The ongoing COVID-19 pandemic has to date infected more than 1 million people and led to tens of thousands of deaths across the globe. Thus, many governments have imposed regional or national mass shelters-in-place in an effort to slow its rapid spread. In this global health emergency, special attention should be paid to the potential impact of the measures taken to combat the pandemic on patients with bipolar disorders (BDs). Shelter-in-place and quarantine are key public health tools, yet they have high psychological and economic costs. They require sacrificing daily routines and public/personal social encounters that enhance health and quality of life and provide emotional support. Even in the general population, the length of social isolation and the constrained physical space in which isolation takes place can be associated with a wide range of adverse psychological effects, including depression, lowered self-esteem, alienation, and helplessness. 1 Anger, clinical anxiety, and posttraumatic stress disorder can persist years after the end of the isolation, as indicated by literature on quarantine. 1 We say this not to undermine the importance of these measures, but rather to underscore the potential consequences for vulnerable and marginalized populations. The impact could be even more severe and long-lasting in persons with BD. The present emergency is disrupting both public and private mental health services, and most patients cannot access outpatient care. Under threat are treatment continuity, alliance and adherence, and patient-driven recovery progress—while the pandemic simultaneously escalates stress levels.

Alarming news reports about the economic and human costs add heightened stress at the same time as social distancing measures reduce opportunities for exercise, sunlight exposure, participation in meaningful activities and social engagement. Job loss and financial uncertainty add more strain, potentially triggering anxiety as well as mood symptoms—again, in a population already vulnerable.