Three times more days depressed than manic or hypomanic in both bipolar I and bipolar II disorder

Ralph W. Kupka, Lori L. Altshuler, Willem A. Nolen, Trisha Suppes, David A. Luckenbaugh, Gabriele S. Leverich, Mark A. Frye, Paul E. Keck, Susan L. Mcelroy, Heinz Grunze, Robert M. Post

Research output: Contribution to journalArticlepeer-review

269 Scopus citations


Objectives: To assess the proportion of time spent in mania, depression and euthymia in a large cohort of bipolar subjects studied longitudinally, and to investigate depression/mania ratios in patients with bipolar I versus bipolar II disorder. Methods: Clinician-adjusted self-ratings of mood were completed daily for oneyear for naturalistically treated outpatients with bipolar I (n=405) or bipolar II (n=102) disorder. Ratings were analyzed for mean time spent euthymic, depressed, manic, hypomanic, and cycling, and the percentages of time spent ill were compared between the two groups. Results: Percentages of time spent ill for bipolar I versus II patients were: euthymia 47.7% versus 50.2% depression 36.0% versus 37.0%; hypomania 11.5% versus 9.8%; mania 1.0% versus 0.2%; and cycling 3.7% versus 2.8%. The depression/mania ratio was 2.9 in the bipolar I and 3.8 in bipolar II sub-groups. Conclusion: Depression represents the predominant abnormal mood state for treated outpatients with bipolar I and II disorder. In contrast to other studies, we found that depression/mania ratios were of a similar magnitude, suggesting the same tendency towards mood instability in both sub-groups.

Original languageEnglish (US)
Pages (from-to)531-535
Number of pages5
JournalBipolar disorders
Issue number5
StatePublished - Aug 2007


  • Bipolar I disorder
  • Bipolar II disorder
  • Course of illness

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry


Dive into the research topics of 'Three times more days depressed than manic or hypomanic in both bipolar I and bipolar II disorder'. Together they form a unique fingerprint.

Cite this