Skip to main content

Advertisement

SpringerLink
Log in

Long-term remission and recovery in bipolar disorder: A review

  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Longitudinal outcome studies of bipolar disorder show that most patients encounter affective recurrences, interepisode symptoms, and residual functional impairment. The kindling model suggests that the timing and periodicity of recurrent episodes may help to predict future illness course. This article examines contemporary data regarding patterns of affective recurrence, and the extent to which variable versus consistent or sustained remissions influence long-term illness course. Consequences of affective recurrence are examined from psychosocial, pharmacologic, and neurobiological perspectives. Multiple affective recurrences may be linked with subsequent treatment resistance, psychosocial disability, and possible functional neuroanatomic changes. Existing data support the prognostic importance of effective treatment early in the course of illness, with a goal to achieve and maintain clinical homeostasis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Kraeplin E: Psychiatrie. Liepzig: Verlag Von Johann Ambrosius Barth; 1913.

    Google Scholar 

  2. Coryell W, Turvey C, Endicott J, et al.: Bipolar I affective disorder: Predictors of outcome after 15 years. J Affective Disord 1998, 50:109–116.

    Article  CAS  Google Scholar 

  3. Judd LL, Akiskal HS, Schettler PJ, et al.: The long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen Psychiatry 2002, 59:530–537. This study reported patterns of variability in affective symptoms across weeks during a 12.8-year follow-up period, showing the chronicity and persistence of predominantly depressive symptoms.

    Article  PubMed  Google Scholar 

  4. Judd LL, Akiskal HS, Schettler PJ, et al.: A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder. Arch Gen Psychiatry 2003, 60:261–269.

    Article  PubMed  Google Scholar 

  5. Goldberg JF, Harrow M: Consistency of remission and outcome in bipolar and unipolar mood disorders: a 10-year prospective follow-up. J Affect Disord 2004, 81:123–131. This longitudinal study reported that early remission of an affective episode predicted later remission. The authors suggest that early and sustained remission is related to and prognostic of better subsequent psychosocial functioning and continued remission.

    Article  PubMed  Google Scholar 

  6. Maj M, Pirozzi R, Magliano L, Bartoli L: Long-term outcome of lithium prophylaxis in bipolar disorder: a 5-year prospective study of 402 patients at a lithium clinic. Am J Psychiatry 1998, 155:30–35.

    PubMed  CAS  Google Scholar 

  7. Tohen M, Waternaux CM, Tsuang MT: Outcome in mania: A 4-year prospective follow-up of 75 patients utilizing survival analysis. Arch Gen Psych 1990, 47:1106–1111.

    CAS  Google Scholar 

  8. Gitlin MJ, Swendsen J, Heller TL, Hammen C: Relapse and impairment in bipolar disorder. Am J Psychiatry 1995, 152:1635–1640.

    PubMed  CAS  Google Scholar 

  9. Tohen M, Zarate CA Jr., Hennen J, et al.: The McLean-Harvard First Episode Mania Study: prediction of recovery and first recurrence. Am J Psychiatry 2003, 160:2099–2107. The McLean-Harvard First Episode Mania Study has generated the most extensive data available to date for prospectively tracking the subsequent course of illness after an initial manic episode. This article identifies the lag between functional and syndromic or symptomatic recovery independent of the effects of illness chronicity.

    Article  PubMed  Google Scholar 

  10. Altshuler LL, Gitlin MJ, Mintz J, et al.: Subsyndromal depression is associated with functional impairment in patients with bipolar disorder. J Clin Psychiatry 2002, 63:807–811.

    PubMed  Google Scholar 

  11. Keller MB, Lavori PW, Kane JM, et al.: Subsyndromal symptoms in bipolar disorder. A comparison of standard and low serum levels of lithium. Arch Gen Psychiatry 1992, 49:371–376.

    PubMed  CAS  Google Scholar 

  12. Goldberg JF, Ernst CL: Clinical correlates of childhood and adolescent adjustment in adult patients with bipolar disorder. J Nerv Ment Dis 2004, 192:187–192.

    Article  PubMed  Google Scholar 

  13. Hirschfeld RM, Lewis L, Vornik LA: Perceptions and impact of bipolar disorder: how far have we really come? Results of the national depressive and manic-depressive association 2000 survey of individuals with bipolar disorder. J Clin Psychiatry 2003, 64:161–174.

    Article  PubMed  Google Scholar 

  14. Perlis RH, Miyahara S, Marangell LB, et al.: Long-term implications of early onset in bipolar disorder: data from the first 1000 participants in the systematic treatment enhancement program for bipolar disorder (STEP-BD). Biol Psychiatry 2004, 55:875–881. The NIMH STEP-BD program represents the largest study to date of individuals with bipolar disorder. This report describes features related to early age at onset, underscoring the importance of early recognition and illness stabilization to minimize future morbidity and suicide risk.

    Article  PubMed  Google Scholar 

  15. Thompson KN, Conus PO, Ward JL, et al.: The initial prodrome to bipolar affective disorder: prospective case studies. J Affect Disord 2003, 77:79–85.

    Article  PubMed  Google Scholar 

  16. Goldberg JF, Ernst CL: Features associated with delayed initiation of mood stabilizers at illness onset in bipolar disorder. J Clin Psychiatry 2002, 63:985–991.

    PubMed  Google Scholar 

  17. Baldessarini RJ, Tondo L, Hennen J: Treatment-latency and previous episodes: relationships to pretreatment morbidity and response to maintenance treatment in bipolar I and II disorders. Bipolar Disord 2003, 5:169–179.

    Article  PubMed  Google Scholar 

  18. Strakowski SM, DelBello MP, Fleck DE, Adler CM, Anthenelli RM, Keck PE Jr, Arnold LM, Amicone J: Effects of co-occurring alcohol abuse on the course of bipolar disorder following a first hospitalization for mania. Arch Gen Psychiatry 2005, 62:851–858.

    Article  PubMed  Google Scholar 

  19. McElroy SL, Altshuler LL, Suppes T, et al.: Axis I Psychiatric Comorbidity and its relationship to historical illness variables in 288 patients with bipolar disorder. Am J Psychiatry 2001, 158:420–426.

    Article  PubMed  CAS  Google Scholar 

  20. Baethge C, Baldessarini RJ, Khalsa H-MK, et al.: Substance abuse in first-episode bipolar I disorder: indications for early intervention. Am J Psychiatry 2005, 162:1008–1010.

    Article  PubMed  Google Scholar 

  21. Regier DA, Farmer ME, Rae DS, et al.: Comorbidity of mental disorders with alcohol and other drug abuse: results from the epidemiologic catchment area (ECA) study. JAMA 1990, 264:3511–2518.

    Article  Google Scholar 

  22. Dunayevich E, Strakowski SM, Sax KW, et al.: Personality disorders in first- and multiple-episode mania. Psychiatr Res 1996, 64:69–75.

    Article  CAS  Google Scholar 

  23. Post RM, Rubinow DR, Ballenger JC: Conditioning and sensitization in the longitudinal course of affective illness. Br J Psychiatry 1986, 149:191–201.

    Article  PubMed  CAS  Google Scholar 

  24. Ghaemi SN, Boiman EE, Goodwin FK: Kindling and second messengers: An approach to the neurobiology of recurrence in bipolar disorder. Biol Psychiatry 1999, 45:137–144.

    Article  PubMed  CAS  Google Scholar 

  25. Goldberg JF, Harrow M: Kindling in bipolar disorders: a longitudinal follow-up study. Biol Psychiatry 1994, 35:70–72.

    Article  PubMed  CAS  Google Scholar 

  26. Drevets WC, Price JL, Simpson Jr JR, et al.: Subgenual prefrontal cortex abnormalities in mood disorders. Nature 1997, 386:824–827.

    Article  PubMed  CAS  Google Scholar 

  27. Franchini L, Zanardi R, Smeraldi E, et al.: Early onset of lithium prophylaxis as a predictor of good long-term outcome. Eur Arch Psychiatr Clin Neurosci 1989, 249:227–230.

    Article  Google Scholar 

  28. Bratti IM, Baldessarini RJ, Baethge C, Tondo L: Pretreatment episode couont and response to lithium treatment in manicdepressive illness. Harv Rev Psychiatry 2003, 11:245–256.

    PubMed  Google Scholar 

  29. Swann AC, Bowden CL, Calabrese JR, et al.: Differential effect of number of previous episodes of affective disorder on response to lithium or divalproex in acute mania. Am J Psychiatry 1999, 156:1264–1266.

    PubMed  CAS  Google Scholar 

  30. Altshuler LL: Bipolar disorder: Are repeated episodes associated with neuroanatomic and cognitive changes? Biol Psychiatry 1993, 33:563–565.

    Article  PubMed  CAS  Google Scholar 

  31. Martinez-Aran A, Vieta E, Colom F, et al.: Cognitive impairment in euthymic bipolar patients: implications for clinical and functional outcome. Bipolar Disord 2004, 6:224–232.

    Article  PubMed  CAS  Google Scholar 

  32. Bearden CE, Hoffman KM, Cannon TD: The neuropsychology and neuroanatomy of bipolar disorder: a critical review. Bipolar Disord 2001, 3:106–150.

    Article  PubMed  CAS  Google Scholar 

  33. Lebowitz BK, Shear PK, Steed MA, Strakowski SM: Verbal fluency in mania: relationship to number of manic episodes. Neuropsychiatr Neuropsychol Behav Neurol 2001, 14:177–182.

    CAS  Google Scholar 

  34. Vita A, Sacchetti E, Cazzullo: A CT scan follow-up study of cerebral ventricular size in schizophrenia and major affective disorder. Schizophr Res 1988, 1:165–166.

    Article  Google Scholar 

  35. Young RC, Patel A, Meyers BS, et al.: Alpha(1)-acid glycoprotein, age, and sex in mood disorders. Am J Geriatric Psychiatry 1999, 7:331–334.

    CAS  Google Scholar 

  36. Mills NP, Delbello MP, Adler CM, Strakowski SM: MRI analysis of cerebellar vermal abnormalities in bipolar disorder. Am J Psychiatry 2005, 162:1530–1532.

    Article  PubMed  Google Scholar 

  37. Strakowski SM, DelBello MP, Zimmerman ME, et al.: Ventricular and periventricular structural volumes in first versus multiple-episode bipolar disorder. Am J Psychiatrty 2002, 159:1841–1847.

    Article  Google Scholar 

  38. Blumberg HP, Kaufman J, Martin A, et al.: Amygdala and hippocampal volumes in adolescents and adults with bipolar disorder. Arch Gen Psychiatry 2003, 60:1201–1218.

    Article  PubMed  Google Scholar 

  39. Strakowski SM, DelBello MP, Sax KW, et al.: Brain magnetic resonance imaging of structural abnormalities in bipolar disorder. Arch Gen Psychiatry 1999, 56:254–260.

    Article  PubMed  CAS  Google Scholar 

  40. Hammen C, Gitlin M: Stress reactivity in bipolar patients and its relation to prior history of disorder. Am J Psychiatry 1997, 154:856–857.

    PubMed  CAS  Google Scholar 

  41. Garno JL, Goldberg JF, Ramirez PM, Ritzler BA: Impact of childhood abuse on the clinical course of bipolar disorder. Br J Psychiatry 2005, 186:121–125.

    Article  PubMed  Google Scholar 

  42. Leverich GS, McElroy SL, Suppes T, et al.: Early physical and sexual abuse associated with an adverse course of bipolar illness. Biol Psychiatry 2002, 51:288–297.

    Article  PubMed  Google Scholar 

  43. DeBellis MD, Baum AS, Birmaher B, et al.: Developmental traumatology I: Biological stress systems. Biol Psychiatry 1999, 45:1259–1270.

    Article  CAS  Google Scholar 

  44. Keck Jr PE, Perlis RH, Otto MW, et al.: The Expert Consensus Guideline Series: Treatment of Bipolar Disorder 2004. Postgrad Med 2004, Spec No:1-120.

  45. Suppes T, Baldessarini RJ, Faedda GL, et al.: Discontinuation of maintenance treatment in bipolar disorder: risks and implications. Harv Rev Psychiatry 1993, 1:131–144.

    PubMed  CAS  Google Scholar 

  46. Tohen M, Chengappa KN, Suppes T, et al.: Relapse prevention in bipolar I disorder: 18-month comparison of olanzapine plus mood stabilizer v. mood stabilizer alone. Br J Psychiatry 2004, 184:337–345.

    Article  PubMed  Google Scholar 

  47. Altshuler L, Suppes T, Black D, et al.: Impact of antidepressant discontinuation after acute bipolar depression remission on rates of depressive relapse at 1-year follow-up. Am J Psychiatry 2004, 161:1312–1313. This controversial report suggested that, contrary to the recommendations of some practice guidelines to limit exposure time to antidepressants, their long-term use (ie, up to 1 year) after remission is associated with significantly fewer depressive recurrences. However, the findings of this report are limited to a small number of depressed bipolar patients without rapid cycling who initially respond to antidepressants (~15%), and the nonrandomized study design precludes causal inferences about treatment effects and outcomes.

    Article  Google Scholar 

  48. Goldberg JF, Ghaemi N: Benefits and limitations of antidepressants and traditional mood-stabilizers for treatment of bipolar depression. Bipolar Disord, In press.

  49. Goldstein TR, Frye MA, Denicoff KD, et al.: Antidepressant discontinuation-related mania: critical prospective observation and theoretical implications in bipolar disorder. J Clin Psychiatry 1999, 60:563–567.

    Article  PubMed  CAS  Google Scholar 

  50. Coryell W, Solomon D, Turvey C, et al.: The long-term course of rapid-cycling bipolar disorder. Arch Gen Psychiatry 2003, 60:914–920. This report from the NIMH Collaborative Depression Study identifies depression, rather than antidepressants, as a more proximal contributor to cyclicity in rapid cyclers, challenging previous reports that antidepressants may cause rapid cycling. Though an important dataset, the conclusions of the study are tempered by its noncontrolled design and retrospective nature.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Silver Hill Hospital, 208 Valley Road, 06840, New Canaan, CT, USA

    Joseph F. Goldberg MD

Authors
  1. Joseph F. Goldberg MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jessica L. Garno PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Martin Harrow PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Goldberg, J.F., Garno, J.L. & Harrow, M. Long-term remission and recovery in bipolar disorder: A review. Curr Psychiatry Rep 7, 456–461 (2005). https://doi.org/10.1007/s11920-005-0067-7

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-005-0067-7

Keywords

Search

Navigation