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Outgrowing bipolar disorder

Bipolar disorder, or manic-depression, causes severe and unusual shifts in mood and energy, affecting a person’s ability to perform everyday tasks. With symptoms often starting in early adulthood, bipolar disorder has been thought of traditionally as a lifelong disorder. Now, University of Missouri researchers have found evidence that nearly half of those diagnosed between the ages of 18 and 25 may outgrow the disorder by the time they reach 30.

“Using two large nationally representative studies, we found that there was a strikingly high peak prevalence of bipolar disorders in emerging adulthood,” said David Cicero, doctoral student in the Department of Psychological Sciences in the College of Arts and Science and lead author of the paper. “During the third decade of life, the prevalence of the disorder appears to resolve substantially,” said David Cicero, doctoral candidate, Department of Psychological Sciences, “suggesting patients become less symptomatic and may have a greater chance of recovery.”

MU researchers found that 5.5 to 6.2 percent of people between the ages of 18 and 24 suffer from bipolar disorder, but only about 3 percent of people older than 29 suffer from bipolar disorder.

“Young adults between the ages of 18 and 24 are going through significant life changes and social strain, which could influence both the onset and course of the disorder,” said Kenneth J. Sher, Curators’ Professor in the Department of Psychological Sciences and co-author of the study. “During this period of life, young adults are exploring new roles and relationships and begin to leave their parents’ homes for school or work. By the mid 20s, adults have begun to adjust to these changes and begin to settle down and form committed relationships.”

Researchers predict the prevalence of the disorder also could be affected by brain development. The prefrontal cortex, the very front part of the brain, is thought to control perception, senses, personality and intelligence. In particular, it controls reactions to social situations, which can be a challenge for people with bipolar disorder.

“The maturing of the prefrontal cortex of the brain around 25 years of age could biologically explain the developmentally limited aspect of bipolar disorder,” Cicero said.
Responding to the study, Jim Phelps, M.D., a psychiatrist in Corvallis, Oregon, warns that young people who have been taking medications for bipolar disorder who believe they have become stable enough to go off their medications should exercise extreme caution.

“For people who have had very damaging symptoms when ill, a return of those symptoms can be devastating,” says Phelps. “Lost relationships, lost jobs, and maybe even lost neurons, can all accompany another manic episode or severe depressive episode. And by the time people are well and have stayed so for several years, they have often accumulated a lot of things they now stand to lose: Family, job, and even a different view of themselves.”

“Someone who is now stable while taking medications may want to work with their doctor to gradually taper off, to see if medications are still needed for them,” says Phelps. “That taper will be systematic, slow, and closely monitored by people whom the patient trusts to recognize early signs, with a game plan worked out in advance for what to do if symptoms reemerge.”

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