Staging and neuroprogression in bipolar disorder: treatment implications

It is known that if, not all, a substantial proportion of patients with bipolar disorder (BD) present a progressive course with functional and cognitive impairment. In addition, patients with BD and multiple mood episodes have a worse response to lithium and cognitive behaviour therapy. However, many current treatment guidelines do not take these clinical features that change with illness progression into account. In order to clarify these clinical questions, the term ‘neuroprogression’ was conceptualized as the pathological rewiring of the brain that takes place in parallel with the clinical deterioration in the course of BD. It provides a heuristic basis for conceptualizing the biochemical foundation of changes in brain circuits related to the progressive course of BD. Herein, we aim to review risk factors, biological underpinnings, and treatment implications related to neuroprogression in BD.