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How Frequent is Relapse?

Bipolar disorder is largely unpredictable. It’s difficult to know when an episode will start and when it will end. There are signs and symptoms that, if monitored closely, can signal the beginning of an episode, but they do not give any indication of when or if a person will relapse. There are rare cases in which a person may have one manic episode in their life and never have another. Between 10 and 20% of people with bipolar disorder are considered rapid-cycling, meaning they experience at least four episodes in a given year. A new article looked at multiple studies to help determine the risk of recurrence after a single manic or mixed episode.

Up to 50% of patients with bipolar disorder first seek help or are hospitalized because of a manic or mixed episode. At this point, caregivers have to make the decision of how and whether to treat patients long-term. Maintenance medications like mood stabilizers have been shown to lengthen time between episodes, but there is a chance that the person may never have another episode and so would needlessly be taking powerful medication.

Because this decision must be made, it’s important to understand how often people who experience a manic or mixed episode will go on to relapse into another episode.

Lars Vedel Kessing of the Psychiatric Center of Copenhagen and his team searched through research on the topic and found six relevant studies to see if the question of how often a person relapses after a first episode of mania could be answered.

Combined, three studies had a total of 293 adult participants and three studies totalling 126 child or adolescent participants. The participants were said to experience relapse if they had a manic or depressive period at any point in the follow-up period of the studies. Approximately 25% of the participants had already experienced at least one depressive episode.

The results showed that approximately 35% of adults experienced relapse within one year. For children and adolescents, the one-year relapse rate was 48%. Within two years, participants relapsed at a rate of 46-59%. Within four to five years, 65% of participants experienced at least one episode.

It only takes one episode of mania or hypomania to receive a diagnosis of bipolar disorder, so even if a person does not relapse within several years, that is not to say that will never have another episode. Everyone experiences the disorder differently.

Because bipolar disorder has such a high relapse rate, it’s important for anyone who has experienced symptoms to keep regular appointments with their healthcare team. It’s also imperative to keep track of symptoms and signs and report them during these appointments. Doctors will be able to come up with a personalized treatment plan including prescribing medication and treatment that best help keep symptoms and episodes at bay.

It is possible to do everything right as far as treating bipolar disorder like taking medication, eating right and getting enough sleep but still experience relapse. Recurrence of episodes is not determined by a person’s behavior. Relapse is simply a part of bipolar disorder.



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Image credit: Lauri Heikkinen

How Frequent is Relapse?

LaRae LaBouff

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APA Reference
LaBouff, L. (2018). How Frequent is Relapse?. Psych Central. Retrieved on October 23, 2020, from


Last updated: 2 Jan 2018
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