Bipolar disorder, formerly known as manic depression, is a mental health condition characterized by extreme shifts in mood and energy levels. People with bipolar disorder experience periods of mania (elevated moods, increased energy and activity levels) and periods of depression (low mood, lack of energy and interest in activities).
What is remission in bipolar disorder?
Remission refers to a period when symptoms of bipolar disorder are minimal or absent. During remission, a person with bipolar disorder experiences a relatively stable mood without manic or depressive episodes. Remission does not necessarily mean the person is completely symptom-free, but their mood symptoms are manageable and do not significantly interfere with daily functioning.
According to the American Psychiatric Association’s diagnostic guidelines, remission is defined as a period of at least 2 months without significant mood symptoms. Partial remission may involve residual or mild symptoms, while full remission indicates a complete absence of symptoms.
Can bipolar disorder go into remission for years?
Yes, it is possible for people with bipolar disorder to experience remission that lasts for years. However, the length of remission varies a great deal between individuals.
In one large study, researchers followed nearly 400 people with bipolar I or II disorder over 16 years. They found:
- 34% experienced 1 or more years of remission during the follow-up period
- 14% experienced 5 or more years of remission
- 4% experienced 10 or more years of remission
Other studies have produced similar findings, with around 10-20% of individuals going 5 years or longer without a relapse of mood symptoms. So while achieving years of remission is possible, it is relatively uncommon.
What factors influence remission length?
Research has identified several factors that appear to influence remission length in bipolar disorder:
Type of bipolar disorder
Bipolar I disorder involves periods of full mania, while bipolar II involves hypomania that is not as extreme. Studies show longer remission is more common in bipolar II.
Number of prior episodes
The more mood episodes a person has experienced, the lower the likelihood they will achieve long remission. After 10-20 years of illness, achieving remission over 2 years becomes increasingly unlikely.
Timeliness of treatment
Getting treatment quickly when new mood symptoms emerge, rather than delaying, increases the chances of getting back into remission sooner.
Consistency with treatment
Consistently staying on prescribed medication and keeping up regular therapy is crucial for maintaining remission over the long-term.
Substance abuse
Having an alcohol or drug use disorder makes remission less likely to last over 1 year.
Age of onset
Developing bipolar disorder at a younger age (teen years or early 20s) is linked to lower remission rates later in life compared to adult onset.
What are the longest documented remissions?
There are cases in the medical literature documenting bipolar patients experiencing remission for 10 years or longer without ongoing treatment. However, this represents only a small percentage of people with the disorder.
Some examples of exceptionally long remission include:
- A man diagnosed with bipolar I at age 20 who experienced two manic episodes by age 25 then had no further symptoms for the next 50 years.
- A woman diagnosed with bipolar II at age 34 who had no relapses over a 13 year period after stabilization on lithium medication.
- A bipolar II patient who was episode-free for 12 years after starting mood stabilizer treatment in his 30s, aside from two brief depressive periods.
While these cases are remarkable, it’s important to emphasize they are rare outcomes and do not reflect the typical course of bipolar disorder.
Is sustained remission possible without medication?
While some people may experience short remissions without ongoing treatment, research indicates medication is necessary for remission lasting years or decades.
One analysis found that individuals with bipolar I disorder who discontinued lithium medication had a relapse rate of 93% over 15 months. This demonstrates medication is typically essential to prevent relapses over the long haul.
Likewise, therapy such as CBT, psychoeducation, and social rhythm therapy helps equip people manage their condition and support remission – but is unlikely to prevent episodes without concurrent medication.
Risk of relapse after long remission
Even after years without symptoms, people with bipolar remain at risk for new mood episodes. Triggers for relapse can include major life stressors, sleep disruption, substance use, and discontinuing treatment.
One study tracked 163 bipolar patients who achieved remission lasting 2 years or more. Over the next 5 years:
- 25% remained in remission
- 37% relapsed to depression
- 7% relapsed to mania/hypomania
- 31% experienced both depressive and manic relapses
Therefore, vigilance for signs of relapse is warranted even after enjoying an extended stable period. Having a plan in place with your doctor can help manage symptoms before they escalate.
Tips for sustaining long-term remission
While achieving years of remission depends on many factors, the following strategies may help increase the likelihood:
- Take all medications as prescribed and discuss any issues with your doctor rather than discontinuing.
- Abstain from drug and alcohol use to avoid provoking episodes.
- Stick to a regular sleep schedule and get 7-9 hours nightly.
- Learn to recognize your personal warning signs of relapse.
- Have a crisis plan for getting help urgently when early symptoms arise.
- Practice stress management and self-care to avoid overwhelm.
- Attend therapy consistently even when feeling well.
Conclusion
Experiencing years or decades without bipolar symptoms is possible in a minority of people with the disorder. Research shows the keys to sustaining prolonged remission are early treatment, medication adherence, avoiding substance use, managing stress and sleep, and keeping up ongoing therapy. While relapses can still happen after many stable years, closely monitoring moods and having an emergency plan allows the best chance of getting back into remission.