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Like a lot of things, the answer is "it depends". Probably the biggest factor I've seen is the willingness to accept their condition and stick with the prescribed medications. The worst cases I've seen all involved individuals who either consistently or intermittently refused to acknowledge their condition and take the meds. It usually resulted in some near tragic circumstances that costs them friends, jobs, and the support of loved ones. In one case I know the end result was fully tragic. However, some people who are bipolar have lived mostly normal lives, so not all hope is lost. It just depends on their willingness to deal with their condition head on.