosis of bipolar disorder fulfilled the criteria for complete mental health. This compares to 74 percent of the sample without bipolar disorder. Factors that were associated with achieving complete mental health by those with a history of bipolar disorder included “older age, higher household income, being married, having a confidant, utilizing religion or spirituality for coping, and being free from substance abuse or dependence and debilitating chronic pain.”

What This Means

Bipolar disorder can severely disrupt an individual’s life. Suicide attempts and completed suicides are unfortunately common in those with bipolar disorder. However, as demonstrated by this study, many individuals improve with a combination of appropriate somatic and psychologic therapies.

This study reveals that over the course of at least a year, about a quarter of individuals do well in terms of symptom remission, decreases in comorbid psychopathology, and emotional, social, and psychological well-being. Although 23 percent is far less than the 74 percent of those without bipolar disorder who do well, these data demonstrate the very real possibility that individuals can achieve favorable outcomes despite having a diagnosis of bipolar disorder. However, given the episodic course of bipolar illness, more systematic data about longer-term outcomes with these types of analyses are needed.

Bipolar Disorder Essential Reads

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Improved implementation of current treatments, more research to develop new treatments, improved efforts to treat co-morbid alcohol and substance use problems, societal efforts to decrease early childhood trauma, and decreasing stigma and discrimination directed against those with bipolar disorder should all help improve outcomes for people with this serious mental illness.

This column was written by Eugene Rubin, M.D., Ph.D., and Charles Zorumski, M.D.

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