Functional Capacity in Euthymic Bipolar Disorder
Patients with bipolar disorder who are in a stable, euthymic state and adherent to maintenance treatment can safely work, drive, and make medical or legal decisions, with their functional capacity considered equivalent to the general population during these periods.
Employment and Occupational Function
Patients with stable bipolar disorder should be actively facilitated to participate in employment and economic activities. 1 The WHO guidelines explicitly recommend that healthcare providers facilitate opportunities for people with bipolar disorders to be included in economic activities appropriate to their social and cultural environment. 1 Supported employment may be considered as an option if patients have difficulty obtaining or retaining normal employment. 1
- Psychosocial interventions to enhance independent living and social skills should be considered for people with bipolar disorders, with careful consideration to patients' functional capacity and need for stability and support. 1
- Patients who are stable and adherent to treatment can return to work, including physically demanding activities, when their clinical state permits. 1
Driving Privileges
Driving can be safely resumed in stable patients with bipolar disorder who are euthymic and compliant with treatment. 1 The key considerations are:
- Patients must be judged to be in compliance with individual state laws regarding driving after serious illness. 1
- Each state's Department of Motor Vehicles has mandated specific criteria that vary by jurisdiction and must be met before operation of a motor vehicle. 1
- Patients should avoid stressful driving circumstances initially, such as rush hour, inclement weather, night driving, heavy traffic, and high speeds. 1
Medical and Legal Decision-Making Capacity
Euthymic patients with bipolar disorder retain full capacity for medical and legal decision-making. During stable periods, cognitive function and judgment are preserved, allowing for informed consent and autonomous decision-making. 2, 3
- Mood symptoms, psychosocial functioning, and overall clinical state must be continually reevaluated during long-term treatment to ensure ongoing stability. 2
- Shared decision-making between patients and clinicians is an essential element of clinical care for bipolar disorder. 3
Maintenance Treatment Requirements
The foundation for maintaining functional capacity is adherence to maintenance pharmacotherapy. 1
- Lithium or valproate should be used for maintenance treatment of bipolar disorder. 1
- Maintenance treatment should continue for at least 2 years after the last episode of bipolar disorder. 1
- Decision to continue maintenance treatment after 2 years should preferably be done by a mental health specialist. 1
Psychosocial Support for Optimal Functioning
Psychoeducation and psychosocial interventions are essential adjuncts to pharmacotherapy for maintaining functional capacity. 1
- Psychoeducation should be routinely offered to individuals with bipolar disorders and their family members/caregivers. 1
- Cognitive-behavioral therapy and family interventions can be considered as options if adequately trained professionals are available. 1
- These interventions help promote medication compliance, avoid relapse, and address functional impairments. 1
Critical Caveats
Functional capacity is contingent on true euthymia, not merely subsyndromal symptoms. 4, 2 Many patients experience subsyndromal symptoms despite medication adherence, which can impact functioning. 4
- Comorbid psychiatric conditions, substance use disorders, and chronic medical conditions must be adequately managed, as these commonly co-occur and can impair function. 2
- Neuropsychological deficits may persist even during euthymic phases, though these typically do not preclude work, driving, or decision-making capacity. 5
- Regular monitoring is essential, as mood episode relapses are common and can rapidly compromise functional capacity. 2