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Progression and Prognosis of Bipolar Disorder

Reviewed by: HU Medical Review Board | Last reviewed: September 2023

Bipolar disorder (BPD) is a chronic, or long-term, mental health condition. It causes intense changes in mood, energy levels, and behavior. A person’s moods swing between mania or hypomania (milder mania) and depression. Most people also have periods of stable mood.1

Prognosis of bipolar disorder

“Prognosis” is the medical term for what is most likely to happen in the future when someone has a health condition. Prognosis also refers to a person’s chances of recovery or relapse.2

BPD does not get better if it is left untreated. In fact, mood episodes get increasingly worse over time. BPD requires treatment with a combination of medicines, talk therapy, and self-care. Most people need consistent, life-long care.1,3,4

With treatment and self-care, many people with BPD lead happy, productive lives. Some gradually develop a higher tolerance to the stresses that originally triggered episodes.3,4

Progression of bipolar disorder

Doctors now recognize that many people’s bipolar symptoms get worse over time. This process is called sensitization. Sensitization means that a person becomes more sensitive to the triggers that cause their moods to get off-balance.4

Some people may be triggered by stressful events, such as a loved one’s death or the end of a relationship. Some may be triggered by unemployment or bouts of substance use. For others, their bipolar episodes themselves are the stressor.3,4

People at higher risk for developing sensitization include:5

  • People who do not respond to lithium
  • People who have rapid cycles or mixed cycles
  • People who are younger when their first episode occurs

Types of sensitization

Three kinds of stress that commonly lead to sensitization are stress, substance use, and bipolar episodes:4

  • Stress sensitization – When someone experiences a stress that reminds them of earlier events. For example, someone who experienced abuse as a child is triggered by abuse in adulthood.
  • Substance use sensitization – When someone repeatedly uses alcohol or drugs that cause changes to take place in their brain. These changes make it easier for new mood swings to occur.
  • Episode sensitization – When repeated rounds of bipolar depression make a person more likely to have more severe depression more often, with less stable times in between episodes.

Symptoms of sensitization

Sensitization is a complex complication of BPD, and its symptoms may vary widely from person to person. Some of the things linked to bipolar sensitization include:4

  • Mood episodes happen faster
  • Stable periods in between episodes are shorter
  • New mood episodes are triggered by less and less severe stress
  • Other mental and physical health conditions build up
  • Substance abuse becomes more likely
  • Ability to think and concentrate declines with each episode
  • Medicines and other treatments become less effective
  • Self-care routines break down
  • Risk of dementia increases

Most people think of BPD as a mental health condition. But with each mood episode, changes take place in the brain and body. Some doctors believe this is why cardiovascular disease, inflammation, and changes in how cells work are common in people with BPD.3,4

Recovering from bipolar episodes

There are many things that figure into how long someone’s mania or depression episodes last, how quickly they recover from them, and how long they stay in balance. The most important factors in getting well and staying well with BPD include:3-5

  • How quickly someone gets treatment when moods and behaviors begin to change
  • How consistent someone is about their treatment plan
  • How proactive the person is about self-management techniques and self-care
  • Whether they have support and encouragement from friends and family
  • Whether they are able to get and keep a job, especially one with health insurance
  • How many other co-occurring health conditions they have, especially substance use disorder and other mental health conditions

Personal factors linked to better outcomes include:5

  • Being married
  • Having a higher level of education
  • Having fewer years of illness

Avoiding sensitization

Certain people are at higher risk of developing sensitization. People with a family history of BPD and a traumatic childhood are at higher risk for early onset of the condition. However, early diagnosis and certain self-management methods can reduce this risk. These self-management methods include:4,5

  • Eating a healthy diet
  • Getting regular exercise
  • Maintaining a healthy weight
  • Reducing stress
  • Forming good sleep habits

Studies also show that consistent, aggressive treatment after a first episode of mania also helps reduce the risk of sensitization. Early research suggests that treatment with a combination of medicines (not just lithium), therapy, and self-management techniques is common for the best outcome.4

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