With every increase or decrease in depressive symptom severity, there is a corresponding significant and stepwise increase or decrease in psychosocial disability among patients with bipolar disorder.

The study is published in the Archives of General Psychiatry.

Bipolar disorder is characterized by cycles of depression and mania.
It has been found to be associated with increased suicidal behavior, increased health care use and costs, higher unemployment, higher dependence on public assistance, lower annual income, increased work absenteeism owing to illness, decreased work productivity, poorer overall functioning, lower quality of life, and decreased life span.
Bipolar I disorder, which includes episodes of mania, and bipolar II disorder, which includes less severe episodes of hypomania, are dimensional illnesses in which patients experience fluctuating levels of severity of manic and depressive symptoms, interspersed with symptom-free periods.

Lewis L. Judd, of the University of California, San Diego School of Medicine, and colleagues conducted a study to provide detailed data on psychosocial disability in relation to symptom status during the long-term course of bipolar I disorder and bipolar II disorder.

They analyzed data on 158 patients with bipolar I disorder and 133 patients with bipolar II disorder who were followed up for an average of 15 years in the National Institute of Mental Health Collaborative Depression Study.

The authors found that symptom severity and psychosocial disability fluctuate together during the course of illness.

" Psychosocial impairment increases significantly with each increment in depressive symptom severity for bipolar I disorder and bipolar II disorder and with most increments in manic symptom severity for bipolar I disorder," they write.

" When patients with bipolar I disorder or bipolar II disorder have no mood disorder symptoms, their psychosocial functioning normalizes and is rated as good; when they are experiencing subsyndromal depression, psychosocial functioning is between good and fair; when minor depressive or dysthymic symptoms are present, functioning is fair; and when patients have symptoms at the threshold for major depression, functioning is poor," the authors write.

" These findings indicate that the depressive phase of bipolar illness is equal in importance to the manic or hypomanic phase, and they confirm the advantage of studying bipolar I disorder and bipolar II disorder separately," the authors conclude.

Source: American Medical Association, 2005


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