Remission VS. Making Symptoms Better

MYTH: 

The treatment goal for patients should be to make them look or act “better”, keeping them quiet and calm.

FACT: 

Among psychiatrists expert in the treatment of bipolar disorder, the goal should always be full remission – not just palliation (making symptoms better).  In lay terms, if we do not stop the mental health syndrome completely, the illness grows more severe as the individual cycles over and over – making it harder and harder to ever treat the patient effectively to a symptom-free state.  In fact, in many patients who now have treatment-resistant illness, it is the failure to treat actively, to remission, early in the disease which has allowed their illness to become treatment-resistant.

The rationale for this is that affective disorders – either untreated or partially treated – tend to worsen in severity, length of illness, and frequency of cycle changes over an individuals’ lifetime.  This process is called cycle acceleration.  To maintain optimal, long-term, life quality it is critical to seek full remission.

As well, breakthrough recurrences of bipolar disorder tend, over ongoing cycles, to be more refractory to medical therapy.  This is called emerging treatment resistance and signifies the potential loss of effectiveness of medications already in use with the patient.

There are those who argue that the increased rate of medical complications, rarely though occasionally fatal (1/300,000), should deter clinicians from aggressive treatment. This view is somewhat shortsighted in that the lethality rate, by suicide, of untreated or incompletely treated bipolar disorder is approximately 25% (1/4).