Will I get manic or depressed again after I have recovered?

Bipolar disorder is generally an episodic, lifelong illness with a variable course.  The risk for becoming depressed or manic again in the future is high, with higher risk for recurrent depression.  Although early in the disease episodes may occur far apart in time, as years go by, episodes frequently become closer together.  This may be due in part to brain changes that occur during ech spisode.  Thus, it is important to prevent as many episodes as possible.  With untreated bipolar disorder, ten or more episodes may occur over a person's lifetime.  In contrast to major depressive disorder, for which consideration can be given to stop medication, the recommendation for an episode of mania is to continue medication for an pisode of mania is to continue medication, due to the high risk for a future episode of depression or mania.  Most medications approved in the treatment of bipolar disorder and the effect of medication on decreasing episodes of depression and/or mania.  Most medications approved in the treatment of bipolar disorer have not been adequately studied for their ability to prevent relapse.  At present, Lamictal (lamotrigine) has FDA approval for prevention of recurrence of depressive episodes.  Maintenance treatment with lithium and Depakote has been shown to lower the risk for suicide in bipolar patients.

The medication regimen that successfully treated the acute manic episode should typically be continued in the maintenance phase.  Often more than one medication is required for stabilization.  Sometimes, efforts to reduce medication dosage or cut back to one medication are made during the maintenance phase, but there is evidence that doing so may increase the risk for relapse.  In a recent two-year-long, multi-center study, published in 2006 in the American Journal of Psychiatry, close to 50% of patients relapsed.  The mean time to recurrence was - 45 weeks.  Two-thirds of the recurrences were depresive episodes and one-third were manic or hypomanic episodes.  Residual depressive and manic symptoms were significantly associated with risk of recurrence.  This study demonstrated that the maintenance treatment of bipolar disorder still requires ongoing investigation.

The goals of maintenance treatment in bipolar disorder are relapse prevention, reduction of subthreshold symptoms, and reduction of suicide risk, as well as recuction of cycling frequency and mood istability, and improvement of functioning.