3 Factors That Determine Well-Being Between EpisodesFor many people with bipolar disorder, there is life between episodes of depression or mania. The nature of bipolar disorder is that it swings along the spectrum between periods of depression, mania/hypomania and euthymia (between episodes). Euthymia does not, as the name implies, mean patients are symptom-free. Bipolar disorder still affects people between episodes. There seem to be three general factors that contribute to how well a person with bipolar disorder is able to function in this euthymic state.

Research led by Ludovic Samalin of the University of Auvergne, France will be appearing in the March issue of the Journal of Affective Disorders. In this research, the team looked at 468 euthymic patients to evaluate what factors may be impacting subjects most between episodes of mania/hypomania or depression. They studied three specific areas to determine which may have the most impact on the participants’ well-being and functioning abilities in areas like autonomy, occupational function, cognitive function, financial issues, interpersonal relationships and leisure time.

1 Residual depressive symptoms
People with bipolar disorder spend about 50% of the time in states of depression. That leaves the other half to be divided between mania/hypomania and euthymia. Maintaining and lengthening time between episodes is the goal of any bipolar disorder treatment. When this doesn’t happen, it can leave a patient in a sort of limbo where they cannot technically be defined as depressed, but are also not well.

The researchers in the study found that even mild residual depressive symptoms impacted all aspects of functioning except occupational function. The most impact from residual depressive symptoms was seen in autonomy, cognitive functioning and interpersonal relationships.

2 Perceived cognitive impairment
Cognitive function is impacted heavily by bipolar disorder. When cognitive function is impaired it influences attention, memory, critical thinking, some motor skills and social functioning. Not everyone with bipolar disorder experiences it (the rate is anywhere from 15%-60%), but it is more common in people who have experienced more episodes. Some cognitive impairment is caused by side effects from treatment for bipolar disorder.

The results of the study indicated that even when a person perceives they are having problems with these areas, regardless of whether or not they are actually affected, the ability to be high-functioning diminishes. Similar to residual depressive symptoms, most areas of functioning were affected.

3 Circadian rhythm disturbances
Problems with sleep patterns exist across the bipolar spectrum. In mania, it’s common for people to sleep less or not at all and not feel the effects. In depression, both insomnia and hypersomnia are common.

In the study, sleep disturbances did not impact functioning directly. However, it did have an impact on both depressive symptoms and perceived cognitive impairment. Essentially, not getting enough sleep, or having the perception of poor sleep, will make cognitive functioning more difficult and it can also cause depressive symptoms to persist.

 

All of these factors should be monitored by patients, caregivers and healthcare professionals. If symptoms are persisting between episodes, it may be that the patient needs an adjustment in their treatment plan, whether that is behavioral therapy, sleep therapy and/or a medication adjustment.

 

 

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Image credit: Garrett