Editor’s note – this post got quite a lot of attention recently, so I brought it forward to today….
A recent study conducted under clinical criteria highlighted something terrifying for those of us who live with, love someone with, or care for people in our community with bipolar disorder.
Relapse and impairment in bipolar disorder
MJ Gitlin, J Swendsen, TL Heller and C Hammen
Department of Psychiatry, University of California, Los Angeles 90024- 6968, USA.
OBJECTIVE: The purpose of this study was to evaluate the outcome of bipolar disorder in the context of maintenance pharmacotherapy.
METHOD: Eighty-two bipolar outpatients were followed prospectively for a mean of 4.3 years (minimum of 2 years); symptom rating and psychosocial outcome scales were used, and pharmacotherapy was rated on a 5-point scale.
RESULTS: Despite continual maintenance treatment, survival analysis indicated a 5-year risk of relapse into mania or depression of 73%. Of those who relapsed, two-thirds had multiple relapses. Relapse could not be attributed to inadequate medication. Even for those who did not relapse, considerable affective morbidity was observed. A measure of cumulative affective morbidity appeared to be a more sensitive correlate of psychosocial functioning than was the number of relapses. Poor psychosocial outcome paralleled poor syndromal course. Poor psychosocial functioning, especially occupational disruption, predicted a shorter time to relapse. Depressions were most strongly related to social and family dysfunction.
CONCLUSIONS: Even aggressive pharmacological maintenance treatment does not prevent relatively poor outcome in a significant number of bipolar patients.
These conclusions are not new – your own Doctor or GP will tell you these things, citing it as the primary reason that you should be placed and stay on medication. Its important however, to note that ‘even aggressive pharmacological mantinence’ doesn’t change this outcome – meds don’t always help. The highest rates of ‘success’ with bipolar disorder come from the patients that understand their mood swings, their reasoning, their reactions – the underlying chemistry that changes their moods, and their investigation into tailoring their own understanding and treatment of their disorder.
Bipolar disorder is debilitating for some people – it can destroy lives, families and support structures that otherwise would survive anything – and its important to ensure that if you, or a loved one, has a mental health issue of any kind, including bipolar disorder, that you are fully informed and can face the consequences, gifts and obstacles of that diagnosis with dignity, pride and preparation.
D Kai Wilson
D Kai Wilson is a writer, artist, and bipolar one businesswoman with an avid interest in bipolar disorder.
Her first book, ‘Pictures in the Dark – a bipolar’s guide to good mental health’ is available today from http://nonfiction.booksbykai.com