Course and variants of Bipolar Disorders

The hallmark of Bipolar disorders is that this illness is episodic with phases or cycles of mania (hypomania) and depression. People do not usually suffer from mania and depression at the same time, but when they do it is described as a mixed affective state. In between episodes of mania and depression, mood may be normal. Any phase may last weeks to months at a time. Episodes of acute mania, whether or not treated, tend to last six months. The condition does, however, recur and often becomes a long term disabling condition. Often greater long-term disability arises from the depressive phases because they are more resistant to treatment.

Rapid cycling disorders are those in which a pattern of frequent relapse and remission occurs (at least 4 episodes a year). Episodes may be manic, depressive or a mixture of both. This type of illness is more commonly seen in women.

The term mixed affective disorder is used to describe the situation in which people have manic/hypo manic and depressive symptoms at the same time. This is commoner in younger people.

For any individual the aims of treatment are to alleviate the severe effects of the manic or depressive phase, to stabilise mood between episodes and to lengthen the intervals free of disabling symptoms. Describing the mood as stabilised does not necessarily mean that the mood is normal, or that the condition should be regarded as cured. 90% of people who have an episode of mania will go on to have a recurrence of mania or depression. Episodes of mania or hypo mania may respond relatively quickly to treatment, but the long-term disabling effects are due to the recurrent nature of the illness and the lack of effective treatment, in particular of the depressive episodes.