Bipolar disorder, formerly known as manic depression, is a mental health condition characterized by extreme shifts in mood and energy levels. People with bipolar experience periods of mania (elevated moods, increased energy and activity) and depression (low mood, low energy, loss of interest in activities). These mood episodes can last for days, weeks or months at a time.
Bipolar is considered a chronic, lifelong condition. However, some people wonder if it’s possible for bipolar to eventually “burn out” or go away on its own. Can effective treatment make the condition disappear completely? Or will a person diagnosed with bipolar have to manage it for life? Here, we’ll explore what the research says about bipolar as a lifelong diagnosis.
Does bipolar disorder ever fully go away?
In short, no—according to experts, bipolar is a lifelong condition that requires ongoing management. After being diagnosed, most people with bipolar need to continue treatment and lifestyle adjustments indefinitely to keep symptoms under control.
That said, there are different stages of bipolar disorder:
– In the early stages after diagnosis, symptoms may be more severe and unpredictable. Finding the right medication and psychotherapy approaches takes time.
– After treatment is established, many people enter a stable “maintenance” phase with less extreme highs and lows. They are able to function well for long periods.
– Over decades, periods of remission may last longer. But medication and lifestyle choices remain important to manage the underlying condition.
So while bipolar may “stabilize” over time, the diagnosis itself doesn’t go away. People who stop managing their bipolar are likely to see symptoms return or worsen.
Why lifelong treatment is recommended
Bipolar arises from complex changes in brain chemistry and circuitry. Research suggests both genetic and environmental factors contribute to these brain changes.
Once the bipolar pattern is established in the brain, it requires active management to prevent relapses:
– **Genetic vulnerability remains.** Even if someone with bipolar feels “cured,” they still carry genes that make them prone to episodes if treatment is abandoned.
– **Brain changes persist.** Studies show neurological differences in people with bipolar, even between episodes. Medication may help correct some of these changes over time. But discontinuing it risks destabilization.
– **Triggers are still present.** Stress, sleep disruption, and other triggers can still flip the “switch” to mania or depression at any time. Ongoing treatment reduces this risk.
– **Medication maintains brain chemistry.** Mood stabilizers and antipsychotics work by balancing brain chemicals like serotonin, dopamine and GABA. Stopping medication alters this balance.
– **Lifestyle habits matter.** Following a structured routine, reducing stress, exercising, and regulating sleep can help control bipolar. But habits need to stay consistent.
For these reasons, abruptly stopping bipolar treatment usually leads to a relapse of symptoms. Gradual treatment reduction may be possible for some people after many stable years. But this approach requires close monitoring by a doctor.
When do symptoms improve the most?
While bipolar is lifelong, most people do see great improvement in symptoms within the first 5 years after diagnosis. Let’s look at the typical progression:
First year:
– Diagnosis and acceptance of condition
– Finding optimal medication and dosage
– Learning to recognize personal triggers and early warning signs
– Working with therapists to develop coping strategies
This period often involves the most severe mood swings and instability. Hospitalization may be needed during manic or depressive crises.
Years 2-5:
– Better ability to maintain mood stability
– Less frequent and extreme highs and lows
– Decreased need for medication adjustments
– Established routines and practices to manage stress and sleep
During this time, episodes may still occur but become shorter and more manageable. Functioning improves between episodes.
Beyond year 5:
– Mood episodes may become less frequent, shorter, and milder
– Longer periods of remission and stability
– Better understanding of personal bipolar patterns and triggers
– Less disruption to work, relationships and health from symptoms
After 5 years, many people report going a year or more between episodes. But medication and lifestyle choices remain essential.
So while bipolar is lifelong, its impact often lessens substantially after initial diagnosis and treatment. Ongoing vigilance is required, but long-term outlook is good for many patients.
Can bipolar disappear completely?
Very rarely, a person’s bipolar symptoms may seem to “burn out” or dissipate altogether later in life. In these unusual cases:
– Episodes become less severe over many years until ceasing.
– Mood and energy stabilize at normal levels.
– Functioning fully normalizes.
– Medication may be stopped with no relapse.
This phenomenon is sometimes called “late recovery from bipolar disorder.” Up to 9% of people with bipolar may fit this category. Reasons for late recovery are not fully understood, but may include:
– Maturing of the brain and nervous system
– Development of better self-care habits over decades
– Avoidance of stigma leading to lack of diagnoses in youth
– Very gradual medication tapering over years
However, even in “recovered” cases, experts recommend caution. Stopping all treatment and abandoning healthy lifestyle habits could still trigger relapse. Some level of management is often still required.
So while extremely rare, late recovery from bipolar may happen for a small percentage of patients after many years. But for the vast majority, active treatment remains necessary lifelong.
Myths about bipolar going away
Despite bipolar’s status as a chronic condition, these incorrect beliefs persist:
Myth: Children and teens will outgrow their bipolar.
In fact, early onset bipolar often persists for life without treatment. Intensive therapy and medication in youth gives the best long-term prognosis.
Myth: You can will yourself to overcome bipolar without medication.
While lifestyle habits help, medication remains essential for most patients to correct biological conditions underlying bipolar. Talk therapy aids recovery but cannot “cure” it.
Myth: Once you feel better, you can stop bipolar treatment.
Symptom improvement usually results directly from consistent treatment. Discontinuing medication or therapy often leads to a return of symptoms.
Myth: Bipolar burns out eventually even without treatment.
This occurs in only about 9% of people after decades of gradual improvement. For most, ongoing management is required lifelong.
Myth: Therapy alone can eliminate bipolar altogether.
Talk therapy helps enormously with coping skills and addressing sources of stress or trauma. But for full symptom relief, medication to balance brain chemistry remains key.
So while myths persist about bipolar disappearing, the evidence strongly supports it being a chronic condition requiring lifelong management for most patients.
Can you ever be discharged from bipolar treatment?
Some physicians may consider discharging stable patients with bipolar from active psychiatric treatment after many years. However, this criteria is strict and discharge remains uncommon.
Typical discharge criteria may include:
– No mood episodes for 10+ years
– Minimal symptoms for 5+ years after stopping medication
– Success maintaining stability through lifestyle alone
– Regular monitoring by a primary care doctor
Even then, discharged patients usually continue seeing their primary doctor, therapist, and/or coach regularly. They are instructed to restart specialist treatment immediately if symptoms recur.
Gradual treatment reduction may begin 10-20 years after diagnosis if the patient:
– Has experienced no hospitalizations or suicide attempts
– Has minimal symptoms between infrequent episodes
– Has strong family/social support and healthy habits
– Is willing to restart treatment if needed
Symptoms, function, and mood stability should be closely monitored. Discharge is still not guaranteed or permanent.
So while some stable patients may meet rigid criteria for discharge decades later, they always need to stay vigilant for relapse. Lifelong self-management remains ideal for most people with bipolar.
Keys to long-term improvement
Although ongoing treatment is required, many people with bipolar can enjoy long periods of excellent function and minimal symptoms. Keys include:
– Taking medication correctly and consistently
– Being aware of personal triggers and early signs of episodes
– Developing a toolkit of coping strategies for highs and lows
– Keeping an eye on comorbid conditions like anxiety
– Making healthy lifestyle choices regarding diet, exercise, sleep and substance use
– Staying socially engaged and asking for support when needed
– Continuing therapy and coaching for motivation and skill building
– Volunteering, working, or joining peer support networks
– Fostering a sense of purpose and meaning in life beyond bipolar
With the right treatment plan and self-care approach, many people report living a full, rich life despite having bipolar disorder. While it may not disappear completely, with proper management its impact often lessens substantially over time.
When to seek help
People with bipolar should always seek medical advice if they notice:
– Symptoms worsening or returning after a stable period
– Difficulty functioning due to extreme highs or lows
– Medication side effects becoming problematic
– Mood instability disrupting work, school or relationships
– Thoughts of self-harm or suicide
Don’t hesitate to involve your treatment team if you are struggling, even after years of stability. Tweaking medication dosage, adding therapy or identifying lifestyle triggers may get symptoms back under control.
Conclusion
In summary, bipolar disorder is widely considered a lifelong diagnosis requiring permanent management. While extremely rare cases of “late recovery” occur, nearly all patients need ongoing treatment to maintain stability and prevent relapse.
However, proper treatment greatly improves long-term prognosis. After an initial adjustment period post-diagnosis, many people with bipolar lead happy and fulfilling lives with long symptom-free intervals. While vigilance is required lifelong, long periods of excellent functioning are attainable for most patients.
