Response, Remission, and Recovery in Bipolar Disorders: What Are the Realistic Treatment Goals?

Bipolar disorder presents particular challenges with regard to assessing response to therapy. Criteriafor determining remission and recovery have been suggested for mood disorders, but the clinicalusefulness of these terms in bipolar disorder is elusive. Formal psychological rating scales may beimpractical in a routine medical practice setting. As an alternative, clinicians might probe for informationabout particular “signal events,” such as sleep disturbances, that may herald mood fluctuations.The ultimate goal of bipolar management should be complete and sustained remission, wheneverpossible, although most patients will not achieve this status for any significant length of time. Furthermore,overaggressive management might entail pushing medication doses to intolerable levels. Individualtreatment goals should always take into account patient acceptance of side effect burden,allowing for trade-offs between treatment effect and quality of life. Noncompliance with therapy, notoriouslycommon among patients suffering from bipolar disorder, can stem from drug side effects,treatment ineffectiveness, or even treatment success if the patient misses the manic symptoms. Despiteeffective treatment, relapse is common. Realistic treatment goals should strive for sustainedsymptom abatement while maximizing patient quality of life from visit to visit.