Table 4.
Practical definitions of response, remission, recovery, and refractoriness, based mainly on the ISBD criteria
| Phase | Scale scores | Trial duration | |
|---|---|---|---|
| Response | Acute mania | <25%, 25–49%, 50–74%, 75–100% reduction in YMRS or MRS scores. No significant increase in MADRS or HDRS scores and MADRS and HDRS scores stay below 6. | 8–10 weeks |
| Acute Bipolar depression | <25%, 25–49%, 50–74%, 75–100% reduction in MADRS or HDRS scores. No significant increase in YMRS or MRS scores and YMRS and MRS scores stay below 5. | 10–12 weeks | |
| Maintenance | Significant change in the frequency of episodes. | 1 year | |
| Remission | Acute mania | YMRS and MRS scores stay below 5. No significant increase in MADRS or HDRS scores and MADRS and HDRS scores stay below 6 | ? |
| Acute Bipolar depression | MADRS and HDRS scores stay below 6. No significant increase in YMRS or MRS scores and YMRS and MRS scores stay below 5. | ? | |
| Maintenance | Very rare new episodes, and MADRS/HDRS scores < 6 and YMRS/MRS scores < 7 between episodes. | 2–3 years? | |
| Recovery | Acute mania | YMRS and MRS scores stay below 5 No significant increase in MADRS or HDRS scores and MADRS and HDRS scores stay below 6. | 8 weeks |
| Acute Bipolar depression | MADRS and HDRS scores stay below 6. No significant increase in YMRS or MRS scores and YMRS and MRS scores stay below 5. | 8 weeks | |
| Maintenance | No new mood episodes and MADRS/HDRS scores < 6 and YMRS/MRS scores <7 between episodes. | 3–5 years? | |
| Refractoriness | Acute mania | No significant reduction in YMRS or MRS scores, or significant increase in MADRS or HDRS scores or MADRS and HDRS scores exceed 6. | 8–10 weeks |
| Acute Bipolar depression | No significant reduction in MADRS or HDRS scores or significant increase in YMRS or MRS scores or YMRS and MRS scores exceed 5. | 10–12 weeks | |
| Maintenance | No change in the frequency of episodes, or MADRS/HDRS scores > 6 or YMRS/MRS scores > 7 between episodes. | 1 year |