Research Provides New Hope For Bipolar Disorder Treatments

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Those of you who suffer from bipolar disorder, as I do, will be pleased to learn that some novel treatments are being developed for this illness, thanks to research combined with careful observations.

Bipolar disorder is also known as manic-depressive illness. It is a mood disorder where a person who suffers from it experiences tremendous emotional shifts, from crushing depressions to intense mania and back again. These mood swings often are independent from what is happening in the person's life, and they can be debilitating, destroying careers, relationships and lives. Unfortunately, this disorder is difficult to treat because bipolar depression often does not respond to traditional antidepressants that are effective for treating clinical "unipolar" depression. It is estimated that one in 25 American adults suffer from bipolar disorder.

So far, lithium is the only medication that provides relief to most people with bipolar disorder. But lithium doesn't help everyone, so other medications, such as anticonvulsant medications and antipsychotics, are used, but they have limited effectiveness. Worse, many people can't tolerate current bipolar medications because of side effects like weight gain, sleepiness, tremor, and the feeling of being "drugged".

However, researchers are testing other medications for treatment of bipolar disorder. For example, NIMH researchers Doctors Maura Furey and Wayne Drevets are working with the drug, scopolamine, which normally is used to prevent seasickness or carsickness. Several years ago, they were studying whether scopolamine could improve memory and attention in depressed people. They gave the drug intravenously to depressed patients, trying to find the right dose for a brain-imaging study and found that their patients felt less depressed the night following the injections. This is truly amazing because it takes weeks for antidepressants to reach effective levels in the brain. Skin patches containing this drug are the focus of a special clinical trial.

"Some patients would say it was the best night of sleep they'd had in many years, and the next morning they woke up feeling a substantial lifting of their depression," Drevets reports. "In many cases that improvement persisted for weeks or even months."

It was discovered that riluzole, which is used to treat treat the paralyzing disorder Lou Gehrig's disease, also known as ALS or amyotrophic lateral sclerosis, appears to be effective at reducing the effects of bipolar depression. Apparently, it does this by increasing the amount of glutamate, as noticed in rat brain cells. riluzole is currently the focus of a clinical trial to better determine its effectiveness.

It was noticed that another drug, tamoxifen which is used to treat some forms of breast cancer, inhibits the action of a particular enzyme, protein kinase C, in the brain -- the same enzyme that lithium interacts with. Even though the long-term effects of tamoxifen use are unknown, this drug has opened the door for testing other drugs that also inhibit this enzyme for treating bipolar mania. The best aspect of this pharmaceutical is that it rapidly reduces the symptoms of mania, which makes it a good candidate for use in hospital emergency rooms.

Another treatment for bipolar depression that is currently being studied doesn't rely on medications at all. Instead, it relies on exposing the brain to electrical fields, similar to those used for magnetic resonance spectroscopic imaging. This was based on the observation that people suffering from bipolar depression often experienced improvement in their mood after undergoing MRI.

So in short, there are plenty of new approaches for dealing with bipolar disorder that are being researched, although like you, I can understand the impatience that you might be feeling at the time investment involved before they are shown to be effective and are approved.



"Low-Field Magnetic Stimulation in Bipolar Depression Using an MRI-Based Stimulator" by Michael Rohan, Aimee Parow, Andrew L. Stoll, Christina Demopulos, Seth Friedman, Stephen Dager, John Hennen, Bruce M. Cohen and Perry F. Renshaw. American Journal of Psychiatry 161:93-98 (January 2004) abstract]

Johns Hopkins.



AP (quotes).

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What I find interesting about this is how it shows science at work. There was the PNAS (?) paper earlier this year saying that they thought they had a mouse model for bipolar disorders, but that's obviously not what has been used here. Instead, there are several groups following up different lines of research. Even without a solid theoretical underpinning, there are still avenues to be explored.

Isn't the process of science wonderful?


This post is a nice update BP news. The research is very interesting.

The NY Times had a good article today about the explosion of BP diagnosis in young children and teens and the controversy it is causing.

"But the magnitude of the increase surprises many psychiatrists. They say it is likely to intensify the debate over the validity of the diagnosis, which has shaken child psychiatry."

Bipolar Illness Soars as a Diagnosis for the young.

Lots of possibilities for new drugs are opening up, but pardon my caution: Sme of these won't work out for one reason or another. Remember the definition of "bleeding edge" -- this is stuff ahead of the cutting edge. Even the survivors will have their own side effects, too.

TMS (the magnetic stimulation) looks like a very promising tool. It probably won't be a "silver bullet", but from the little I've read, it seems fairly safe and generally worth trying (modulo cost issues).

By David Harmon (not verified) on 04 Sep 2007 #permalink

New treatments are good - methods of administration would be better, IMHO. As a bipolar 2 who frequently loses or misplaces medsI want a different way of taking them. Patches sound good - a once-a-year shot for lithium would be pretty nice too. You're a scientist - how come they can pull this off for pregnancy (Norplant) but not mental illness? (I'm sure it's terribly complicated, but still. Would be nice.)

Don't miss this one:
Biologic Clocks and Treatment
... details from that study ... and some links for much more information on the role of light and dark in bipolar ...

Fascinating about scop. I used TransdermScop patches for motion sickness, years ago.
(aside -- if you try this, do it on a day you don't drive; I found cutting them into thirds gave me a very effective dose; the full size patches were way too strong; they've changed the manufacturing process and recertified the patches since then so YMMV as always)

By Hank Roberts (not verified) on 05 Sep 2007 #permalink

I have been a practicing psychiatrist for 15 plus years and a Skeptic for only 5. It is important to remind people "Bipolar Disorder". is a construct as are all psychiatric disorders. They have no grounding in empiric testing nor any known causal link. There are no natural boundaries between any psychiatric disorders. In 200 years there have been no breakthroughs of any real kind in our real understanding of such problems and I doubt there ever will be. As Wittgenstein said we suffer from "conceptual confusion" The incidence of this disorder has increased from .1 % of the population in 1900 to 1 in 25 now for one simple reason.We lable more. Do we really believe this "illness" has increased 40 fold in kids in 10 years? Doctors call things bipolar disorder they never used to. Prior to the 80's it required a hospital admission for "manic psychosis." Now anyone who has a self report of mood lability gets a label of "Bipolar" In training we labeled these folks as having a "personality disorder" Come spend the day with me and look at charts of people who have been coming to the clinic for 10 years. They have 10 DX and all get the same drugs.Each label is equally useless as it is artificial and carries with it no real understanding based on empiric science. Current TX's are not disease specific and I am convinced work either through sedation or simple gross emotional blunting. Sometimes this can be a good thing but over the long term mostly what I see is life, circumstance and decisions overwhelming them. The brain does not live in a vacuum as much as current biologic psychiatry wants to pretend it does. I used to be a biologic psychiatrist but have been forced to abandon this myopic view. I wish it was that simple. Human emotional suffering is real but the world psychiatry creates is not.…