What’s Next for Bipolar Treatment?

By Paula Zimbrean, MD, arsenic told to Hallie Levine

Over nan past 2 decades, location person been immense advancements successful nan curen of bipolar disorder. We’ve learned that location are respective types: bipolar I, bipolar II, and cyclothymic. All coming otherwise and require different treatments.

We’ve gotten amended astatine teasing retired if symptoms are genuinely owed to bipolar upset aliases thing else. And we’ve developed groundbreaking caller treatments that are easier connected nan assemblage and make it imaginable for group pinch bipolar upset to unrecorded afloat lives. Here’s what I’m astir excited about.

We’ve moved distant from lithium.

A study published successful nan American Journal of Psychiatry looked astatine information collected complete 2 decades -- from 1997 to 2016 -- and recovered that patients coming are overmuch much apt to beryllium prescribed an antipsychotic aliases an antidepressant medicine than a temper stabilizer for illustration lithium. There’s nary uncertainty lithium is an important drug

when it comes to bipolar disorder, and it’s very effective. But it carries a consequence of broadside effects, particularly astatine precocious doses, including some kidney and thyroid disease. I’ve worked pinch patients who took lithium for galore years who yet required kidney transplants. The bully news is coming we cognize overmuch much astir lithium and really it works, truthful erstwhile we do request to usage it, we prescribe overmuch little doses.

Over nan past mates of decades, we’ve besides realized that immoderate of nan anticonvulsant medications, specified arsenic carbamazepine, lamotrigine, and valproate are effective ways to dainty nan mania from bipolar disorder. At nan aforesaid time, a group of narcotics known arsenic second-generation antipsychotics became available, too. These medications, which see aripiprazole, cariprazine, lumateperone,olanzapine, quetiapine, and risperidone, among others, transportation little consequence of broadside effects than earlier antipsychotics. These broadside effects see weight gain, elevated cholesterin and humor sweetener levels, and tardive dyskinesia -- stiff, jerky movements of nan look and body.

There are moreover much of these being approved. Some look to transportation a overmuch little consequence of broadside effects specified arsenic weight summation aliases elevated cholesterin aliases humor sugars. Some besides look little apt to interact pinch different medications, which is thing I interest astir regular arsenic a prescriber.

There are much semipermanent medications.

Another important measurement guardant has been nan readiness of long-acting atypical antipsychotics. These narcotics play an important domiciled successful treating bipolar disorder, since there’s often a precocious complaint of noncompliance. But medications specified arsenic aripiprazole monohydrate and risperidone are now disposable arsenic long-acting injectables, fixed successful your doctor’s agency each 2 weeks aliases erstwhile a month. This is overmuch much acceptable to group pinch bipolar disorder, particularly those who are progressive and don’t want to deliberation astir taking a pill each azygous day. Research shows these semipermanent injectables amended betterment outcomes. People are much apt to instrumentality to curen and summation power of symptoms. Hopefully, we will spot much and much of them successful nan future.

We’re shifting toward cistron therapy.

We cognize location are circumstantial genes associated pinch your consequence of processing bipolar disorder. Just this past year, nan largest familial study of bipolar upset frankincense acold was capable to place 64 different spots connected nan genome that raise your likelihood of bipolar disorder. But we’re not rather location yet erstwhile it comes to making nan leap that modifying definite genes will cure nan disease. The dream is yet we’ll beryllium capable to use what’s known arsenic precision medicine to bipolar disorder. Ideally, we’ll analyse a patient’s cistron to fig retired which targeted treatments and therapies they’ll astir use from, conscionable for illustration we do for patients pinch different conditions, specified arsenic bosom cancer.

There are narcotics to dainty unwanted broadside effects.

One of nan reasons group don’t instrumentality to their medicine authorities is because of broadside effects for illustration weight summation aliases tardive dyskinesia. But we’re learning that location are different narcotics we tin springiness them to antagonistic these broadside effects. For example, we now often usage metformin to thief reverse rises successful humor sugar, aliases nan anticonvulsant supplier topiramate to offset weight gain. While you ne'er want to springiness patients excessively galore prescriptions, these narcotics tin ward disconnected immoderate of nan adverse effects that make it difficult for immoderate group to return antipsychotic medicine agelong term. Eventually, we dream pharmacies will beryllium capable to harvester 2 to 3 different narcotics to maximize a treatment’s effectiveness and trim nan consequence of broadside effects.

Nondrug therapies are connected nan rise.

Electroconvulsant curen tin beryllium effective for bipolar upset that hasn’t responded to medications. It’s erstwhile an electrical existent is sent done nan encephalon to origin a controlled seizure. But it requires wide anesthesia and has broadside effects specified arsenic confusion, headache, and nausea. Now, researchers are studying whether transcranial magnetic stimulation (TMS), a noninvasive process that uses magnetic fields to stimulate encephalon nervus cells, is effective. Early investigation is promising, particularly for nan depressive stages of bipolar disorder.