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Bipolar disorder

A world-leading researcher into bipolar disorder has called for a revolution in how the illness is diagnosed and treated.

Professor Nick Craddock, whose work is funded by the Wellcome Trust, the UK's largest medical research charity, has called for a better understanding of the genetic, biological and psychological factors that determine a person's susceptibility to the illness.

Bipolar disorder has been much in the news since comedian Stephen Fry revealed that he suffered from the illness. In his documentary series The Secret Life of the Manic Depressive, Fry visited Professor Craddock's team at the School of Medicine, where they are conducting the largest study of individuals with bipolar disorder in the world.

Speaking to Pendulum, the journal of MDF (The Bipolar Organisation), Professor Craddock has set out a vision of how research into the pathogenesis of the disorder will lead to better diagnosis and more precise tailoring of existing treatments to the specific needs of the individual.

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Research conducted by the Mood Disorders Research Team at Cardiff, in collaboration with the University of Birmingham, emphasises that bipolar disorder can manifest itself very differently in different people and that the symptoms may change over time. Professor Craddock believes that the current labels, such as bipolar 1, bipolar 2 and major depression can lead to confusion and misdiagnosis, with patients showing identical symptoms being diagnosed as having bipolar disorder, schizophrenia or depression.

"We might move towards talking, for example, about bipolar spectrum disorder which would mean that the person is susceptible to ups and downs - but it might include people at the moment who are variously diagnosed as having bipolar 1 disorder, severe depressions and schizophrenia," he says.

"We would have to look very closely at the person’s own individualised experience of the illness in order to get a full understanding of what is required to treat them effectively."

A better understanding of the specific biological, psychological and environmental factors that trigger mood-swing disorders will lead to a wider, more tailored range of treatments being made available, argues Professor Craddock.

"It may well be that we identify forms of illness which only occur when there are certain triggers," he says. "One example might be something that is related to hormonal problems, particularly in women. Another example is something that is triggered only by sleep deprivation. If we find that their illness is only likely to occur under certain triggers, maybe the only thing we need to do is to advise the person to avoid the triggers."

Some form of medication will still be necessary in most cases, believes Professor Craddock; however, research being carried out by his team should pave the way towards allowing doctors to anticipate better potential side-effects caused by medication such as lithium.

He said: "By understanding more about the illness, the hope is that we’ll be able to develop treatment that will rather precisely adjust the chemicals that are out of balance without causing chemical changes that might cause side effects."