Range of Remission in BPI & BPII
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Q:  What is the range of remission in bipolar and bipolar II?

Dear Heather -- 
Well there's a question it would be nice to have a good answer for, eh?  Unfortunately, you'll see that we don't have really good data on that.  I'll show you just a little that will give you a taste of the results and the difficulty in such research.  Obviously, the main problem is that to really answer this question you'd need to follow a (1) large group of people in a (2) really systematic way for a (3) good long time.  Those are the three main reasons (because they all translate into "money") why we don't have good answer. 

The main research group that's studying this published 6-month results more than 2 years ago, so by now there will be more they can say, but I haven't seen it or found it on searching today.  That's Mauricio Tohen's group at Harvard, here's the article on 6-month outcomes, and if you can dig up something (maybe even by calling the research group at Harvard) from their more recent work, that may go farther on this answer.  

Here's a two-year look in Bipolar I, which shows some of the factors which seemed to predict outcome to some degree. 

And here's a look at some research in kids, who were followed as long as 8 years, the longest study I found today, but you'll note that it only had 26 kids in it.  (It's like somebody said about buying a product, like a hamburger: you can have it fast and cheap, or cheap and good, but you can't have fast/good/cheap all at once. In this case, it's too costly to have large numbers, close measurements, and long-term follow-up all at the same time!).   

Now I heard Tohen speak once and say that 10% of people who have a psychotic episode and are hospitalized won't have one again, and that may reflect his long study of this issue, but you can imagine how hard it would be to come up with good numbers to support that statement.  

And as for bipolar II, which is generally less studied, well, sorry, not much to report.  I'll tell you what I see, which ends up sounding pretty close to what I heard from Dr. Tohen (but remember, this is just one impression, full of sampling error and other reasons to think it could be pretty far off):  

  • about 80% of people get much better with treatment; 
  • of the remaining 20%, at least 3/4 show some response but not as much as we'd hope; 
  • that leaves about 5% who we really struggle to get any better at all, those are the hard ones; 
  • meanwhile, of the entire group we started with, about 20-30% get all the way or close to "normal" again; 
  • which leaves about 20-30% of the whole group getting much better but still having symptoms. 

Now, how many of the all-the-way-to-normal group (which in my experience is much more common in bipolar I) just stays normal?  Here's where Tohen says 10%.  That means there are some people out there who don't need to stay on medications, right?  The problem is, who?  We have no markers for that.  Don't any of you readers go trying to see if you're one, okay?  Talk to your doc' about all this. 

Hope that helps.

Dr. Phelps

Published February, 2003


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