Abstract
A review of two centuries’ literature on the natural history of bipolar disorder,
including modern naturalistic studies and new data from a lifelong follow-up study
of 220 bipolar patients, reaches the following conclusions: the findings of modern
follow-up studies are closely compatible with those of studies conducted before the
introduction of modern antidepressant and mood-stabilizing treatments. Bipolar disorder
has always been highly recurrent and considered to have a poor prognosis.
Bipolar patients who have been hospitalized spend about 20% of their lifetime from
the onset of their disorder in episodes. Fifty percent of bipolar episodes last between
2 and 7 months (median 3 months). The intervals between the first few episodes tend
to shorten; later the episodes return at an irregular rhythm of about 0.4 episodes
per year with high interindividual variability. Switches from mania into mild depression
and from depression into hypomania were frequently reported in the 19th century and
the first half of the 20th.
Antidepressant and antimanic drugs have to be given as long as the natural episode
lasts. Given the poor outcome of bipolar disorders found in naturalistic follow-up
studies and our lifelong investigation, intensive antidepressant, antimanic, and mood-stabilizing
treatments are required in most cases. Despite modern treatments the outcome into
old age is still poor, full recovery without further episodes rare, recurrence of
episodes with incomplete remission the rule, and the development of chronicity and
suicide still frequent.
Keywords
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Article info
Publication history
Accepted:
April 20,
2000
Received in revised form:
April 13,
2000
Received:
January 13,
2000
Identification
Copyright
© 2000 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
