Do you have friends or family members who don’t believe bipolar disorder is real? Are there people in your life who still believe you need to just pull yourself up by your bootstraps? Are you skeptical that there will ever be more effective treatments for bipolar? According to a special issue of Harvard Review of Psychiatry, several lines of research have opened exciting new frontiers in scientific understanding and clinical management of bipolar disorder. In other words, there’s good news about bipolar disorder.
Bipolar disease is a “prevalent, complex, and hard-to-treat illness [leading] to extreme and erratic shifts of mood, thinking, and behavior, with a very high risk of suicide as well as increased risks of dying from common medical disorders,” write Guest Editors Dost Öngür, MD, PhD, of McLean Hospital, Belmont, Mass., and Ayşegül Yildiz, MD, of Dokuz Eylül University, Izmir, Turkey. The special issue presents concise updates on recent advances in basic science and clinical research into bipolar disorder, contributed by internationally renowned experts in the field. It’s about time for good news.
The papers comes out of a recent meeting of leading researchers in bipolar disorder in Cappadocia Turkey, sponsored by the Depression & Bipolar Disorder Foundation. The foundation was created for investigating the frequency and prevention of suicidal acts and deaths associated with psychiatric disorders such as bipolar, depression, anxiety disorders, and substance abuse. Dr. Yildiz, the president of the meeting notes that Cappadocia was selected as the meeting place because bipolar disorder was first described by Aretaeus in Cappadocia nearly 2,000 years ago.
The experts who spoke at the conference gave reports highlighting important new findings in the understanding of, and treatment of, bipolar disorder. Here are some of them:
If you investigate the brain of a person with bipolar disorder, you will not find physical evidence which validates an illness exists. This is what the naysayers have been saying for years to back their argument that there is no such thing as mental illness. Until recently, there has been some merit to this argument. Recent studies, however, show this may no longer be true. Studies have linked the cognitive and emotional difficulties in bipolar disease to widespread signs of disrupted white matter microstructure in the brain. In addition, there’s evidence that long-term treatment with lithium—a mainstay of treatment for bipolar disorder—counteracts this effect, increasing functional connectivity between key brain areas. Further studies of white matter structure may help to explain the biological underpinnings of bipolar disorder.
While we’re on the subject of lithium, about one-third of patients treated for bipolar have an excellent response to the drug. I’d guess lithium ranks up there with Prozac as being controversial in the public’s eye. However, new research has identified a wide range of factors associated with lithium responsiveness, including patient, clinical, and, more recently, genetic characteristics. Ongoing studies will provide new insights into the genes and pathways affecting lithium responsiveness.
Now, let’s talk about stress. Researchers have been exploring new approaches to understanding the interrelated effects of stress and genetic factors in patients vulnerable to bipolar. Dysfunction of the hypothalamic-pituitary-adrenal axis (say that three times fast)—which plays a critical role in stress responses—could contribute to the neurocognitive impairment seen in this condition. This line of research could lead to new “testable hypotheses” regarding the development of bipolar disorder.
The researchers also discussed stimulants for bipolar disorder. This one surprises me. I thought it was a commonly accepted belief that stimulants actually reduce mania for those with bipolar. Apparently, however, there is continued debate over this. Research now supports the belief some stimulants can have augmentative effects to standard treatment for bipolar disorder, including possible reduction in manic behaviors.
If I had to choose one form of therapy that fellow bloggers discuss the most, it would easily be cognitive therapy. Whenever the subject is brought up, I can’t think of a single time that it was not viewed in a positive way. Now, a Spanish group reports on a functional remediation program for bipolar disorder, including training in neurocognitive skills for patients to incorporate into their daily routines. This “neuro-cognitive-behavioral” approach shows promise in improving functioning for some groups of patients.
“We are pleased to share these brief reports in this most important field with a wider audience,” Drs. Öngür and Yildiz conclude. Together with the editors of Harvard Review of Psychiatry, they hope the perspectives presented in their special issue will increase awareness and stimulate further research to better understand bipolar disorder and to develop effective treatments for the millions of affected patients worldwide. I’m just happy to read there’s good news about bipolar disorder.