"Advances in Bipolar Disorder,"
By Sachi Bhati
For the past 60 years, Lithium has been common in treating bipolar disorder. There haven’t been many advancements in the treatment because of the unawareness of what else is affected by the disorder. Researchers are now spending more time studying mood instability, rather than the individual clinical episodes. The experimental medicine will allow doctors to have early indications of target engagement and therapeutic responses, which would thus reduce the cost, time, and risk involved in evaluating different mood stabilizers. After finding a substantial amount of evidence, researchers believe that calcium channel genes are involved in the disorder. Studies are being conducted on mice to find out the effects of potential drugs.
As of right now the treatment for bipolar disorder starts with medications to balance moods. The medications are used as a short-term treatment, until the doctors can make a long-term treatment plan. Generally, bipolar disorder requires a life-long treatment, in which the patient must maintain to avoid a relapse of symptoms, which could turn into depression or full-blown mania. The different medications used are: mood stabilizers, antipsychotics, antidepressants, antidepressant-antipsychotic, and anti-anxiety medications. The mood stabilizers help with controlling drastic changes in mood. The antipsychotics are used in the case that the symptoms worsen. The antidepressants are generally used to help manage depression, although they can cause an episode, doctors generally prescribe an antidepressant with a mood stabilizer. Antidepressant-antipsychotic work as both a treatment for depression and mood stabilizer. Anti-anxiety medications are a short-term treatment prescribed to improve sleep and help with anxiety. These medicines can also affect pregnancies. Psychotherapy is also an important part of treating bipolar disorder. Other treatment options include: Electroconvulsive therapy (ECT) and Transcranial Magnetic Stimulation (TMS). Electric currents are passed through the brain, in ECT, to affect levels of neurotransmitters in the patient’s brain, and generally provide immediate relief. Side effects of ECT include a headache and temporary memory loss, but is generally prescribed to patients where the medications don’t help, the patients can take antidepressants because of other health reasons, are at a high risk of suicide, or are pregnant. TMS is another option available if the patient doesn’t respond to antidepressants. In TMS, the patient sits in a reclining chair with a treatment coil placed on the head, the coil sends brief magnetic pulses to stimulate nerve cells in the brain that are involved in regulating mood and depression.
There are three phases for the treatment of bipolar depression: mania, depression and prophylaxis. The most common treatment for mania is an antipsychotic. Although lithium is efficient in helping maintain the symptoms of bipolar disorder, the risks of using lithium must be balanced. Since lithium has various harmful pharmacological and cellular effects, researchers are developing alternative medications. Examples include Ebselen, which has been found to have therapeutically relevant effects in animal models and human subjects. However, Ebselen is still a relatively new drug for the treatment of bipolar disorder, and is still being evaluated.
Another reason why bipolar disorder treatments haven’t advanced very much is that traditionally, psychiatric diagnoses are based upon “follow-ups” and history of the patient. However, in bipolar disorder, mood fluctuates inconsistently, which makes the “follow-up” diagnosis unreliable. In a recently completed CEQUEL trial, patients would respond to a weekly text or e-mail prompt. The trial allowed patients to be followed up frequently without requiring clinical visits. These weekly responses allowed for a better analysis of the responses for the treatment, rather than periodic visits to the doctor. By using technology, researchers could capture the moods of patients more efficiently and accurately.
To find out more, follow the link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4850752/#nyas13048-bib-0017
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