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Age of Onset Influences Prognosis in Bipolar

People with bipolar disorder whose symptoms began in childhood have a worse prognosis as adults.

The earlier in life an individual’s bipolar symptoms appear, and the longer the illness goes undiagnosed and untreated, the more severe the illness seems to be throughout life.

According to Dr. Robert M. Post, from the Bipolar Collaborative Network in Bethesda, Md., “Both childhood onset and treatment delay were associated with a persistently more adverse course of illness rated prospectively in adults.”

Bipolar disorder, also known as manic depression, is a mental disorder that is characterized by alternating periods of mania (elevated or agitated mood) and depression. Bipolar disorder affects more than 5 million American adults according to the National Institute of Mental Health.  Although the average age of onset is 25 years, there is an increasing awareness of the disease in children.  Bipolar disorder in children often presents differently than in adults and can be difficult to diagnose.

Post and his colleagues followed 529 adult outpatients with bipolar disorder over a period of four years.  The average age of the patients was 42. The participants were rated daily using the National Institute of Mental Health-Life Chart Method.  The study participants also completed questionnaires regarding the history of their symptoms and illness.

15 percent of the participants had symptoms before the age of 13 and 35 percent between the ages of 13-18.  During the first year of followup, compared to the patients whose symptoms developed as an adult, those with childhood onset had more manic and depressive episodes, more severe episodes of mania and depression, more days depressed, more rapid cycling, and fewer days of normal mood.

After following the participants for four years, those with onset during childhood, compared to those with adult onset, continued to have on average longer and more severe periods of depression, and fewer days of normal mood.

On average, the earlier the age at which symptoms appeared, the longer it took for the patients to be diagnosed.  In addition, the longer the delay in diagnosis, the more time patients spent depressed, the more episodes of depression they had, the worse the episodes were, and the more rapid the cycling of episodes.

There is a great deal of controversy in the media regarding the increasing awareness and diagnosis of bipolar disorder in children.  This study is significant in that it might help encourage parents to seek earlier diagnosis and treatment, if they suspect bipolar disorder in their children.  These results may also encourage earlier referral from pediatricians, and more aggressive treatment by psychiatrists.

Writes Post, “These data should help foster efforts to ensure earlier and more effective treatment of bipolar illness in children and adolescents.”

“The findings emphasize the importance of early intervention in bipolar disorder,” says Post. “Whether early intervention to shorten the delays to first treatment could alter this adverse course of illness in adulthood, or whether early onset is harbinger of worse course regardless of intervention, remains to be studied.”

Dr. Post’s results are published in the July edition of the Journal of Clinical Psychiatry.

Source: Journal of Clinical Psychiatry

Age of Onset Influences Prognosis in Bipolar

Jessica Ward Jones, MD, MPH

APA Reference
Jones, J. (2019). Age of Onset Influences Prognosis in Bipolar. Psych Central. Retrieved on September 28, 2020, from
Scientifically Reviewed
Last updated: 18 Mar 2019 (Originally: 28 Jul 2010)
Last reviewed: By a member of our scientific advisory board on 18 Mar 2019
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