Transition time from manic and mixed episodes to depression: a retrospective cohort study

Background For people with bipolar disorder, recovery from manic or mixed episodes is frequently complicated by depression. Depression after manic/mixed episodes may occur within a broader episode sequence pattern of mania-depression-euthymic interval, proposed as a bipolar disorder subtype for which lithium is effective. However, the window of risk for mania/mixed-to-depression transition remains unclear, as is the relationship with clinical factors and outcomes. Methods In this retrospective cohort study, we identified a cohort of 10,437 people with bipolar disorder (42,314 mood episodes; 90,727 person-years) within the NeuroBlu health record database (United States) with records from 1959