Drug treatments
There are three major classes of thymoregulatory or mood-regulating therapies: lithium-based therapies, drugs belonging to the family of anticonvulsants, and some atypical antipsychotics.
Lithium
Different forms of lithium, such as lithium salts, may be effective in preventing suicidal risk.
Unfortunately, lithium is under-prescribed because of its long-term side effects, including possible effects on renal function and the thyroid, which require regular biological monitoring. It is important to note that despite its side effects, lithium decreases mortality (and therefore increases life expectancy) in patients.
Anticonvulsants and other drug treatments for bipolarity
The other two classes of treatment are certain anti-seizure drugs (anti-epileptics), as well as the majority of atypical antipsychotics. Certain antidepressant treatments may sometimes be used, but only on an ad hoc basis, i.e. for the management of a depressive episode, in combination with thymoregulatory therapy, and for a short period of time.
Complementary non-medicinal treatments?
Non-drug treatments also exist to complement the drug approach, such as light therapy or neurostimulation, with transcranial magnetic stimulation and especially electroconvulsive therapy in severe and resistant forms of bipolarity.
An absolutely fundamental aspect of helping someone with bipolar disorder is psychoeducation, or therapeutic education. Indeed, the patient must be an expert in his disease, and its treatments. In particular, they need to learn how to spot the warning signs of a depressive or manic episode. This is essential to act quickly and avoid hospitalization. This work needs to be done with loved ones, as they are sometimes the ones who report symptoms before an episode.
The various forms of psychotherapy and hygiene-dietetic rules are important in everyday life. Healthy living is an element in itself of controlling the disorder. Have fixed sleep schedules, a fixed hour of daytime in the week, limit the taking of exciting and toxic products such as cocaine or cannabis…
Bipolar Disorders Research at the Paris Brain Institute
At the Paris Brain Institute, the “Motivation, Brain and Behaviour” team is working on two aspects of mood disorders.
The first concerns the effects of thymic episodes. Mood variations have an impact on decision-making, motivation, and patient information processing. Some of the work carried out at the Brain Institute therefore seeks to characterize motivational disorders during thymic episodes, particularly during depression.
More information: https://institutducerveau-icm.org/en/actualite/dire-secoue-toi-a-personne-deprimee-ca-ne-sert-a-rien/
The other aspect of the research undertaken at the Brain Institute is to understand the kinetics of mood fluctuations. Is it possible to describe, from a cognitive point of view, how mood fluctuations that we can all experience in our daily lives or pathological fluctuations arise? Do they follow the same pattern and logic? How does mood affect information processing?
In recent years, some teams have been interested in building a computational model of mood, that is, trying to describe, using equations, how a sequence of positive and negative events can be integrated over time into a mood signal. Of course, this is a reciprocal phenomenon: the mood is influenced by the life events we experience, but it also affects how we perceive them.
A special focus on mood changes
A first step in this line of research is to induce minimal mood fluctuations in healthy subjects over a short period of time, for example using positive or negative stimuli, to describe how they affect the mood of participants (as measured by subjective assessments). It is then possible to describe this phenomenon mathematically, to couple this approach with neuroimaging to see the brain correlates, or to study the impact of these mood fluctuations on decision-making.
More information: https://institutducerveau-icm.org/en/actualite/humeur-influence-nos-decisions/
One limitation is the issue of time scale. In the laboratory, let alone in an MRI machine, only fluctuations on a short time scale, a few minutes or a few hours are typically studied. By contrast, in the clinic, these fluctuations are obviously much more intense, but also much slower: thymic episodes last for weeks or even months.
The birth of a research project on bipolarity and mood disorders
The research team wants to use the same logic, but to understand mood fluctuations on a much longer time scale, particularly through the creation of an application.
In general, the question is whether the equations used to describe minimal mood fluctuations over a short period of time can also be applied to predict much more intense fluctuations over several weeks.
One way will be to transfer the same kind of cognitive tasks that we have already used in healthy volunteers (i.e., over a short period of a few dozen minutes) to patients with bipolar disorder. The next step is to apply the computational model developed by the researchers to extract what are called free parameters, that is, numbers describing — in this case — how positive and negative signals are accumulated over time within the mood signal. In addition to direct comparison with healthy volunteers, they will also be able to see if these free parameters (obtained over a short period of time) predict mood changes over a much longer period of time, as measured by the application.
In the very long term, this type of strategy could be one element, among others, to guide the clinician in his or her treatment choices.
A second aspect of the project is to study the neurobiological basis of this mood kinetics. Unfortunately, most imaging techniques cannot track the activity of different brain regions over a long period of time (it is not possible to leave a patient in a scanner for several days!) There is therefore a real technological challenge to change time scales and describe a process on the scale of several weeks!
In particular, this research on the fluctuation of moods over a longer period of time may provide the basis for a more granular, and richer, research on bipolar spectrum disorders.