Leading researcher calls for revolution in diagnosis and treatment of bipolar disorder

9 April 2007

A world-leading researcher into bipolar disorder has called for a revolution in how the illness is diagnosed and treated based on a better understanding of the genetic, biological and psychological factors that determine a person's susceptibility to the illness. Professor Nick Craddock, whose work is funded by the Wellcome Trust, the UK's largest medical research charity, makes the call at the start of Mental Health Action Week (8–14 April 2007).

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

Speaking to 'Pendulum', the journal of MDF (The Bipolar Organisation), Professor Craddock sets out his 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.

Research conducted by the Mood Disorders Research Team at Cardiff University, 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 that 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 [rather than prescribing medication]."

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.

"The problem at the moment is that medications tend to do a lot of things. Lithium…causes a lot of different chemical changes in the brain and we don't know which of the chemical changes are the important ones that have therapeutic benefit.

"We know some of the changes have side effects in some people. So 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."

Contact

Craig Brierley
Media Officer
Wellcome Trust
T +44 (0)20 7611 7329
E c.brierley@wellcome.ac.uk

Notes for editors

1. The Wellcome Trust is the largest charity in the UK. It funds innovative biomedical research, in the UK and internationally, spending around £500 million each year to support the brightest scientists with the best ideas. The Wellcome Trust supports public debate about biomedical research and its impact on health and wellbeing.

2. MDF The Bi-Polar Organisation is the largest user-led mental health charity in the UK, with over 160 self help groups across the country. MDF The Bi-Polar Organisation supports, campaigns for and educates those with the illness and their carers.

3. Cardiff University is recognised in independent Government assessments as one of Britain's leading teaching and research universities. Founded by Royal Charter in 1883, the University today combines impressive modern facilities and a dynamic approach to teaching and research. The University's breadth of expertise in research and research-led teaching encompasses: the humanities; the natural, physical, health, life and social sciences; engineering and technology; preparation for a wide range of professions; and a longstanding commitment to lifelong learning. Cardiff is a member of the Russell Group of Britain's leading research universities.