Bipolar Disorder Treatment: Hope on the Horizon
Before I began researching mental health conditions, I thought the reason we didn’t have reliable bipolar disorder treatment options was that they were just too hard to figure out. Human brains are difficult to study. Researchers can’t obtain live brain tissue samples for experiments and must rely on limited options for study, such as genetics and neuroimaging.
Unfortunately, genetics research concluded that, rather than being due to a single gene, most neuropsychiatric disorders likely arise from a complex combination of slight variations in dozens, if not hundreds, of genes acting together. In other words, based on genetics, these disorders are too complex to immediately understand.
Combined, I believe these issues are why so many of us received the message that finding better bipolar disorder treatment is an insurmountable goal. However, since I began researching bipolar disorder myself, I realized that this perception of impossibility is flat-out untrue. There is real hope on the horizon, and some of it is not far off.
Learning How the Brain Works
After genetics research failed to identify one single root cause for most psychiatric conditions, researchers began to focus more effort on the other big tool in the non-invasive research toolbox: neuroimaging. Neuroimaging refers to techniques that create pictures of the brain’s structure and activity, such as MRI (Magnetic Resonance Imaging) and CT (Computed Tomography) scans. These methods allow researchers to observe the brain non-invasively, studying both its physical structure and how it functions during different activities; Scientists have been working hard to identify how brains differ in people with depression, bipolar disorder, and schizophrenia versus people who do not have these conditions.
Essentially, researchers are working to better understand how different parts of the brain respond and talk to each other. For example, if you write, “I love you!” inside a card to a loved one, you’re using the parts of your brain needed for
- vision (seeing what you wrote)
- physical coordination (holding and moving your pen to write)
- language (because you’re writing words)
- thinking (developing the concept you’re writing about into a cohesive thought or statement)
- and emotion (the love behind the statement).
All of these regions in your brain work together in a perfectly choreographed dance that allows you to complete the activity successfully.
However, in neuropsychiatric disorders, the choreography falls out of sync: the wrong part of your brain may activate, or the right part may over- or under-activate. For example, someone suffering from depression may have a disproportionately small response in their brain’s activity to happy images or images of loved ones compared to someone without depression. This phenomenon can make it difficult—or outright impossible—for someone who is managing severe depression to feel loved or to gain a sense of reward from the good things in life. We still don’t know exactly what drives these changes in brain activity, but researchers are making progress on treatments that address them.
Promising Bipolar Disorder Treatments
Transcranial Magnetic Stimulation
At its core, the nervous system is an electrical system. We call these connections in the brain neural circuits because they are literal electrical circuits. The great news is that, just like other types of electrical circuits, neural circuits can be influenced by magnets. With a really, really strong magnet (you can’t do this with any personal device or magnet), clinicians can selectively stimulate or dampen regions of the brain that are under- or over-active in a given mental health condition. This is the principle behind transcranial magnetic stimulation (TMS), which has been showing great promise as a treatment for many individuals living with severe depression.
TMS uses a powerful magnet to stimulate activity in a part of the brain (the prefrontal cortex) that is important for emotional regulation and is often underactive in depression. TMS is becoming increasingly available in clinics around the world, but it is currently only FDA-approved for unipolar depression, and thus insurance will usually only cover TMS for unipolar depression. However, TMS is not currently an approved treatment for bipolar depression.
If you have bipolar disorder, your insurance will not cover TMS, and you may not be able to access TMS treatment through your clinic, even if they offer it for unipolar depression. The reason for this stipulation, cruel as it may seem, is that stimulation of the brain in someone with bipolar disorder can swing them from depression into mania. TMS is a new enough treatment that researchers and clinicians are still working out whether it helps (or harms) people with bipolar disorder, as well as what the specific parameters of treatment should be for bipolar patients (such as which region of the brain should be treated, what frequency of magnetic pulse do you use, etc.).
But if you or a loved one have bipolar disorder, don’t give up hope: There are currently many active clinical trials that are looking at TMS specifically in bipolar disorder. You may be eligible to participate in a clinical trial (check www.clinicaltrials.gov to see if there is a relevant trial near you), but even if not, the results of the current trials will hopefully lead to TMS treatments that are safe and effective for bipolar patients in the coming years.
Ketogenic Diet
As promising as TMS is, there is another treatment currently being researched that is even more promising—and more immediately accessible—to a larger number of people: the ketogenic diet (KD).
Although the KD has become something of a fad diet in recent years, it was originally developed at the Mayo Clinic in 1921 by a physician, Russell Wilder, as an epilepsy treatment. The essence of the KD is that one eats very few carbohydrates (generally not more than 20 g per day) and obtains dietary calories primarily from fat and protein. When dietary carbs are kept so low, the body stops burning sugar and carbs as a fuel source, and it instead begins to produce an alternate fuel source, ketone bodies, from dietary fat.
Evidence from pilot-scale clinical trials is currently starting to be reported with very promising findings for a variety of mental health conditions. So far, researchers have found evidence that suggests the KD improves symptoms—sometimes profoundly—in patients with bipolar disorder, schizophrenia, depression, and anxiety. Although larger scale studies are still needed, the results so far are some of the most promising data in the field of psychiatric research in many years.
The best news of all is that the KD has fewer and less severe side effects than most psychiatric medications, and it does not require a prescription to implement (though you should still check with your doctor to verify it is safe for your particular body). However, there are a few key considerations to be aware of. The first is that the KD is not recommended for individuals with heart, liver, kidney, or gallbladder issues, as the increase in dietary fat and protein can stress these systems. Second, by cutting out carbs almost entirely, it can be easy to miss essential nutrients in the diet that are normally found in carb-heavy foods, so you may need to take additional supplements. It is important to consult with a physician or nutritionist to make sure you meet your nutritional needs.
Lastly, there is anecdotal evidence that suggests psychiatric symptoms may get worse before they improve as your body and brain chemistry adjust to the large change. For this reason, it is important to discuss the KD with your psychiatrist, if you decide to try it out. Do not stop taking your meds if you decide to try the KD. You will want to talk with your doctor about what to expect and how to best manage the symptoms as you adjust. Keep in mind, it may take months to see maximum results, and real efficacy requires strict adherence to the diet. This is not something to try for a week to see if it works for you—it’s more a try it and stick to it religiously for a year to see if it works for you.
For more information on using the KD for mental health conditions, I highly recommend checking out the website for the Metabolic Mind, a nonprofit focused on the growing field of nutritional psychiatry. There, and on their YouTube channel, you can find reputable resources and discussions about using the KD for mental illness treatment.
Keep Hope for Bipolar Disorder Treatment on the Horizon
Overall, we have more reason than ever to be hopeful about the future of psychiatric medicine. It has been a long while with no huge breakthroughs, but there is a lot to be excited about. The growth in technology, combined with advances in artificial intelligence and machine learning, mean that researchers are increasingly able to identify and address differences in brain activity between people with a mental health condition and those without.
And even more exciting, scientists are just beginning to delve into how food and supplements might be harnessed to treat mental health conditions. We have a whole new frontier to explore, and even though the journey has just started, we already have a treatment—the KD—that is showing tremendous promise. For many, it is something you can try right now. In the meantime, we researchers will chase all new leads, we will continue to fight, and we will not give up. The struggle of mental health is not too difficult a problem to solve, and we have not forgotten about your pain. I can’t say when, but brighter days are coming.
Karina Kruth received her PhD in biochemistry from the University of Iowa in 2013, where she studied actin, which is a structural support protein that acts like a skeleton inside cells. After completing her PhD, Karina transitioned to studying how cellular energy metabolism—how our cells use the food we eat—interacts with actin in neurons, and how that interaction affects neuronal function. She was awarded a NARSAD Young Investigator Award by the Brain and Behavior Research Foundation in 2021 to study metabolism and actin in bipolar disorder, and she hopes that the (as yet unpublished) results of her work will kickstart an opportunity to lead her own lab focused on finding new mental health treatments through modulation of brain energy metabolism.