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Bipolar II Disorder Is Chronic

Patients reported symptoms 54% of weeks during a mean of 13 years, and somatic treatment frequently seemed inadequate.

Bipolar disorder is traditionally regarded as an episodic condition, but many clinicians find that their bipolar patients are more often ill than well. In this prospective study at 5 academic centers involving 86 patients with DSM-III bipolar II disorder, symptom status was repeatedly assessed via structured interviews (mean follow-up, 13.4 years). Patients were drawn from the NIMH Collaborative Depression Study.

Patients were asked to reconstruct week-by-week symptoms every 6 months during the first 5 years of follow-up and then once a year; memory cues were used to aid patients' recall. To limit the influence of denial or exaggeration of symptoms, patients were not interviewed when grossly symptomatic. Interviewers also analyzed medical records and systematically recorded weekly medication use.

Patients were symptomatic for a mean of 54% of weeks: Subsyndromal symptoms during 16% of weeks; minor depression, dysthymia, or hypomania during 25%; and DSM-III-defined major depressive episodes during 13%. Depressive symptoms were 39 times more frequent than hypomanic symptoms and 22 times more common than cycling/mixed symptoms. Patients received medication 54% of weeks when symptomatic and 42% of weeks when symptom-free. Antidepressants were prescribed without mood stabilizers during 26% of weeks and with mood stabilizers during 22% of weeks; mood stabilizers alone were used only during 1% of weeks.

Comment: Although this study was prospective, symptom recall (even with memory cues) every 6 to 12 months was retrospective, limiting conclusions and possibly explaining why cycling and mixed symptoms seemed so infrequent when most clinicians see them often. However, the results do suggest that bipolar-II patients spend much time in (or at least perceiving) depression and that, even at these academic centers, treatment is frequently inadequate.

— Steven Dubovsky, MD

Published in Journal Watch Psychiatry April 24, 2003

Citation(s):

Judd LL et al. A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder. Arch Gen Psychiatry 2003 Mar; 60:261-9.

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