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December 6, 2005
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Bipolar Depression More Disabling Than Mania

NEW YORK (Reuters Health) Dec 05 - The psychosocial disability that occurs with bipolar disorder is worse during depressive episodes than during manic or hypomanic episodes, new research suggests. In fact, for patients with bipolar II (BP-II) disorder, hypomania may actually improve functioning.

As reported in the Archives of General Psychiatry for December, Dr. Lewis L. Judd, from the University of California at San Diego, and colleagues assessed how psychosocial disability fluctuated in 291 patients with bipolar disorder over the course of their illness. The subjects included 158 with bipolar I disorder (BP-I) and 133 with BP-II who were followed for a mean of 15 years.

For both BP-I and BP-II, psychosocial impairment increased as depressive symptoms worsened.

By contrast, the disorders differed in the impact of manic or hypomanic symptoms. For BP-I, as these symptoms worsened, so did the psychosocial impairment. For BP-II, however, there was evidence that subsyndromal hypomanic symptoms were not disabling and may actually improve functional ability.

As noted, depressive symptoms were at least as disabling as manic ones and frequently more so, the report indicates.

Psychosocial functioning is generally good in asymptomatic patients with BP-I or BP-II, but still falls short of well controls, the authors note.

"These findings indicate that the depressive phase of bipolar illness is equal in importance to the manic or hypomanic phase, and they confirm the advantage of studying BP-I and BP-II separately," the researchers conclude.

Arch Gen Psychiatry 2005;62:1322-1330.

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