News & Resources

Sensitivity to Stress Among the Offspring of Parents With Bipolar Disorder

Bipolar Disorder News | 16 May 2013

It is well known that the hypothalamic–pituitary–adrenal (HPA) axis is compromised in major depression and bipolar disorder. There is increasing evidence that subtle HPA abnormalities, such as elevated cortisol levels, precede the development of an affective disorder. Interpersonal stress is also associated with the development of affective disorders. This study sought to determine whether interpersonal chronic and episodic stress moderated the relationship between cortisol levels in the natural environment and risk status, defined as having a parent with bipolar disorder.

"Previous research has shown that children of parents with bipolar disorder are four times as likely to develop mood disorders as those from parents without the condition," said the senior author Dr. Mark Ellenbogen. "The goal of our study was to determine how this is happening."

They already knew that high levels of the stress hormone cortisol often occur in people who later develop bipolar disorder - and that high stress levels can contribute to developing bipolar disorder. What they found out in this study is that people with a bipolar parent react to both low-level and high-level stress by producing more cortisol than those with the same stress level but no bipolar parent.

These results, said Dr. Ellenbogen, might lead to finding ways to prevent the increased sensitivity from developing.

Preventing Bipolar Relapse with Web Therapy

Bipolar Disorder News | 07 May 2013

"I tend to think I am in a film - it's like The Truman Show. I'm the star of the film, off on my own planet.”  "It's quite pleasurable for me, but a bit strange for other people."

Michael, 29, from Cheshire, was diagnosed with bipolar disorder after experiencing these feelings during his "most severe high" while travelling after university.

A spell in hospital a few years ago led to weekly sessions of therapy for a year which helped him manage the impact mood has on his life.

But research into web therapy being carried out at Lancaster University may hold the key to ensuring he does not relapse.

As a teenager, Michael had noticeable mood swings to the extent that his GP thought he had ADHD (attention deficit hyperactivity disorder).

But it wasn't until 2007 that he could put a name to the periods of mania which characterize his type of bipolar disorder.

Stabilizing his moods and controlling the triggers for his condition are a daily challenge, and yet being bipolar is clearly part of who he is.

"I'm a very productive person. I have to keep busy and stimulated. People say I'm like a machine sometimes."

Michael has had 30 or 40 jobs since he was 16. He currently combines three different part-time jobs and he writes poetry and tutors in English during his spare time.

He can experience weeks of low mood too, but the extreme highs tend to dominate.

Michael says having access to an online psychological resource, which has been developed by a research team at the Spectrum Centre for Mental Health Research in Lancaster, was invaluable because he could tailor it to his own needs.

What is bipolar disorder?

Bipolar, also known as manic depression, causes severe mood swings that usually last several weeks or months and can be:

• Low mood, intense depression and despair
• High or "manic" feelings of joy, over-activity and loss of inhibitions
• A "mixed state" such as a depressed mood with the restlessness and over-activity of a manic episode

Exact causes are not known, but it is thought the following play a part:

• Genes seem to be important; if you have a relative with bipolar disorder, your chance of developing it is higher
• There may be a physical problem with the brain systems which control mood
• Stress can trigger mood swings

People suffering Bipolar II have more than one episode of severe depression, but only mild manic episodes. 

Prof Steve Jones, who led the study, says web therapy provides an alternative to traditional face-to-face therapies which few people with bipolar actually access.

A controlled trial of 100 people with bipolar, half of whom used the interactive web tool, has produced some encouraging findings, he says.

"We provided them with information about what the disorder is and strategies to improve their mood, then we looked at their experiences of recovery and getting on with their lives.

"There was a significant increase in people's self-reported recovery. They also felt more positive and optimistic."

Limited knowledge

He puts this down to a limited knowledge of bipolar disorder among GPs and other medical professionals which means there is often a delay in diagnosis and a lack of information about the nature of the disorder.

"It still takes 10 to 15 years to get a diagnosis in most cases," he says.

"Some clinicians will just tell people what to do without giving any rationale why. As a result people are half-hearted about the treatment and it doesn't seem to work because they don't know what's in it for them."

By giving individuals more information they in turn gain more autonomy and can learn to manage their own symptoms.

Offering it online makes it accessible to more people too.

Michael has given his boyfriend and his family access to the online resource so that they can support him in managing his disorder - something he says has been beneficial to them as well.

He says being able to keep his bipolar disorder under control has meant making simple changes to his life.

"If I need to eat, I just need to go and do it. If I need to take a break from work, I have to take one.” "When it's mental health, you can't regulate emotions." He also tries to maintain a routine and a good work-life balance.

Another study being carried out at the Centre will look at how best to help parents with bipolar disorder.

"If you are living with a disorder characterized by instability then parenting becomes much more of a challenge than for the rest of us," explains Prof Jones.

By creating a multi-media resource for people to increase their confidence in parenting, the aim is to encourage more stable parenting too.

The knock-on effect may be that their own moods are stabilized and their children become less likely to develop the same bipolar symptoms, which evidence shows is possible in families.

Bipolar Disorder and Emotional Abuse in Childhood

Bipolar Disorder News | 01 May 2013

Emotional abuse experienced in childhood, especially in children aged 5 years and younger, confers an increased risk for bipolar disorder, new research shows.

"Our results show the importance of childhood trauma, not only as a risk factor for bipolar disorders per se but also for a more severe clinical and dimensional profile of expression of the disorder," author Monica Aas, MD, from the University of Oslo, in Norway, told Medscape Medical News.

The findings were presented here at the 14th International Congress on Schizophrenia Research (ICOSR).

Bipolar disorder is due in part to genetic risk variants, but it is also likely to be due in part to environmental susceptibility factors. Among these, childhood trauma has been proposed as a likely environmental factor, Dr. Aas said.

"We wanted to look into it because we know that patients with bipolar disorder seem to have a high prevalence of childhood trauma, and there is also evidence in the literature that this may be related to clinical symptoms," she said.

Most studies focus on physical and sexual abuse and neglect emotional abuse as a possible contributing factor to the development of bipolar disorders, Dr. Aas added.

To address the issue, the investigators, led by Bruno Etain, MD, Groupe Hospitalier Henri Mondor, Pôle de Psychiatrie and Inserm, Créteil, France, first assessed 206 bipolar patients and 94 control participants in a case-control study using the Childhood Trauma Questionnaire.

The questionnaire asked about emotional abuse, sexual abuse, physical abuse, emotional neglect, and physical neglect.

Next, they recruited 587 consecutive patients with bipolar disorders from France and Norway and again used the Childhood Trauma Questionnaire to analyze various clinical features.

Finally, they used the Affective Lability Scale and the Affect Intensity Measure to link childhood trauma and affective instability in adulthood.

Compared with control individuals, multiple trauma occurred almost twice as frequently in patients with bipolar disorder (63% for patients vs 33% for control participants).

When the researchers looked further, they found that only emotional abuse was associated with bipolar disorder.

Regression analysis showed that children who were emotionally abused were more than twice as likely to develop bipolar disorder (odds ratio [OR], 2.14; 95% confidence interval [CI], 1.51 - 3.02).

Dose-Dependent Effect

Additionally, the greater the severity of the emotional abuse, the higher the rate of subsequent bipolar disorder, Dr. Aas said.

Emotional and sexual abuse were also associated with younger age of onset, more suicide attempts, more rapid cycling, and greater proneness to depression.

Children who were emotionally or sexually abused had the most attempts at suicide compared with those who were not abused (OR = 1.60, 95% CI, 1.07 - 2.39 for emotional abuse, and OR = 1.80, 95% CI, 1.14 - 2.86 for sexual abuse). The investigators also found that sexual abuse was the strongest predictor of rapid cycling, with an OR of 1.92 (95% CI, 1.14 - 3.24).

In addition, the more that children were exposed to trauma in childhood, the higher the level of affective instability, according to the Affective Lability Scale and the Affect Intensity Measure.

"We hope that clinicians will take into account the occurrence of childhood emotional abuse when they see children, because it is even more significant as a cause of psychiatric disability than physical abuse," Dr. Aas said.

Clinically Useful

Commenting on the findings for Medscape Medical News, Richard Drake, MD, PhD, senior lecturer at University of Manchester, in the United Kingdom, said the finding that emotional abuse was so strongly linked to the development of bipolar disorder was "interesting."

The work brings together large studies of different aspects of the relationship between childhood trauma and bipolar disorder. This gives an indication not only of what aspects of childhood abuse are most important in driving the relationship with the illness but also what aspects of bipolar disorder seem most directly related to emotional abuse as the main driver, he said.

But, he cautioned: "This is retrospective data, and of course that makes one cautious in interpreting the results. If this was done prospectively, the same findings may not come up."

Dr. Drake agreed that the findings can be useful to practitioners. "We all have patients who have various forms of abuse. Trying to tease apart what we can expect as a result of that, and what the relationship is between the abuse and the outcome and where we might best intervene, is of direct value in clinical practice."

Bipolar Disorder Myths

Bipolar Disorder News | 24 April 2013

Dealing with a bipolar diagnosis is hard. Dealing with parents, friends, and relatives who have slightly, er, misguided notions about what having bipolar entails can be even harder. You can help someone who is dealing with mental illness for the first time by being open, understanding, and well-informed—and by nixing any false beliefs and assumptions you have about bipolar.

There are many misconceptions about bipolar. Here are five myths and the surprising truths about a bipolar diagnosis:

1. Just because someone has been diagnosed with bipolar doesn’t mean that person is either depressed or manic 24/7. Lots of people with bipolar cruise through long periods (months or even years at a time) without any major episodes. During these stable periods, people with bipolar lead pretty normal lives, with pretty normal moods. The goal of treatment is to make sure these stable periods last for as long as possible, with as few manic or depressive episodes as possible in between. With the right combination of treatment, lifestyle adaptations, and plain old luck, people with bipolar can fend off future episodes and minimize their severity when they do happen.

2. Sure, some of the things people who are bipolar say and do are directly fueled by depression or mania, but please don’t attribute their every word and deed to having bipolar disorder. It can be tempting for friends and family members of people with bipolar to explain that person’s behavior, actions, and personality completely in terms of their disorder—not only their flaws, but also their successes. Statements like “She wouldn’t have won that poetry contest if she wasn’t hypomanic” or “He’s a reckless driver—he has bipolar” can be hurtful to the person with bipolar, not to mention unfair (there are a lot of excellent poets and terrible drivers out there, and they don’t all have bipolar).

3. Bipolar isn’t a dirty little secret, and it isn’t something to be ashamed of. If you’re curious about what it’s like to have bipolar disorder, just ask. Most of people who are bipolar would be happy to share some stories, and it helps to know others are interested (as opposed to freaked out). You can even ask for specific ways that you might help under certain circumstances. For example, “What are some ways I can make life easier for you when you’re depressed?” or “How can I let you know when I think you’re getting manic in a way you won’t find offensive?” 

4. Dealing with bipolar disorder can be as exhausting and time-consuming as training for the Olympics. So be understanding if people who are bipolar need a little extra time to accomplish things that seem easy for other people. They may not finish college/move out/get a job/fulfill every hope and dream as quickly as you expect or would like. Then again, they’ve got a lot on their plates already. And they’ll get there … just have patience and faith, and offer your support.

5. If someone you love has bipolar disorder and is ill, that’s not the way he or she will always feel. They can recover. They can bounce back, find themselves again and get back on track. They can have happy, productive, meaningful, awesome lives. Yes, the awesomeness will be interspersed with periods of depression and mania, but that’s just how they roll.

So there it is. We don’t expect you to stay up late reading the latest research papers on GABA receptors, to drop psychiatry jargon like “mixed episode” and “affect,” or even to know how to pronounce the names of bipolar meds. Just keep in mind the truths behind the five bipolar myths. Stay cool, and remember that people are people first, not their diagnoses.

Bipolar Disorder Often Misdiagnosed

Bipolar Disorder News | 19 April 2013

Bipolar disorder is often misdiagnosed and as a result those affected may not receive the treatment that they need, a consultant psychiatrist has warned.

Bipolar disorder, also known as manic depression, is a severe and chronic condition. Those affected experience sustained high moods, followed by periods of sustained low moods. High moods can see the person feeling elated and needing less sleep. Low moods can range from mild to severe depression. However, for months or even years, the person's mood can be otherwise normal.

One in every 100 people is affected.

According to Dr Paul Scully of St James's Hospital, ‘not infrequently, bipolar can be misdiagnosed as depression and, as a result, patients don't receive the treatment and support they need'.

"In some cases, the medication they are prescribed can worsen symptoms and can precipitate an affective episode, or can increase the frequency of major bipolar episodes," he explained.

Dr Scully made his comments at the launch of a new bipolar disorder campaign, 99 & Me, which aims to raise awareness of the condition in Ireland. Research carried out as part of this campaign found that among those with bipolar, just one in three were diagnosed by their GP, indicating a need for more understanding of the condition at primary care level.

Meanwhile, almost one in three people with the condition had to wait between two and three years to be diagnosed. Furthermore, while six in 10 people sought help via the public health system, more than one-third of these had to wait for at least three months to get an appointment with a psychiatrist.

"It is only through effective working between GPs, psychiatrists and community-based services that people with bipolar disorder can be appropriately supported,' Dr Scully commented.

The campaign, which is supported by Lundbeck, aims to tackle misunderstandings about the condition, to remove the stigma surrounding it and to encourage people to get the treatment they need as soon as possible.

Study: Drugs for bipolar disorder "normalize" brain gene function

Bipolar Disorder News | 16 April 2013

Every day, millions of people with bipolar disorder take medicines that help keep them from swinging into manic or depressed moods. But just how these drugs produce their effects is still a mystery.

Now, a new University of Michigan Medical School study of brain tissue helps reveal what might actually be happening. And further research using stem cells programmed to act like brain cells is already underway.

The study involved brain tissue from deceased people with and without bipolar disorder, which the U-M team analyzed to see how often certain genes were activated, or expressed. Funding support came from the National Institutes of Health and the Heinz C. Prechter Bipolar Research Fund.

“We found there are hundreds of genes whose activity is adjusted in individuals taking medication – consistent with the fact that there are a number of genes that are potentially amiss in people with bipolar,” says senior author Melvin McInnis, M.D., the U-M psychiatrist, U-M Depression Center member and principal investigator of the Prechter Fund Projects who helped lead the study. “Taking the medications, specifically ones in a class called antipsychotics, seemed to normalize the gene expression pattern in these individuals so that it approached that of a person without bipolar.”

Digging deeper into bipolar genetics

Scientists already know that bipolar disorder’s roots lie in genetic differences in the brain -- though they are still searching for the specific gene combinations involved.  

McInnis and his colleagues have now embarked on research developing several a lines of induced pluripotent stem cells derived (iPSC) from volunteers with and without bipolar disorder, which will allow even more in-depth study of the development and genetics of bipolar disorder.

The newly published study looked at the expression, or activity levels, of 2,191 different genes in the brains of 14 people with bipolar disorder, and 12 with no mental health conditions. The brains were all part of a privately funded nonprofit brain bank that collected and stored donated brains, and recorded what medications the individuals were taking at the time of death.

Seven of the brains were from people with bipolar disorder who had been taking one or more antipsychotics when they died. These drugs include clozapine, risperidone, and haloperidol, and are often used to treat bipolar disorder. Most of the 14 brain donors with bipolar disorder were also taking other medications, such as antidepressants, at the time of death.

When the researchers compared the gene activity patterns among the brains of bipolar disorder patients who had been exposed to antipsychotics with patterns among those who weren’t, they saw striking differences.

Then, when they compared the activity patterns of patients who had been taking antipsychotics with those of people without bipolar disorder, they found similar patterns.

The similarities were strongest in the expression of genes involved in the transmission of signals across synapses – the gaps between brain cells that allow cells to ‘talk’ to one another. There were also similarities in the organization of nodes of Ranvier – locations along nerve cells where signals can travelfaster.

McInnis, who is the Thomas B. and Nancy Upjohn Woodworth Professor of Bipolar Disorder and Depression in the U-M Department of Psychiatry, worked with U-M scientists Haiming Chen, M.D. and K. Sue O’Shea, Ph.D., of the U-M Department of Cell and Developmental Biology. They also teamed with Johns Hopkins University researcher Christopher Ross, M.D., Ph.D. on the new research; U-M and Johns Hopkins have a long history of collaboration on bipolar disorder research.

The research used brain tissue samples from the Stanley Brain Collection of the Stanley Medical Research Institute in Maryland.

Using “gene chip” analysis to measure the presence of messenger RNA molecules that indicate gene activity, and sophisticated data analysis, they were able to map the expression patterns from the brains and break the results down by bipolar status and medication use. The bipolar and control (non-bipolar) brains were matched by age, gender and other factors.

“In bipolar disorder, it’s not just one gene that’s involved – it’s a whole symphony of them,” says McInnis, who has helped lead U-M’s bipolar genetics research for nearly a decade. “Medications appear to nudge them in a direction that aligns more with the normal expression pattern.”

Among those that were “nudged” were genes that have already been shown to be linked to bipolar disorder, including glycogen synthase kinase 3 beta (GSK3β), FK506 binding protein 5 (FKBP5), and Ankyrin 3 (ANK3).

Going forward, says McInnis, cell culture studies will be critical to studying how medications for bipolar disorder work, and to screen new molecules as potential new medications.

Scans reveal key difference in mental disorders

Bipolar Disorder News | 03 April 2013

Scans have revealed a critical difference in the way the brain processes emotions in people with two closely related mental disorders.

In a letter published recently in the prestigious journal Molecular Psychiatry, Australian researcher Professor Gin Malhi shows biological differences in the brain between people with bipolar disorder and those with borderline personality disorder.

Director of the CADE Clinic at the University of Sydney, Malhi says the findings have important implications for treatment as the two disorders are often misdiagnosed.

"Bipolar disorder and borderline personality disorder are difficult to distinguish because emotion dysregulation is a key feature of both," says Malhi.

"The key problem is we don't have biological markers for any psychiatric disorder," says Malhi. "Diagnosis is dependent on symptoms and grouping of symptoms into syndromes."

These groupings are outlined in the Diagnostic and Statistical Manual of Mental Disorders with the latest and fifth edition, DSM5, to be released in May.

Malhi says the two disorders have traditionally been separated as Axis 1 and Axis 2 disorders within the manual. Axis 2 disorders are personality based and therefore long-term disorders, while Axis 1 can come and go and can theoretically be cured," says Malhi.

Wrong treatment

Critically the treatments for the two disorders are quite distinct with those with bipolar treated primarily with medication, while borderline personality disorder is treated psychotherapeutically.

"If patients are misdiagnosed they are not getting the treatment they need," says Malhi.

The study involved imaging the brains of 16 non-depressed bipolar patients, 13 borderline personality disorder patients and 14 controls with no mental illness.

While the brain was being scanned they undertook a task known as the emotional Stroop that makes participants work and engage key networks within the brain.

"The task causes a lot of conflict and if you have to do it repeatedly it is exceptionally taxing," he says. Malhi says he adapted this task to focus on emotional responses and looked at how the regulatory circuits in the brain responded.

He says the study showed a clear difference in the biology of the two mental disorders. "Patients with bipolar are able to function quite normally when well," says Malhi.

"[But] they have to do it at the cost of extra effort in the brain." He likened it to the extra energy a short person would use when trying to keep pace walking with a taller person. "The dorsomedial prefrontal cortex is critical and this is the area that they are drawing on," says Malhi.

Borderline personality disorder patients show heightened activity in the amygdala, which is the area related to our fear response. "It is the key node in the lower part of the brain that co-ordinates emotional understanding … and they are not able to regulate it," he says.

Replication needed

Malhi says the results are "significant" however he stresses the study needs replicating with a larger cohort. He says the finding has "huge" clinical implications and opens the way for better targeted diagnosis and therapy.

"It would be wonderful to put a patient in a scanner, look at their brain and inform our clinical judgments with biological information and direct our therapies accordingly," says Malhi.

However he says the discipline is "still stuck in the previous century in the taxonomy of psychological disorders". "For the first time in the past two decades we have the technology to see the brain functioning [but] these insights and understanding have to be translated into clinical practice."

Medicines Used to Treat Bipolar Disorder

Bipolar Disorder News | 01 April 2013

Bipolar Disorder is a very challenging condition to treat. While there are few that would argue against the fact that there is a "chemical imbalance," there remain many questions as to which chemicals need to be addressed. Our brain is bathed in many different neurotransmitters. These neurotransmitters serve as the communication devices between neurons. Therefore, without properly functioning neurotransmitters, our brain does not function in a healthy and predictable manner. In the case of Bipolar Disorder, theorists believe that symptoms are a result of a combination of problematic chemicals in several key regions of the brain.

As I mentioned last week, there is not a test that can be performed to identify the presence of Bipolar Disorder. Rather, the condition is a clinical diagnosis, made through close assessment of behaviors and emotions over a period of time.

Back to the issue at hand. That is, if Bipolar Disorder is identified, what do we do about it?

The cornerstone of treatment for Bipolar Disorder is medication. There are several classes of medications used, including mood stabilizers and antipsychotics. Lithium, like most other mood stabilizers, levels out particular neurotransmitters, thereby reducing the fluctuations in brain chemistry. Similarly, antipsychotics are used to calm the brain, especially neurotransmitters such as serotonin and dopamine.

Medication for these patients are very important. That said, many people with Bipolar Disorder dislike taking the medications. Some, like the antipsychotics, are often accompanied by troubling side effects. Moreover, antipsychotic medications often make people feel unable to experience excitement and happiness. This is because these medications decrease dopamine, the "pleasure chemical" in our brain.

While there are benefits to the mood stabilizers in regard to medication, some of them slow cognitive processing. More importantly, some of them, like Lithium, require frequent blood monitoring to avoid toxicity.

Despite the issues related to medication use in Bipolar Disorder, the need for the medications remain. Without medication support, many people with Bipolar Disorder are unable to control the variations in their mood. Nonetheless, some people will benefit from therapy to help learn relaxation techniques and stress avoidance strategies. Well-known to most, stress and a tendency to over-commit are often major triggers for manic episodes.

In addition to treatment for the patient, family members also require support. Psychoeducation is critical for family members, who often find themselves in the midst of a storm they cannot avoid. They tend to be victims of the manic or depressive episodes experienced by their loved one with little power to help. Many, especially children, have great difficulty understanding the aberrant behaviors and unpredictable actions.

While Bipolar Disorder is a life-long condition that will always require treatment, therapy (both psychotherapy and medication therapy) is often beneficial to the person. Treatment may decrease the frequency and intensity of mood episodes. In fact, for some, treatment can eliminate them all together. This can lead some into a false sense of safety, resulting in a discontinuation of treatment. Unfortunately, problems tend to reemerge. In these times, it is important that loved ones support the individual until they are prepared to return to treatment. Unless they are a danger to themselves or others, no one can be forced into treatment. As such, we are often left to watch the disaster occur. We must, however, remain vigilant so that when the storm passes, we can help our loved one pick up the pieces.

Bipolar Disorder Treatment for Children

Bipolar Disorder News | 28 March 2013

Bipolar disorder treatment for children often is not effective, and this is also true for the various subtypes (phenotypes) of the condition. But recent research efforts have shown that use of a drug known mainly as an anesthetic has provided impressive results when used by children with a certain phenotype of bipolar disorder.

Bipolar disorder (also referred to as manic-depressive disorder) affects approximately 5.7 million adults in the United States. Although the average age of onset is 25 years old, younger people can develop the disease as well.

The Depression and Bipolar Support Alliance reports that bipolar disorder is more likely to affect children whose parents suffer with the condition. Presence of bipolar disorder in one parent increases the risk to each child by 15 to 30 percent. More than one million children and adolescents who have depression in the United States may actually have early onset of bipolar disorder.

Symptoms of bipolar disorder among young people tend to differ from those in adults. Children and adolescents are more likely to display aggression, irritability, sleep problems, and destructive outbursts when in the manic stage than are adults. During the depressive stage, young people usually have more physical complaints than do adults, such as headache and fatigue, and also to be extremely sensitive to failure or rejection and suffer feelings of worthlessness.

Psychiatrist Demitri Papolos, director of research at the Juvenile Bipolar Research Foundation and a researcher at the Albert Einstein College of Medicine, has published a study concerning the use of a new way to treat children with a subtype of bipolar disorder that he calls “fear of harm.”

Although there is still much controversy among mental health professionals about the presence of bipolar disorder in children and adolescents and the existence of a fear of harm phenotype, Papolos believes there are hundreds of thousands of such individuals.

In an NPR interview, Papolos discussed how he treated a young man, George McCann, who has suffered with bipolar disorder since he was very young. Specifically, McCann has a form of fear of harm phenotype, and he can become very aggressive, particularly if he feels threatened, although his actions are not premeditated.

Papolos reported how McCann responded to treatment withketamine, a drug used mainly as an anesthetic. However, it has been shown to have rapid antidepressive qualities when given intravenously to adults with treatment-resistant depression.

For McCann, once he got over his extreme fear of trying the drug, use of an intranasal form of ketamine, taken every three days, has dramatically improved his life. Papolos has treated about 60 other young people with ketamine, and only two have not had extraordinary responses.

Results of a new study by Papolos and his team appearing in the issue of theJournal of Affective Disorderreported on 12 young people (10 males, 2 females) ages 6 to 19 years who had fear of harm-phenotype bipolar disorder. None of the young people had responded to prior treatment with the typical drug options, including antipsychotics, mood stabilizers, and benzodiazepines.

One to two weeks before and after treatment with intranasal ketamine, the participants were evaluated for symptoms.

Use of ketamine results in “substantial reduction” in mania, fear of harm, and aggressive behavior. Overall, significant improvements were noted in anxiety and behavioral symptoms, insomnia and other sleep problems, mood, and attention.

Much still is not understood about bipolar disorder among young people, and especially about the fear of harm phenotype. However, the results of the work by Papolos and the use of ketamine as a bipolar disorder treatment offer hope and may open new doors to therapeutic possibilities.

Brain alterations evident in bipolar II disorder

Bipolar Disorder News | 26 March 2013

Results from a combined voxel-based morphometry (VBM) and diffusion tensor imaging (DTI) study show that patients with bipolar II disorder (BD II) have structural brain alterations compared with mentally healthy individuals.

However, these alterations are less pronounced than those previously observed in patients with BD I, "confirming reports that brain structure of [BD II] patients is less severely affected than that of [BD I] patients," say Elisa Ambrosi (Sapienza University, Rome, Italy) and team.

The findings come from a study of 20 euthymic BD II patients, aged between 18 and 65 years (mean age 41.9 years), and 21 mentally healthy controls.

There were no significant differences between the groups regarding age, gender and handedness, but controls had received significantly more years of education than BD II patients, at a mean of 16 vs 13 years.

All of the participants underwent magnetic resonance imaging of the brain, with VBM and DTI used to assess between-group differences in gray and white matter volume.

The team found that, compared with controls, BD II patients showed localized gray matter volume reductions mainly in the right middle frontal gyrus (Brodmann area 8) and the right superior temporal gyrus (Brodmann area 22). There were no brain regions in which BD II patients showed greater gray matter volume than controls.

Regarding white matter, BD II patients showed significantly lower fractional anisotropy values than controls in all major white matter tracts studied, including cortico-cortical association tracts (ie, the uncinate, inferior fronto-occipital, inferior longitudinal, and superior longitudinal fasciculi), interhemispheric tracts, and limbic tracts.

The researchers note that education level did not correlate with any VBM or DTI measure.

Ambrosi and team conclude in the Journal of Affective Disorders: "Our preliminary combined VBM-DTI study found structural brain differences between [BD II] patients and HCs [healthy controls]; these differences are less pronounced than previously described differences between [BD I] patients and HCs.

"Further studies should seek to address some still unresolved issues, i.e., stability of alterations over time and their possible phase-relatedness, and their correlation with clinical and neuropsychological measures."