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CREST_BD289 karma

Steven Barnes here - I have bipolar disorder Type I, and talk about it openly both when teaching about psychiatric disorders and in general (as you can see...). Having bipolar disorder has had an immense impact on where I am and what I am doing (and probably vice versa). Some of those have been positive impacts, some negative. It continues to guide the choices I make in my career. For example, I am less tolerant of stressors than many around me, so I tend to avoid higher stress activities.

CREST_BD235 karma

Trisha here - I am a psychiatrist working at a specialized center for mood disorders. In this center, I and my colleagues see many individuals with bipolar disorder who have been struggling for a long time to find the right treatment. With this experience, let me start off by saying that I 100% understand the frustration at the seemingly arbitrary nature of prescribing treatments for bipolar disorder.

There are many reasons why it can be difficult to find the right medication for an individual. One reason that I will focus on in this response is the current lack of ‘personalized medicine’ in psychiatry. We have many medications that have been studied for the treatment of bipolar disorder, and many that have shown efficacy. The problem is that these studies demonstrate efficacy by showing that a group of people who received the medication overall did better than a group of people who received placebo. These types of studies are essential to establish that a medication provides some benefit in treating symptoms. Unfortunately, these types of studies can’t tell us which particular individuals would benefit from this particular medication. I can estimate that, based on the studies, if I give medication X to 10 people, 6 people would benefit and 1 might experience side effects. However, I can’t estimate with any degree of certainty whether the individual sitting in front of me will be one of those six who might benefit, or the one who will experience side effects.

There are a number of ongoing studies looking at genetic and symptom profiles, and how this might help us with individual prediction of response and side effects. Unfortunately, though, we still have a ways to go in this area of research. We currently have treatment guidelines (like those from CANMAT) that ‘rank’ medications based on the efficacy they show in these types of group studies, the quality and quantity of studies that back them up, and the overall side effect burden. Taking a thorough clinical history, getting a detailed medication history, and combining that with recommendations from treatment guidelines is currently the best approach we have in deciding on treatment options. Sometimes using this approach we can fairly quickly find the best fit for the person, but unfortunately sometimes it is a much longer process.

CREST_BD230 karma

Steven Barnes here - There is an emerging literature on the role of the gut microbiome is psychiatric disorders. There are known differences in the constituents of the gut microbiome in individuals with bipolar disorder, but it is currently unclear which differences matter and whether the addition of a specific microbe might alter the course of bipolar disorder. There are a handful of good review articles on the topic, though they are all pretty technical. If you feel comfortable with the technical language, here is a good recent one:

Järbrink-Sehgal, E., & Andreasson, A. (2020). The gut microbiota and mental health in adults. Current Opinion in Neurobiology, 62, 102-114.

CREST_BD136 karma

Steven Barnes here - Not a silly question at all! Lithium does kill mites (e.g., the type that kill honeybees) and has deleterious effects on the larvae of certain mosquitos (e.g., the ones that cause yellow fever). However, I know of no studies that have looked at the incidence of insect bites in people who are on lithium.

CREST_BD124 karma

Steven Barnes here - What we know about the natural progression of bipolar disorder is that, when left untreated, the mood episodes (i.e., mania, depression) tend to become more severe and more frequent over time. We know much less about what happens with people who have been on mood stabilizers for an extended period of time, given that there are so many different mood stabilizers available and because it is hard to conduct the sorts of studies that would address the question. If you are seeing increases in the intensity of your symptoms, I would highly recommend you speak to your healthcare provider about this.