What are the Risks of Untreated Bipolar Disorder?

Summary: The risks of untreated bipolar disorder include a wide range of negative psychological, emotional, social, functional, and behavioral outcomes, and are associated with greater disease severity and poorer long-term outcomes.

Key Points:

• Bipolar disorder is characterized by chronic, recurring, extreme changes in mood, thought, and behavior.
• Patients experience periods of high energy and activity, called manic episodes.
• Patients experience period of low energy and low mood, called depressive episodes.
• Chronic, long-term recurrence of manic and depressive episodes exert a negative effect on long term health and wellness.

Misdiagnosis, Late Diagnosis, Delayed and Untreated Illness (DUI)

The risk of experiencing negative outcomes increases the longer bipolar disorder goes undiagnosed and/or untreated. In a large-scale narrative review published in 2025 called “Duration of Untreated Illness in Bipolar Disorder,” a group of mental health researchers explored the following phenomenon associated with bipolar disorder:

“Duration of Untreated Illness (DUI) has emerged as a crucial prognostic factor in bipolar disorder (BD), with growing evidence linking longer DUI to worse clinical, functional, and cognitive outcomes.”

The research team introduces the study with this important fact:

“DUI in bipolar disorder ranges across studies, with an average of 9 years.”

After an exhaustive review of the available literature on the consequences and risks of untreated bipolar disorder, researchers identified five primary areas vulnerable to risks associated with untreated bipolar disorder, including:

1. Neurobiological changes
2. Molecular dysfunction
3. Clinical presentation
4. Disease comorbidity
5. Psychosocial outcomes

We’ll share how untreated BD affects those areas below. First, however, please learn more about the bipolar disorder by reading our bipolar disorder treatment page, as well as this article on our blog:

What Kind of Therapy Helps Bipolar Disorder?

We’ll spend this article focusing on the aspect of bipolar disorder we introduce above: the risks of untreated bipolar disorder. Our treatment page and the article offer helpful details about the prevalence, diagnosis, and treatment of bipolar disorder among adults in the U.S.

Now let’s get to our topic.

Consequences and Risks of Untreated Bipolar Disorder

We’ll share the findings associated with the five primary risk areas associated with bipolar disorder we mention above.

Neurobiological Changes

Leaving BD untreated may result in a range of neurobiological changes that can cause:

• Impairment in social functioning:
  • Peer, family, partner relationships
• Impairment in occupational functioning
  • Difficulty performing work tasks
• Decreased academic achievement
• Decline in cognitive performance:
  • Executive functioning
  • Attention
  • Memory

Recurrence of manic episodes can cause structural changes in brain areas associated with emotional regulation:

• Reductions in gray matter volume in prefrontal cortex
• Reductions in gray matter volume temporal cortex

In addition, recurring manic episodes can cause:

• Hippocampal atrophy
• Ventriculomegaly, i.e. Inflammation in some brain areas

Researchers propose that:

“…a shorter DUI, and thus earlier treatment, may reduce the risk of further affective recurrences, particularly mania, thereby potentially limiting the progression of degenerative processes.”

Molecular Changes

Leaving BD untreated may result in a range of molecular alterations in brain factors associated with neuronal survival and synaptic plasticity:

• Reduced levels of brain-derived neurotrophic factor (BDNF)
• Hypermethylation of the BDNF gene promoter
  • Can be reversed by mood-stabilizing treatments such as valproate and lithium)
• Elevated indicators of oxidative/nitrosative stress
• Increased activation of neuroinflammatory mechanisms

Clinical Presentation

Leaving BD untreated may result in the following negative clinical outcomes:

• More severe and chronic course of illness
• Increased number of both manic and depressive episodes
• Greater likelihood of rapid cycling
• More prominent psychotic features
• Overall poorer functional recovery

Disease/Disorder Comorbidity

Patients with longer DUI also show higher rates of comorbid conditions, including, but not limited to:

• Anxiety
• Substance use disorders, most often:
  • Alcohol use disorder
  • Cannabis use disorder
• Suicidality:
  • Increased frequency of suicide attempts
  • Increased risk of suicide fatality

Presence of co-occurring mental health and addiction disorders can complicate clinical observations and conclusions, often causing significant delay in accurate diagnosis and treatment planning. With regard to suicidality, misdiagnosis and subsequent treatment with antidepressants – in the absence of mood stabilizers for BD – can increase risk of suicidality.

Psychosocial Outcomes

Evidence shows untreated BD can lead to:

• Withdrawal from friends and family
• Decreased social activity
• Decreased self-care
• Reduced exercise/activity
• Weight gain
• Increased frequency of chronic illness

That’s what happens when BD goes undiagnosed and/or a patient chooses to defer or delay treatment after diagnosis. It leads to a wide range of negative emotional, behavioral, psychological, physical, and social consequences.

What’s the answer?

How can people with BD avoid these consequences?

Early Accurate Diagnosis, Early Appropriate Intervention

The best way to avoid these consequences – and the negative consequences of any serious mental health issue – is to seek professional support early on, as soon as possible after the onset of symptoms. And the first step to getting best type of professional support is to arrange an evaluation from a mental health professional.

For the record:

• Articles like this one offer helpful information but cannot diagnose a mental health disorder.
• An online screening tool cannot diagnose a mental health disorder.
• Large language model (LLM) software – often referred to as artificial intelligence (AI) – cannot diagnose a mental health disorder.

When a person with bipolar disorder gets an accurate diagnosis and early intervention in the form of evidence-based treatment, studies show that long-term outcomes improve significantly. Positive outcomes associated with early diagnosis and treatment include, but not limited to the following:

• Reduced risk of relapse
• Reduced functional impairment
• Decreased overall symptoms
• Decreased symptom severity
• Reduced cognitive impairment
• Reduced suicidality

The most effective treatment for bipolar disorder – addressed in the article we link to above, “What Kind of Therapy Helps Bipolar Disorder?,” – includes a combination of psychotherapy, lifestyle changes, and medication.

However, people seeking treatment for bipolar disorder, who may have deferred or declined treatment in the past, should understand this fact:

Adherence to a mood stabilizing medication such as lithium leads to the best long-term outcomes for people with bipolar disorder.

In addition to a prescription mood stabilizer, effective treatment for bipolar disorder may include:

• Cognitive behavioral therapy (CBT)
• Mindfulness based cognitive behavioral therapy (MBCBT)
• Family-focused therapy (FFT)
• Psychoeducation
• Functional/cognitive remediation

In addition, basic healthy lifestyle habits such as good sleep, daily exercise/activity, healthy eating, practical stress management, and staying connected to other people can create a solid foundation for improving or maintaining mental health for people with bipolar disorder. When combined with an early accurate diagnosis, these changes, as part of a treatment plan that includes medication and therapy, can help a person with untreated bipolar disorder initiate treatment, manage their symptoms, restore functioning, and live a full and fulfilling life.