Convalescent phase of bipolar disorder.

The interepisode interval in bipolar disorder has been relatively unstudied, in part because patients are generally considered to be well during that period. The author proposes that a symptomatic convalescent phase follows acute episodes of mania and depression and precedes the return to the entirely well state. A case is presented of a 15-month convalescence that followed a manic episode. The most prominent features of the convalescence were its long duration, its saw-toothed pattern of remitting and recurring symptoms, and the presence of dysphoria. The fluctuation of dysphoric symptoms was at times associated with and at times independent of life events and was independent of lithium levels. Supportive psychotherapy is apparently a critical element in the management of this phase. Questions about the nature and optimal management of the convalescent period are raised.