New Study Identifies Two Distinct Courses of Bipolar

Rudolph Uher of the Department of Psychiatry at Dalhousie University in Canada recently identified two separate course trajectories of bipolar that are different from the previously recognized classifications of bipolar I and bipolar II. Understanding how the course of bipolar varies in individuals could be beneficial for treatment of the illness. Uher believes that the current distinction between bipolar I and bipolar II leaves many symptom elements unexplored, and can limit the effectiveness of treatments. For instance, some individuals with bipolar have histories of rapid cycling between manic and depressive episodes, while others experience either long periods of depression and hypomania. Understanding how these courses evolve and the trajectory of the illness can help clinicians target those issues that are most prevalent in the disorder and most debilitating to quality of life.

In his study, Uher examined lifetime records of 176 individuals with bipolar and looked at the severity of depressed or manic episodes, the duration of the episodes and the stability of the episodes. He also looked at presence of mixed moods and cycling. After a thorough analysis, Uher found that two distinct course trajectories emerged as the most common. Nearly half of the participants were identified as having episodic bipolar while just over 30% were identified as having depressive type bipolar. Several smaller classes of trajectories were revealed as well, but none of the participants demonstrated prolonged manic episodes in the absence of depression.

Uher also looked at anxiety and found that it did not increase risk of episodic or depressive trajectory. However, he did find a link between alcohol/substance misuse and episodic bipolar. This research underscores the need for further distinction between classifications of bipolar that is not being achieved with the current distinction of bipolar I and bipolar II. Uher hopes that these results will help clinicians choose treatment options based on mood variations, course trajectory and symptomology as demonstrated here. “In conclusion,” said Uher, “we have introduced a method to analyze prospective life charts to propose a typology of the recent clinical course of bipolar disorder.” He hopes future work will be conducted to validate his findings and expand the understanding of how bipolar manifests in various individuals.

Uher, R., et al. (2013). Typology of clinical course in bipolar disorder based on 18-month naturalistic follow-up. Psychological Medicine 43.4 (2013): 789-99. ProQuest. Web.

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  • G.C


    April 1st, 2013 at 10:06 PM

    Neither are more classifications needed nor are labels. Going into the innards of a disorder will yield a million variants and the permutations and combinations may give hundreds of courses of a disorder.A much better option would be for the professionals to do what’s best in light of the observations made.That is the only way to this.

  • Lindsey


    April 2nd, 2013 at 10:53 AM

    I guess I didn’t even know that there were different kinds of bipolar illness until Catherine Zeta Jones came out a year or so ago and distinguished which one she suffers with.

    I think that I am like the previous poster, in that why do we need all of the different labels and stuff? I mean, if there is a problem then there is a problem and it has to be treated. I think that it doesn’t help the general public have a better understanding of the issue, only serves to help doctors create a different diagnosis and treatment plan I guess.

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