Bipolar Disorder and the Future

Despite the advances in the treatment of bipolar disorder in recent decades, there are many areas where we hope and expect to see new research translate eventually into better understanding of the disorder and more effective treatment. Obviously, the identification of specific genes and combinations of genes related to the development and onset of bipolar disorder promises to increase significantly our understanding of this illness and suggest new therapeutic targets. While this avenue of research is often discussed, other approaches may turn out to be just as promising.

Imaging the Brain

Today, it is possible to see deep inside the brain of a living person. The equipment may be bulky, but the images they produce are impressive and informative. When brain-imaging tools (such as functional magnetic resonance imaging and positron emission tomography) are directed at the brains of people with bipolar disorder, we get to look at the organ where mood disorders originate and go out of control.

So far, we have learned there may be a common pattern of brain development in some people that makes them susceptible to mood disorders. Other neuroimaging studies have found specific brain regions that are larger or smaller than normal in the brains of people with bipolar disorder. Continued research along these lines, combined with information gained from genetic studies, should help scientists better understand psychiatric illnesses. When we better understand the brain in health and disease, scientists may someday be able to develop better treatments and predict which types of treatment will work most effectively in an individual. All patients, and especially those now resistant to treatment, might benefit from the development of new drugs and better understanding of the underlying basis of the disorder.

Far in the future, it may even be possible to head off the development of illnesses like bipolar disorder. But that won't happen until billions of dollars have been invested in mental health research.

Better Insight into Mood

It isn't easy to convince someone experiencing a manic episode to cooperate with a researcher and lie perfectly still while images of his brain are made. It is much easier to obtain the cooperation of someone who is experiencing hyperthymia or perhaps hypomania, less-than-manic but still elevated moods. Perhaps, better understanding of mood changes such as these will be helpful in understanding more serious mood fluctuations.

It may be useful, for example, to investigate the nature of subthreshold moods; that is, mental states that don't quite satisfy the criteria for mood disorders set out by the American Psychiatric Association — bipolar I, II, and cyclothymia as well as depressive disorders. Some researchers believe that clinically significant subthreshold bipolar disorder may be as common as what is now recognized as biopolar disorder. What we learn about the spectrum of mood disorders may advance our understanding of the most serious forms such as major depression and bipolar I.

Slowly Diminishing Stigma?

Stigma has long been and remains a challenge for people with mental disorders and their families.

Advocacy groups are making progress in fighting back the ignorance that fuels misconceptions surrounding psychiatric care. Some politicians are becoming more aware of the problem, too. They showed it by passing a bill that requires businesses with fifty or more employees to provide equal insurance coverage for physical and mental health problems. The bill, which went into effect at the start of 2010, followed ten years of lobbying by mental health care advocates. It will correct injustices such as higher deductibles, higher copayments, and limited treatment options for people being treated for addiction and mental illness.

Another positive development is the publicity that bipolar and other mental disorders receive when celebrities discuss their experiences with it or become advocates and fundraisers for organizations that promote better understanding. Popular culture in the U.S. is largely driven by celebrities, and their activities can have a significant impact on how all kinds of illnesses are perceived. Continuation of this trend would be a positive way to educate the public in a society that devotes large amounts of time and money to celebrity watching. Increasing public awareness could lead to better allocation of funds for research by the federal government. At the very least, it may result in increased familiarity with mental disorders and less stigma.

Essential

Despite the dismal statistics on suicide, crime, cost to the taxpayer, and cost to the economy, bipolar disorder and other serious mental conditions traditionally have not attracted the same interest or sympathy on the part of the general public as other illnesses that afflict far fewer people. A good example is suicide, a serious risk in mood disorders. It's seldom discussed, although it ranks among the major causes of death in the U.S. and around the world.

Emma Parker Bowles dealt with bipolar disorder for years. She found that “admitting I have a mental illness is the first step in the road to recovery. Sharing it takes the power out of it. To hell with you, bipolar. I am not ashamed any more.”

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