To manage the outward signs of bipolar disorder day-to-day, a type of treatment is available that helps to prevent the depressive and manic phases.
While care and treatment of bipolar disorders still rely on medication, there are also non-drug solutions that can help to reduce symptoms.
Drug treatments
There are three main categories of mood-stabilizing or mood-regulating treatments, for example: lithium-based treatments, medicines belonging to the anti-convulsant family, as well as certain atypical anti-psychotics.
Lithium
Different forms of lithium, such as lithium salts, may be effective in preventing the risk of suicide.
Lithium is, unfortunately, under-prescribed because of its long-term side effects, including possible effects on kidney and thyroid function, which require regular biological monitoring. It is important to know that, despite its side effects, lithium reduces patients’ mortality (increasing their life expectancy).
Anticonvulsants and other drugs-based treatments for bipolar disorder
The two other types of treatment are certain types of anti-convulsant (anti-epileptic) drugs, as well as the majority of atypical anti-psychotics. Certain anti-depressant treatments can sometimes be used, but only to manage a specific episode of depression, in combination with mood stabilizers, and only for a short time.
Are non-drug treatments available as complementary therapies?
Non-drug treatments are available to complement the medicinal approach, such as light therapy and neurostimulation, and transcranial magnetic stimulation or electroconvulsive therapy in severe and persistent forms of bipolar disorder.
A fundamental part of helping someone who has bipolar disorder is something called psychoeducation, or therapeutic education, where the patient becomes an expert on their disease and its treatments. They must learn how to spot the warning signs of a depressive or manic episode. This is essential, to help them act as quickly as possible and avoid hospitalization. This work needs to be done alongside loved ones, as they are often the ones reporting symptoms before an episode.
Different psychotherapies and lifestyle and dietary measures are important in everyday life. A healthy lifestyle is a key part of getting the disorder under control. Keeping to fixed sleep schedules, a consistent waking up time during the week, and limiting the use of excitatory or toxic products such as cocaine and cannabis.
At Paris Brain Institute
At Paris Brain Institute, the "Motivation, Brain and Behaviour" team is researching two aspects of mood disorders.
The first looks into the effects of mood episodes. Changes in mood have an impact on patients’ decision-making, motivation and information processing. Some of the work done at Paris Brain Institute seeks to profile motivational disorders during bipolar mood episodes, and especially during depressive episodes.
The other aspect of the research undertaken at Paris Brain Institute seeks to understand the kinetics of mood fluctuations. Is it possible to describe, from a cognitive perspective, how the mood fluctuations that we all experience every day, or pathological fluctuations, occur? Do they follow the same pattern and logic? How does mood impact information processing?
In recent years, some teams have focused on building a computational model of mood. In other words, using equations to try to describe how a sequence of positive and negative events can be integrated over time within a mood signal. This is of course a reciprocal phenomenon: mood is influenced by the life events we experience, but it also impacts how we perceive them.
A special focus on mood fluctuations
An initial step in this line of research is to induce minimal fluctuations in mood in healthy subjects over a short time, for example using positive or negative stimuli, to describe how they affect participants’ mood (as measured by subjective assessments). It is then possible to capture this phenomenon mathematically, to combine this approach with neuroimaging to see the brain correlates, or to study how these mood fluctuations influence decision-making.
One limitation is timescale. In the laboratory, and especially in an MRI machine, we usually only study fluctuations over a short timescale of just a few minutes or hours. By contrast, in clinical practice, these fluctuations are clearly far more intense, but also much slower: the bipolar mood episodes last for weeks or even months.
Emergence of a research project on bipolar disorder and mood disorders
The research team seeks to apply this same logic, but to understand mood fluctuations over a much longer timescale, for example by creating an application.
The key question is whether the equations used to describe minimal mood fluctuations over a short time can also be used to predict much more intense fluctuations over several weeks.
One way of doing this is to use the same kind of cognitive tasks previously used in healthy volunteers (i.e. over a short period of just ten or so minutes) in patients with bipolar disorders. The next step is to apply the computational model developed by the researchers to extract what are known as free parameters, i.e. numbers describing (in this instance) how positive and negative signals accumulate over time within the mood signal. Beyond direct comparison with healthy volunteers, this will also show whether these free parameters (obtained over a short period of time) make it possible to predict how mood fluctuates over a far longer period, as measured by the application.
In the longer term, this kind of strategy could be one of many elements that guide clinicians in their treatment choices.
A second focus of the project is to study the neurobiological bases of these mood kinetics. Unfortunately, most imaging techniques do not allow us to track the activity of different brain regions over a long period of time (a patient cannot be left in a scanner for several days!). There is therefore a significant technological challenge in changing the timescale and mapping out a several-week-long process! This research into mood fluctuations over a longer period of time could offer a starting point for more granular, richer research into bipolar spectrum disorders.
