Diagnosing bipolar disorder is a difficult task. No chemical markers are yet known, and prescribing the wrong treatment can be detrimental. A new study makes headway into this complex arena.
Bipolar disorder, previously referred to as "manic depression" involves extreme changes in activity levels within sufferers.
Different from life's normal ups and downs, those with bipolar disorder experience the most manic highs and the most dismal lows.
Bouts of sleeplessness, racing thoughts and delusions of grandiosity give way to boundless swathes of the bleakest misery.
The effects on everyday life can be devastating; relationships, jobs and friendships can be shattered. Bipolar can be treated, but it is essential that diagnosis of the condition is accurate.
There is a nebulous array of symptoms, many of which overlap with other conditions, such as unipolar depression, schizophrenia and other personality disorders.
To muddy the waters further, there are a number of different bipolar conditions to consider.
Types of bipolar disorder
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), there are four recognized clinical subsections within bipolar disorder:
Bipolar I disorder: manic episodes that last at least 1 week. The attacks may be so severe that the individual needs immediate hospitalization. Depressive episodes are also present, often 2 weeks in duration
Bipolar II disorder: depressive episodes and hypomanic (less serious than manic) episodes. No full manic episodes
Bipolar Disorder Not Otherwise Specified (BP-NOS): bipolar symptoms are presented but do not fit the criteria for types I or II
Cyclothymic Disorder (Cyclothymia): episodes of hypomania and mild depression for at least 2 years but not meeting the diagnostic requirements of the bipolar types above.
Current diagnosis of bipolar disorder is purely interview based; sometimes a brain scan and blood test are involved, but these are only to rule out other potential conditions. There are no blood-based or scan anomalies that can assist in the diagnosis.
People with bipolar disorder are often substance abusers. The reasons for this link are unclear, but a certain amount of self-medication is thought to be involved. This can add its own mental health issues and potentially increase the severity of depressive symptoms, making diagnosis more difficult.
Because of the disruptive effect of bipolar on an individual's life, it is essential that the correct diagnosis is made as swiftly as possible.
A protein marker for bipolar disorder?
Recent research carried out by the Mayo Clinic attempts to identify a marker in the blood for bipolar. To this end, they investigated 272 different proteins within 288 patients' blood samples.
The group of participants was split between bipolar I disorder (46), bipolar II disorder (49), unipolar depression (52) and 141 individuals without mood disorders, to act as controls.
The researchers believe this biochemical study to be:
"One of the first studies to assess the feasibility of high throughput multiplexed immunoassay technology (272 proteins) trying to distinguish different types of mood disorders."
The team found 73 of the measured proteins differed between the four study groups, and six were found to significantly differ between bipolar I disorder and the control group.
Although the trial is on a relatively small scale, it gives a starting point for the next round of investigations.
Previous research and hope for the future
Although there is no cure for bipolar disorder, many people do respond well to treatment. Sadly, symptoms generally persist, even once treatment has begun.
The sooner medication begins and the closer an individual works with health care professionals, the better the outcome. A quicker and more accurate diagnosis could positively influence the lives of sufferers.
Previous research, looking at proteins in cerebrospinal fluid, threw out some interesting results. They found altered concentrations of neurofilament light chain proteins (a marker for nerve damage) in participants with bipolar disorder.
Other studies have found elevated levels of C-reactive protein (a protein of the immune system involved in inflammation) in people with bipolar disorder.
Researchers elsewhere have searched for links between bipolar and increased levels of brain-derived neurotrophic factors (factors involved in nerve growth).
Science has certainly carved inroads toward a deeper understanding of bipolar chemistry, and this current study is the next level. Dr. Mark Frye, lead author of the study and head of psychiatry and psychology at Mayo Clinic, says:
"The potential of having a biological test to help accurately diagnose bipolar disorder would make a huge difference to medical practice. It would then help clinicians to choose the most appropriate treatment for hard-to-diagnose individuals."
A reliable and consistent biomarker for bipolar disorder may still be some distance away, but now more than ever, it seems plausible. Perhaps even imminent.
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