Bipolar I Disorder Burden of Illness

Over 1/3 of individuals with bipolar disorder who were initially misdiagnosed in 1992 and 2000 did not receive an accurate diagnosis for 10 or more years after seeking treatment1

Bipolar disorder is a chronic, recurrent mental health disorder with significant morbidity.2 The illness can worsen if left undiagnosed and untreated, and episodes may become more frequent or more severe over time.3

WHO Global Burden of Disease Study 2010 estimated that 58.9 million people suffer from bipolar disorder worldwide.4

WHO = World Health Organization.

Bipolar disorder has been shown to be a complex illness5

  • Bipolar depression differs from MDD, namely with regard to presence of manic episodes and symptomatology6
  • When symptomatic, patients with bipolar I disorder spend most of their time in the depressed phase of the illness vs mania/hypomania or cycling/mixed state7

  • According to one study, the rate of hospitalization for bipolar depression during a 12-month period significantly exceeded that for unipolar depression—6.0% vs 1.7%, respectively (P<0.007)2
  • In another study, 70% of patients with bipolar I disorder (n=45) were hospitalized at least once due to suicide attempt with a high risk of death8*
  • A third study, in patients ages 12-66, showed that a majority of suicide attempts (73%) occur during depressive episodes (16% during mixed episode, 11% during manic episode)9

*This study focused on the social and work impairment associated with bipolar II disorder, using bipolar I disorder and major depressive disorder as comparison groups.

Research demonstrated antidepressants are not appropriate for bipolar depression10-11

  • According to the NIMH-funded STEP-BD study, antidepressants are no more effective than placebo among individuals with bipolar depression10*
  • In another study, adjunctive antidepressant use for bipolar depression did not prevent rehospitalization compared with mood stabilizers or atypical antipsychotics alone11

Historically, many antidepressants and atypical antipsychotics have been studied for bipolar depression either as monotherapy or as adjunctive therapy12,13

  • Few atypical antipsychotics are FDA-approved for the treatment of bipolar depression14


  1. Hirschfeld RM, Lewis L, Vornik LA. Perceptions and impact of bipolar disorder: how far have we really come. J Clin Psychiatry. 2003;64(2):161-174.
  2. Frye MA, Calabrese JR, Reed ML, Hirschfeld RM. Health care resource utilization in bipolar depression compared with unipolar depression: results of a United States population-based study. CNS Spectr. 2006;11(9):704-710. 
  3. National Institute of Mental Health (NIMH). Accessed May 1, 2014. 
  4. Whiteford HA, Ferrari AJ, Degenhardt L, et al. The global burden of mental, neurological and substance use disorders: an analysis from the Global Burden of Disease Study 2010. PloS One. 2015;10:1-14. 
  5. Center for Quality Assessment and Improvement in Mental Health (CQAIMH). Accessed May 2, 2014. 
  6. American Psychiatric Association. Bipolar and Related Disorders. In: Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013:123-188. 
  7. Judd LL, Akiskal HS, Schettler PJ, et al. The long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen Psychiatry. 2002;59(6):530-537. 
  8. Ruggero CJ, Chelminski I, Young D, Zimmerman M. Psychosocial impairment associated with bipolar II disorder. J Affect Disord. 2007;104(1-3):53-60. 
  9. Tondo L, Baldessarini RJ, Hennen J, Floris G, Silvetti F, Tohen M. Lithium treatment and risk of suicidal behavior in bipolar disorder patients. J Clin Psych. 1998;59(8):405-414.
  10. Sachs GS, Nierenberg AA, Calabrese JR, et al. Effectiveness of adjunctive antidepressant treatment for bipolar depression. N Engl J Med. 2007;356(17):1711-1722. 
  11. Vardi K, Warner JL, Philip NS. Effects of antidepressant use and anxiety on psychiatric rehospitalization in bipolar depression. Ann Clin Psychiatry. 2014;26(3):207-216.
  12. Selle V, Schalkwijk S, Vázquez GH, Baldessarini RJ. Treatments for acute bipolar depression: meta-analyses of placebo-controlled, monotherapy trials of anticonvulsants, lithium and antipsychotics. Pharmacopsychiatry. 2014;47(2):43-52.
  13. Clinical Trials website. Accessed June 16, 2016. 
  14. website. Accessed January 14, 2020.