Historical perspectives and natural history of bipolar disorder

A review of two centuries' literature on the natural history of bipolar dis order, including modem naturalistic studies and new data from a lifelong fo llow-up study of 220 bipolar patients, reaches the following conclusions: t he findings of modem follow-up studies are closely compatible with those of studies conducted before the introduction of modem 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 lifeti me from the onset of their disorder in episodes. Fifty percent of bipolar e pisodes last between 2 and 7 months (median 3 months). The intervals betwee n the first few episodes tend to shorten; later the episodes return at an i rregular rhythm of about 0.4 episodes per year with high interindividual va riability. Switches from mania into mild depression and from depression int o 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 natural istic follow-up studies and our lifelong investigation, intensive antidepre ssant, antimanic, and mood-stabilizing treatments are required in most case s. Despite modern treatments the outcome into old age is still poor, fill r ecovery without further episodes rare, recurrence of episodes with incomple te remission the rule, and the development of chronicity and suicide still frequent. (C) 2000 Society of Biological Psychiatry.