Insight Matters
Summer, 2001

UC researches treatment for patients with Bipolar Disorder

Bipolar disorder is a common, recurrent and severe psychiatric illness associated with substantial risks of morbidity and mortality. Numerous studies have described the enormous economic costs of untreated bipolar disorder. The costs in human suffering are staggering. For over 50 years lithium was the cornerstone of treatment for patients with this illness. Unfortunately, at least 40% of people with bipolar disorder do not have an adequate therapeutic effect from lithium or are unable to tolerate its side effects. Furthermore, patients with rapid cycling (4 or more episodes of mania or depression within a year) or with mixed episodes (co-occurring mania and depression) have been less likely to benefit from lithium than patients without these clinical features. These limitations of lithium therapy have stimulated the search for other medications with mood-stabilizing and antimanic properties. The good news is that after decades of frustration, treatments for patients with bipolar disorder are improving. In the last 7 years, two medications, divalproex (Depakote ®) and olanzapine (Zyprexa®) received U.S. Food and Drug Administration approval for the treatment of acute bipolar mania (and mixed episodes). In addition, both medications appear to have expanded the breadth of mood stabilization by having efficacy in patients with rapid cycling and mixed episodes. Although the availability of these medications represents real therapeutic advances, a substantial number of patients with bipolar disorder do not respond adequately to these agents. Fortunately, a number of new medications are under active study for the treatment of various aspects of bipolar disorder. These include omega-3 fatty acids, the atypical antipsychotics, quetiapine, ziprasidone and aripiprazole (not yet available), and new anticonvulsants, lamotrigine, oxcarbazepine, topiramate, zonisamide, and levetriacetam.

The treatment of bipolar depression has been the most neglected aspect of treatment research in bipolar disorder. Presently, we do not know if one class of antidepressants is more effective or less likely to be associated with switching into mania than others.

The Stanley Foundation Bipolar Network (SFBN) is a five center research program dedicated to finding new treatments for patients with bipolar disorder. The centers include the University of Cincinnati Medical Center, University of Texas Southwestern at Dallas, University of Los Angeles, and the National Institute of Mental Health (NIMH). Studies conducted at the SFBN sites are designed to address important unanswered questions about treatment for patients with bipolar disorder and to offer treatment protocols encompassing all aspects of the illness. Currently, a number of studies are being conducted at the University of Cincinnati site. The first study is a comparison of the effectiveness of three antidepressants in the treatment of bipolar depression. The second study is an investigation of the effectiveness of omega-3 fatty acids (a type of fish oil) in treating bipolar depression and in preventing mood cycling.

Two new anticonvulsant medications, zonisamide and levetiracetam, are being studied for their possible mood-stabilizing effects. Finally, two medications are being studied to treat weight gain, which is sometimes a side effect of other mood-stabilizing medications.

These studies should provide important information about the effectiveness of these potential medications for patients with bipolar disorder. Information about these studies is available by contacting (513) 558-5117 or at www.bipolarnetwork.org or http://psychiatry.uc.edu/triallistings/stanley_foundation_bipolar.asp.

Paul Keck, M.D.,
Professor of Psychiatry and Vice Chairman for Research, University of Cincinnati