Study Opens Up Possibilities For New Bipolar Disorder Treatments

The human mind remains one of the most elusive and mysterious entities in the world. Despite the tremendous gains made in our understanding of mental health and the careful codification of mental states through the DSM, there remain significant gaps in the way we conceptualize psychological well-being and treat mental illness. This may be particularly true for bipolar disorder.

Bipolar disorder is often considered by many outside observers to be one of the most straightforward of mental illnesses, characterized by extreme mood swings that disrupt normal function and impair quality of life. While it is true that most forms of bipolar disorder are classified according to strict diagnostic criteria, it is also true that the experiences of many people with these conditions expand beyond current clinical definitions. Indeed, there is an entire bipolar diagnosis subtype defined by its lack of adherence to standard bipolar symptoms, referred to as bipolar disorder not-otherwise-specific (NOS). As Natasha Tracy writes:

It is understood in diagnostic circles that sometimes bipolar disorder can present with symptoms outside the norm and yet still be classified as bipolar disorder. Bipolar disorder NOS is a bipolar condition that does not neatly fit into the symptomology of bipolar I or bipolar II.

But new research is indicating that even bipolar subtypes with well-defined diagnostic criteria may, in fact, be more complex than previously assumed, opening up the door to new bipolar disorder treatments.

Bipolar I disorder has long been defined as the presence of at least one manic episode or manic episodes alternating with periods of depression. According to a study by researchers at the University of Columbiapublished last month in Molecular Psychiatry, however, anxiety is just as likely to follow manic episodes as depression. The findings are based on a series of interviews with over 34,000 adults in the United States; in the first interview, researchers quantified incidents of manic episodes and follow-up interviews were conducted three years later to identify subsequent experiences of depression or anxiety:

Participants with mania had an approximately equal risk of developing depression (odds ratio of 1.7) or anxiety (odds ratio of 1.8). Both conditions were significantly more common among participants with mania than without. In addition, participants with depression had a significantly higher risk of developing mania (odds ratio of 2.2) or anxiety (odds ratio of 1.7) compared with those without depression.

These results support twin studies indicating high comorbidity of depression and generalized anxiety disorder, suggesting that the two conditions “behave virtually as the same genetic condition.” The University of Columbia study presents the possibility that this is also true in people with bipolar I disorder.

“Although it has long been widely assumed that bipolar disorder represents repeated episodes of mania and depression as poles along a single continuum of mood, the clinical reality is often far more complex,” explains Dr. Mark Olfson, professor of psychiatry at Columbia University Medical Center and lead author on the study. “The link between mania and anxiety suggests that patients whose main symptom is anxiety should be carefully assessed for a history of mania before starting treatment.”

So what do these findings mean for people with bipolar disorder? For one, it may indicate that many more people have bipolar I disorder than previously thought; because anxiety has not been considered a discrete symptom of bipolar disorder, only a symptom of manic or depressive episodes, it is possible that people whose primary complaint is anxiety have not been thoroughly evaluated for bipolar disorder.

The study also suggests that people with existing bipolar I diagnoses may not currently be adequately treated for anxiety; because anxiety is not screened for as a separate symptom, both patients and their treating physicians may not focus on anxiety symptoms as a primary target for treatment, even if they create significant distress. Additionally, both bipolar disorder treatment research and clinical practice may have overlooked the impact of current treatments on anxiety symptoms. “For years, we may have missed opportunities to evaluate the effects of treatment for bipolar disorder on anxiety,” says Dr. Olfson. “The results of our study suggest that researchers should begin to ask whether, and to what extent, treatments for bipolar disorder relieve anxiety as well as mania and depression.”

These factors could go some way toward explaining the high rate of perceived treatment resistance amongst people with bipolar disorder. As Drs. Marcelle Mostert and Steven L. Dubovsky write in Current Psychiatry, “All phases of bipolar disorder can be difficult to treat, and patients remain symptomatic on average about half the time.” If anxiety symptoms have not been adequately treated or mistaken for symptoms of mania or depression rather than treated as discrete episodes, it is possible that it is not that treatment has failed, but that the symptom was not treated in the first place.

As clinicians gain awareness of the role anxiety plays in bipolar disorder, existing pharmacological and psychotherapeutic treatments could begin to include anxiety as a vital area of focus, and anxiety symptoms as a standard measure of treatment efficacy. Additionally, new pharmacological interventions may be developed that target episodes of anxiety alongside mood episodes. Ultimately, new bipolar disorder treatments that take anxiety into account could mean a higher chance of remission of symptoms and better treatment outcomes for patients.

The University of Columbia study sheds light on the complex and diverse symptomology of bipolar disorder. It also casts into sharp relief the importance of connecting with treatment providers who continuously stay abreast of emerging developments in the field to derive benefits of new findings as quickly as possible.

At Bridges to Recovery, we are committed to continuously expanding our knowledge and deepening our understanding of mental health for the benefit of our clients. This allows us to integrate the latest insights, best therapeutic practices, and cutting-edge pharmacological treatments to address the diverse needs of our clients in a way that makes sense for them. If you are struggling with bipolar disorder and have been unable to find relief in other forms of treatment, our residential program could open up new doors to healing through our innovative, comprehensive approach that combines intensive psychotherapy with holistic therapies and judicious use of medication. With kindness, compassion, and the highest standard of clinical expertise, we can create the treatment experience you need to find lasting stability and create a more fulfilling, purposeful, and joyful life.

Bipolar Treatment at Bridges

Bridges to Recovery is a residential treatment center for bipolar disorder and other mental health disorders. Contact us to learn more about our renowned program and how we can help you or your loved one start the journey toward healing.

Lead Image Source: Roksolana Zasiadko