It depends. Mood shift frequency varies from person to person. A small number of patients may have many episodes within one day, shifting from mania (an episode where a person is very high-spirited or irritable) to depression. This has been described as “ultra-rapid cycling.”

Not necessarily. Studies have shown that approximately 10% of patients have a single episode only. However, the majority of patients have more than one. The number of episodes within a patient’s lifetime varies. Some individuals may have only two or three within their lifetime while others may have the two or three within a single year. Frequency of episodes depends on many factors including the natural course of the condition as well as on appropriate treatment. Not taking medication or taking it incorrectly are frequent causes of episode recurrence.

Although it is possible that during the natural course of the illness individual patients may get well without any medication, the challenge is that it is impossible to identify or determine beforehand who those fortunate patients are. Although some patients don’t get well or just have partial response to the best available treatments, on average—and for the vast majority of patients—the benefits of medications outweigh the risks.

The term “mixed episode” was changed to “mixed features” in the last edition of the Diagnostic and Statistical Manual (DSM-5-TR) published by the American Psychiatric Association in 2022. The new term may apply to either episodes of mania with additional symptoms of depression or the opposite, episodes of depression with additional symptoms of mania. The overall idea is that the presence of both symptoms of mania and depression can exist at the same time. Symptoms of mania include elated or irritable mood, decreased need to sleep or racing thoughts. Symptoms of depression can include depressed mood, impaired sleep and feelings of hopelessness or worthlessness.

Outcomes are always better when there is a strong family support network. Think of bipolar disorder as any other severe medical condition. However, also note that in many severe psychiatric conditions, patients may not be aware that they are ill. They may minimize the severity of their condition. The result of these factors may be that patients will not follow through on their treatment. In very severe cases, there may be instances of a lack of behavioral control where family members may not be able to look after their loved ones. In those cases, assistance from providers or crisis services (call the national 988 Suicide and Crisis Lifeline) may be necessary.