Depression

Bipolar disorder is a lifelong condition. Bipolar I disorder is generally considered to have a poorer long-term outcome than Major Depressive Disorder. The reasons for this are unclear but may be a result of poor compliance with medical treatment. Bipolar II disorder and the soft bipolar spectrum disorders have a better outcome

The course varies from person to person. Bipolar disorder can start with major depression or a manic episode. Manic episodes usually begin suddenly with a rapid escalation of symptoms over a few days. They tend to be shorter and end more abruptly than depressive episodes. It is important to note that over a lifetime patients with bipolar mood disorder have a much higher likelihood of suffering from a depressive episode than from a hypomanic/manic episode. For some there may be long symptom-free periods between episodes. Episodes have been described to last for days, weeks or months. However, more recent research suggests that some individuals may experience several switches in mood state within one day. The average person with bipolar I disorder has four episodes (manic or depressed) during the first ten years of the illness. A minority of people may have several episodes of mania and depression with only brief periods of normal moods in between.

If properly controlled by medication, a person can lead a full, productive life. If left untreated, moods will continue to swing from one extreme to another and cause severe impairment in functioning. The time period between episodes usually narrows and episodes become more severe. In such cases, suicide is a real danger, especially if the person abuses substances and/or suffers from anxiety.

Reviewed by Dr Stefanie van Vuuren, Psychiatrist, MB ChB (Stell), M Med (Psig) (Stell), FC (Psych)SA, (November, 2010)

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