Is Bipolar Disorder a Progressive Mental Illness?

Suffering through a manic or depressive episode of bipolar disorder is difficult and draining. But each battle with bipolar may also have long-term impact on the brain and contribute to the progression of the disorder.

Bipolar Disorder Symptoms May Increase Over Time

It is not entirely understood if and how bipolar disorder changes over time, but psychiatrists have long suspected that every episode can make the nature of the disorder evolve. It is suspected that discrete manic and depressive episodes, if untreated or undertreated, can eventually lead to an increase in mixed episodes (experiencing mania and depression at the same time) and then culminate in a rapid cycling type of bipolar, with a high frequency of cycles in which mania quickly changes to depression and back to mania, etc., with almost no symptom remission.

Bipolar Disorder May Become More Difficult to Treat as it Progresses

In addition to the possibility that the time spent in remission decreases the longer a person is bipolar, it is also suspected that the disorder becomes more treatment-resistant over time; the more episodes of mania and depression a person experiences, the more difficult it is for medication and counseling to bring the patient back into remission.

The idea that bipolar changes, and that the disorder becomes more treatment-resistant over time, is not yet irrefutably proven, but is certainly strongly suspected by mental health professionals (Stahl, 2008).

Bipolar Disorder Shrinks Your Brain

There have also been several studies showing that those with bipolar disorder experience progressive changes in brain anatomy over time; losing gray matter more quickly than subjects who do not suffer from a mood disorder. This tissue loss has been associated with a decline in cognitive function and appears to contribute to the course of the illness. (Kalmar, 2009; Moorhead, 2007).

Importance of Getting Treatment and Staying on Medications

I've struggled with bipolar disorder for 20+ years, and during that time, earned a degree in psychology, having a great deal of personal interest in abnormal behavior and mental disorders. But you don't need a degree in mental health to see that, as science reveals more about bipolar disorder, the importance of patients getting treated and staying on medication is continually reinforced.

If you, or a loved one, have bipolar disorder, don't give up if the first medication regimen tried doesn't work out. There are now many different types of effective medications for bipolar patients; Seroquel, Depakote, Lithium, Abilify, Celexa, just to name a few.

Work with your psychiatrist and counselor, and stick with it until you find that combination of counseling and medication that works best for keeping your bipolar symptoms in remission. When you have bipolar disorder, symptoms never entirely go away, but the mood swings can be kept within a range that is manageable. And by managing that swinging pendulum of bipolar mood, you may also be getting the long-term benefit of slowing the course of your illness.

Sources

Kalmar JH; Wang F;Spencer L; Edmiston E; Lacadie CM; Martin A; Constable RT; Duncan JS; Staib LH; Papademetris X; Blumberg HP. (2009). "Preliminary evidence for progressive prefrontal abnormalities in adolescents and young adults with bipolar disorder." J Int Neuropsychol Soc, Vol.15, Iss.3; p.476-81.

Moorhead TW; McKirdy J; Sussmann JE; Hall J; Lawrie SM; Johnstone EC; McIntosh AM. (2007) "Progressive gray matter loss in patients with bipolar disorder." Biol Psychiatry, Vol.62, Iss.8; p.894-900.

Stahl, Stephen M. (2008) Stahl's Essential Pharmacology: Depression and Bipolar Disorder. Cambridge University Press.