Objectives: Functional recovery (FR) in bipolar disorder (BPD) is highly prevalent. We hypothesized that it would be less likely with higher total time ill and especially more time ill in depressive/dysphoric illness.

Method: Type-I BPD patients (N=152) were followed systematically from first-hospitalizations, prospectively every 6 months for 2 years. Definition of FR was achieving/exceeding both highest pre-morbid vocational & independent-living status. We assessed percent-of-weeks in specific morbid states & other clinical and demographic factors for 152 entered patients using bivariate and multivariate logistic analysis.

Results: FR was achieved by 61.2% of patients within 2 yrs from first-hospitalization. Risk-ratios for attaining/not-attaining FR were: higher baseline vocational status (3.01), married (1.80), older at onset (1.25), lower %-wks in major depression (2.47) or total illness (1.25), & lower initial depression score (1.21). %-of-weeks in major illnesses ranked: ≥ depression (3.7%) mixed (5.3%); mania (8%) >> psychosis (0.32%); minor morbidity ranked: dysthymia (15.5%) > subsyndromal mixed (6.72%) > hypomania (3.13%). Pooled morbidity ranked: Mostly D (31.3%) > Mostly M (11.5%). Multivariate logistic-regression found 3 factors independently associated with FR: higher prior employment level, older at onset, & lower initial depression score.

Conclusions: More morbidity, especially in depressive or dysphoric-mixed states, was associated with less functional recovery among BP-I patients. FR was associated with less severe illness at intake, fewer morbidity, especially depression, early manic diagnostic, and high previous vocational status, among 152 BP-I patients followed prospectively for 2 yrs from first episodes. Longer outcomes can test observed, apparently opposite, effects of depression and mania.