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Duration of Mood Episodes

David A. Solomon, MD; Andrew C. Leon, PhD; William H. Coryell, MD; Jean Endicott, PhD; Chunshan Li, MA; Jess G. Fiedorowicz, MD; Lara Boyken, BA; Martin B. Keller, MD

Arch Gen Psychiatry. 2010;67(4):339-347.

Context  The phenomenology of bipolar I disorder affects treatment and prognosis.

Objective  To describe the duration of bipolar I mood episodes and factors associated with recovery from these episodes.

Design  Subjects with Research Diagnostic Criteria bipolar I disorder were prospectively followed up for as long as 25 years. The probability of recovery over time from multiple successive mood episodes was examined with survival analytic techniques, including a mixed-effects grouped-time survival model.

Setting  Five US academic medical centers.

Participants  Two hundred nineteen subjects with bipolar I disorder.

Main Outcome Measures  Level of psychopathology was assessed with the Longitudinal Interval Follow-up Evaluation every 6 months for the first 5 years of follow-up and annually thereafter.

Results  The median duration of bipolar I mood episodes was 13 weeks. More than 75% of the subjects recovered from their mood episodes within 1 year of onset. The probability of recovery was significantly less for an episode with severe onset (psychosis or severe psychosocial impairment in week 1 of the episode) (hazard ratio [HR] = 0.746; 95% confidence interval [CI], 0.578-0.963; P = .02) and for subjects with greater cumulative morbidity (total number of years spent ill with any mood episode) (HR = 0.917; 95% CI, 0.886-0.948; P < .001). Compared with the probability of recovery from a major depressive episode, there was a significantly greater probability of recovery from an episode of mania (HR = 1.713; 95% CI, 1.373-2.137; P < .001), hypomania (HR = 4.502; 95% CI, 3.466-5.849; P < .001), or minor depression (HR = 2.027; 95% CI, 1.622-2.534; P < .001) and, conversely, a significantly reduced probability of recovery from a cycling episode (switching from one pole to the other without an intervening period of recovery) (HR = 0.438; 95% CI, 0.351-0.548; P < .001).

Conclusions  The median duration of bipolar I mood episodes was 13 weeks, and the probability of recovery was significantly decreased for cycling episodes, mood episodes with severe onset, and subjects with greater cumulative morbidity.

Author Affiliations: UpToDate, Inc, Waltham, Massachusetts (Dr Solomon); Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, Rhode Island (Drs Solomon and Keller and Ms Boyken); Department of Psychiatry, Weill Cornell Medical College (Dr Leon and Mr Li) and New York State Psychiatric Institute (Dr Endicott), New York; and Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City (Drs Coryell and Fiedorowicz).

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