What is the Prognosis
There is no cure for bipolar disorder and it is an illness that should be carefully managed throughout a person’s life. Because the condition can have a high rate of misdiagnosis, it is often difficult for people living with the condition to get effective and timely treatment which will inevitably affect recovery outcomes. However, a high proportion of people with bipolar disorder can live productive and creative lives with early intervention and good treatment.
The justification for early and effective treatment is clear. As with schizophrenia, people living with bipolar disorder have higher mortality rates from suicide than the general population. Between 10 and 15% of patients with bipolar I disorder commit suicides and the risks appear to be highest during episodes of depression or mixed mania. Some studies have suggested that the risk for patients with bipolar II disorder is even higher.
Bipolar disorder can also affect cognition and behaviour over long periods. Studies suggest that people living with bipolar disorder can experience problems with short-term and long-term memory, information processing and mental agility. While these symptoms appear to be more acute during manic episodes, they can even persist between episodes. Some people living with bipolar disorder can also experience heightened awareness and periods of robust productivity and creativity during manic episodes, but they can also lead to distorted thinking and impaired judgement. In addition, many people with bipolar disorder experience mild depressive episodes and anxiety in between more extreme mood swings. These are frequently undertreated or not recognised. Often, these erratic symptoms make it difficult for people living with bipolar disorder to adhere to medications or to participate fully in engaged psychotherapy.
Community management of acute episodes of mania or depression depends on the degree of risk associated with the behaviours and mood. People will be hospitalised if their mania caused them to engage in life-threatening or risk-taking behaviours or if their depression triggers suicidal tendencies. A biopsychosocial approach that uses medication, but also acknowledges and treats the psychological and social aspects of the disorder, is the most effective method in the treatment of bipolar disorder.
Medication is important. Medications commonly used for bipolar disorder include:
- Antipsychotic medication: used to control psychotic symptoms and severe agitation and sometimes over a longer period to maintain stability
- Anticonvulsant medications: these are frequently used to help stabilise mood both in acute illness, but also over the longer term during maintenance therapy
- Lithium: which is the most commonly used mood stabiliser
- Antidepressant medications: that are used sometimes to help people recover from a depressive swing. These are best used in combination with lithium or an anticonvulsant medication
Psychological therapies are a very useful adjuncts to medication for the treatment and management of bipolar disorder. The therapy of choice is Cognitive Behavioural Therapy (CBT), but family therapy and other therapies can also be helpful. Bipolar disorder can be very stressful for the families of those with the disorder. There is also a high rate of substance abuse/dependence that may need to be treated. Improving coping mechanisms and identifying triggers to episodes can be achieved in this context. The development and adherence to a Wellness Recovery Action Plan can be a very useful strategy for prevention of relapse for people experiencing bipolar disorder.
Social interventions can also be important for people with bipolar disorder. Support support and improving social skills are important for some. However, others may need financial and other counselling for the damage that a manic episode can cause because of reckless spending and arguments and irritability with family members.