Bipolar Quality of Life Between Episodes (During Euthymia)

Quality of life in bipolar disorder varies depending on the type of mood episode being experienced. As a reminder, moods in bipolar disorder can be depressed (a severely low mood), manic (a highly elevated, energetic mood), hypomanic (a less-heightened version of mania), mixed (with manic/hypomania and depressed symptoms occurring at the same time) or euthymic (when no diagnosable mood episode is present; you might think of it as "normal"). Bipolar disorder is considered a cyclical disorder and euthymia is what happens between mood episodes; and quality of life in euthymia in bipolar disorder is important -- after all, it's our "normal" mood. It's what we're striving for. It's our version of remission. So what is the quality of life in bipolar disorder like in euthymic periods?

Bipolar Type I vs. Bipolar Type II

One of the things that really bugs me in the bipolar disorder community is that some people insist that one version of bipolar disorder is "worse" than the other. Usually, it's people stating that bipolar type I is worse or more severe than bipolar type II. Well, I'm not going to be sucked into the I'm-worse-off-than-you argument, but what I will say is that they are different and each provides their own challenges. For example, people with bipolar type I experience mania -- a psychiatric emergency that people with bipolar type II don't experience.¹ But people with bipolar type II experience more depression on average² -- also entirely capable of taking your life. And one of the other areas where the types diverge is quality of life during euthymic periods. People with bipolar II actually have a lower quality of life during euthymic periods.

What Is Quality of Life in Bipolar Disorder?

"Quality of life" in bipolar disorder -- or any disorder -- is difficult to measure.

One of the things to know, though, is that just because a person is in a euthymic period, that doesn't mean that no bipolar symptoms are present. What it means is that a full-on bipolar mood episode is not diagnosable. This means that symptom intrusiveness during euthymia drastically affects the quality of life in bipolar disorder. Other aspects of health are also taken into account when looking at bipolar quality of life.

Quality of Life in Bipolar Disorder Euthymia

According to "Quality of Life and Lifestyle Disruption in Euthymic Bipolar Disorder"³ from the Journal of Psychiatric Research bipolar disorder quality of life in euthymic periods is considerably impaired when compared with a person without a psychiatric disorder:

"The degree of total illness intrusiveness experienced by individuals with BD [bipolar disorder] was similar to that of subjects with multiple sclerosis and greater than subjects with end stage renal disease and rheumatoid arthritis. It seems apparent that quality of life, as determined by illness intrusiveness, is compromised in subjects with BD even during periods of euthymia . . . Those with a type II BD report greater impairment in all domains compared with type I."

Similarly, another study that looked at "health-related quality of life" found that those in bipolar euthymia had poorer health than those without psychiatric illness⁴ as well as:

" . . . bipolar type II is associated with poorer HRQoL [health-related quality of life] compared to type I even during sustained periods of euthymia and excluding residual symptoms. Interventions targeting rehabilitation and/or functional enhancement may be helpful to improve HRQoL, especially among patients with bipolar II disorder."

My Experience of Bipolar Quality of Life

All this jives with my experience of quality of life with bipolar disorder type II. It feels like I'm never, ever free of the illness. I find the illness oppressive every day. Sure, some days the blanket is heavier than others, but it is virtually always there. I've always felt bad about saying that because someone will inevitably throw in my face: "you obviously don't have bipolar because people with bipolar cycle through moods" or "obviously bipolar treatment doesn't work if you're always sick."

But now I've found data that actually backs up my experience. 

Moreover, the first study notes that bipolar disorder was at least intrusive as several chronic illnesses. In other words, even though bipolar disorder is considered cyclical, for some (like me) it feels a heck of a lot more chronic. And I know I'm not alone in this. I have heard from many, many people who have considered themselves acutely ill for years at a time. 

And while all this may mirror and validate your own experience, I know it doesn't sound like great news. One thing I will say is that with knowledge comes power. If we acknowledge that bipolar disorder is chronic for some then that changes the way we approach it and the way we work to rehabilitate it. Some organizations like CREST.BD⁵ are looking to patient-driven data to define what quality of life in bipolar disorder really is (from our perspective) and they are providing tools to improve it based on that data (seriously, check them out under sources). 

So don't give up hope. If you're one of the people who have it hard every day, I'm sorry, but know that you're not alone. I'm standing with you. We'll fight -- every day -- together.

Sources

1. Epocrates, Bipolar Disorder in Adults; Diagnostic Criteria. Accessed Feb. 8., 2019. 
2. Kupka RW, et al, "Three Times More Days Depressed Than Manic or Hypomanic in Both Bipolar I and Bipolar II disorder." Bipolar Disorders. Aug. 2007.
3. Robb, JC, et al, "Quality of Life and Lifestyle Disruption in Euthymic Bipolar Disorder." Journal of Psychiatric Research. Sept.-Oct. 1997.
4. Maina, G, et al, "Health-Related Quality of Life in Euthymic Bipolar Disorder Patients: Differences Between Bipolar I and II Subtypes". The Journal of Clinical Psychiatry. Feb. 2007.
5. CREST.BD. Quality of Life Tool.