New research, treatments for bipolar disorder sought

Two decades ago, psychiatric researchers thought they had found an effective treatment for manic-depressives — a drug called lithium carbonate — and then many of them turned their attention to other mental illnesses that seemed more compelling.

But the victory declaration was premature. It has since become clear that more people suffer from the disease, now known as bipolar disorder, than doctors once thought, and that only about 30 percent of patients can be successfully treated with lithium.

"It's not quite 'The Emperor's New Clothes,' " said Dr. David Kupfer, chairman of psychiatry at the University of Pittsburgh School of Medicine. "But it's close."

Dr. Thomas Insel, who became director of the National Institute of Mental Health last fall, now calls the search for new treatments for bipolar disorder "an urgent issue."

Insel said scientists need to find the root cause of the disorder, an insight that would help them design drugs specifically for the disease.

In the meantime, Insel said, there is a need for research into what combination of existing drugs might help, because bipolar disorder afflicts between 1 million and 2 million Americans and is a leading cause of disability.

"That (research) can't wait until we work out the neurobiology of this disorder," he said between presentations at the Fifth International Conference on Bipolar Disorder, continuing here through Saturday.

When the international meetings began in 1994, between 300 and 400 researchers showed up; this week, more than 1,000 researchers from 30 countries are attending and Kupfer predicted that the next meeting, in 2005, will probably be so large it will have to be moved to a larger center.

As a mood stabilizer, lithium often works wonders at controlling mania — episodes marked by high energy, lack of self-control and inflated self-esteem.

"Everybody was always worried about mania — the spending sprees, the public embarrassment," said Kupfer, the immediate past president of the International Society for Bipolar Disorders.

But it's the other side of the disease — depression — that has proven more disabling and difficult to treat. People with bipolar disorder might spend 50 percent to 60 percent of their lives in a low-grade depression. "They're not bothering anybody," as they might during a manic episode, Kupfer said, "but they're not functioning very well, either."