Further analysis

Often I feel restless and agitated all at once. I feel high, but also have a sense of hopelessness and feel low. I often have bad thoughts and I feel scared, with feelings of rage building up as everyone around me gets on my nerves. It’s really hard to describe, but it affects me hugely" – Terri Cheney, Bipolar I disorder patient (1)


Further analysis of the IMPACT of bipolar study has been published in the Journal of Affective Disorders.2 The analysis looks further into the phenomenology of mania and depression in bipolar patients, as defined in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).2 The findings show that bipolar I disorder patients who experience mania with depressive symptoms experience delays in diagnosis and shorter symptom free periods, which can be associated with poorer patient outcomes.

Symptom free periods

Patients suffering from mania with depressive symptoms are more likely to experience a delay in diagnosis with bipolar I disorder than mania patients without depressive symptoms, and shorter symptom free periods (45% vs 21%).3

 Shorter Symptom Free Periods



The aim of bipolar I disorder treatment is to achieve remission of symptoms for the longest period possible. Of those questioned, 62% of patients suffering mania with depressive symptoms did not reach remission (no symptoms for 6 weeks or longer) compared to 34% of those suffering from mania without depressive symptoms.3

Percentage of patients who did not reach remission


Anxiety, irritability and agitation

Anxiety and irritability or agitation during a manic episode is a relevant discriminator of depressive symptoms.

72% of patients experiencing mania with depressive symptoms reported symptoms of anxiety and irritability or agitation, compared to 27% of patients without depressive symptoms.3

Percentage of patients who reported symptoms of anxiety and irritability or agitation


Implications for clinical practice

These additional analyses are important because they provide new insight into the impact of suffering from mania with depressive symptoms, which can lead to:

  • More frequent episodes of longer duration
  • Longer time to achieve symptomatic remission
  • More suicidal thoughts
  • Longer hospital stays

 Compared to those suffering pure manic or depressive episodes.

Moreover, anxiety, irritability or agitation are prominent components of mania with depressive symptoms4,5,6


  1. Cheney T., Manic: A Memoir, 2009. Harper Paperbacks.
  2. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5), 2013.
  3. Vieta, E et al., Phenomenology of Manic Episodes According to the xPresence or Absence of Depressive Features as Defined in DSM-5: Results from the IMPACT Self-reported Online Survey. Journal of Affective Disorders. 2014; 156C:206-213.
  4. Vieta E & Valentí M. J, Affect Disord. 2013;148(1):28–36.
  5. Swann AC et al., Am J Psychiatry. 2013;170(1):31–42.
  6. Ösby U et al., J Affect Disord. 2009;115(3):315–322.
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