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Bipolar Disorder (Manic Depression) Part II - Page 2

© John McManamy

Partly because the experts have viewed unipolar and bipolar depression as the same, there has been precious little research into bipolar depression, much less a quest for a bipolar antidepressant. Accordingly, we are compelled to make do with antidepressants designed for the unipolar patient, which we take at the risk of inducing hypomania, mania, or rapid-cycling, even with a mood-stabilizer to control these effects.

A likely candidate for the DSM-V as bipolar III is "cyclothymia," listed in the current DSM as a separate disorder, characterized by hypomania and mild depression. One third of those with cyclothymia are eventually diagnosed with bipolar, lending credence to the "kindling" theory of bipolar disorder, that if left untreated in its early stages the illness will break out into something far more severe later on.

The medical literature refers to bipolar as a mood disorder, and the popular conception is one of mood swings from one extreme to the other. In actuality, this represents only a small part of what is visible to both the medical profession and the public, like the spots on measles. (Many of those who are bipolar, incidentally, can function untreated in the "normal" mood range for sustained periods of time.)

The cause and workings of the disorder are total terra incognita to science, though there are lots of theories. At the Fourth International Conference on Bipolar Disorders in June 2001, Paul Harrison MD, MRC Psych of Oxford reported on the Stanley Foundation's pooled research of 60 brains and other studies:

Among the usual suspects in the brain for bipolar are mild ventricular enlargement, smaller cingulate cortex, and an enlarged amygdala and smaller hippocampus. The classical theory of the brain is that the neurons do all the exciting stuff while the glia acts as mind glue. Now science is finding that astrocytes (a type of glia) and neurons are anatomically and functionally related, with an impact on synaptic activity. By measuring various synaptic protein genes and finding corresponding decreases in glial action, researchers have uncovered "perhaps more [brain] abnormalities ... in bipolar disorder than would have been expected." These anomalies overlap with schizophrenia, but not with unipolar depression.

Dr Harrison concluded that there is probably a structural neuropathology of bipolar disorder situated in the medial prefrontal cortex and possibly other connected brain regions. Still,

Still, so little is actually known about the illness that the pharmaceutical industry has yet to develop a drug to treat its symptoms. Lithium, the best-known mood stabilizer, is a common salt, not a proprietary drug. Drugs used as mood stabilizers - Depakote, Neurontin, Lamictal, Topomax, and Tegretol - came on the market as antiseizure medications for treating epilepsy. Antidepressants were developed with unipolar depression in mind, and antipsychotics went into production to treat schizophrenia.

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