Innovative approaches to bipolar disorder and its treatment

Journal article

All psychiatric disorders have suffered from a dearth of truly novel pharmacological interventions. In bipolar disorder, lithium remains a mainstay of treatment, six decades since its effects were serendipitously discovered. The lack of progress reflects several factors, including ignorance of the disorder’s pathophysiology and complexities of the clinical phenotype. After reviewing the current status, we discuss some ways forward. First, we highlight the need for a richer characterisation of the clinical profile, facilitated by novel devices and new forms of data capture and analysis. Such data are already promoting a re-evaluation of the phenotype, with an emphasis on mood instability rather than on discrete clinical episodes. Second, experimental medicine can provide early indications of target engagement and therapeutic response, reducing the time, cost and risk involved in evaluating potential mood stabilisers. Third, genomic data can inform target identification and validation, such as the increasing evidence for involvement of calcium channel genes in bipolar disorder. Finally, new methods and models relevant to bipolar disorder, including stem cells and genetically modified mice, are being used to study key pathways and drug effects. A combination of these approaches has real potential to break the impasse and deliver genuinely new treatments.

Authors: Harrison, P; Cipriani, A; Harmer, C; De Ozorio Nobre, A; Saunders, K

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Wiley
• Journal: Annals of the New York Academy of Sciences
• Volume: 1366
• Issue: 1
• Pages: 76–89
• Publication date: 2016-01-01
• Acceptance date: 2016-03-01
• DOI: 10.1111/nyas.13048
• ISSN: 1749-6632
• Keywords: bipolar disorder; therapy; genetics; mood; clinical