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Emerging Diagnosis and Treatment Options for Bipolar Disorder

Reviewed by: HU Medical Review Board | Last reviewed: September 2023

Bipolar disorder (BPD) carries a high burden for the people who have this serious mental health condition. The recurring bouts of mania and depression can be hard to manage. When they are not well-controlled, these cycles can limit a person’s ability to engage in work, school, and relationships.1

Bipolar disorder fails to improve with current treatments more often than major depressive disorder (MDD). For those with bipolar disorder, long-term depression leads to structural changes in the brain, which makes it even harder to treat.1

Doctors recognize the desperate need for new and better treatments for BPD. Lithium, the main drug used to treat the condition, was approved for use in the United States over 50 years ago. Lithium and other traditional mood stabilizers work well for many people, but not all. And it has significant side effects.2

Thanks to scientific research, experts have identified some promising new treatment options.2

Blood tests for bipolar disorder

Right now, diagnosis and treatment for BPD often involve trial and error. But researchers at Indiana University have created a blood test that looks at a person’s genetic material to find their risk for several mental health issues.3

The test can measure:3,4

  • How severe a person’s depression or pain may be
  • A person’s risk of developing severe depression or bipolar disorder
  • A person’s risk of wanting to end their life through suicide

This information helped doctors prescribe medicines in a more targeted and accurate way.3,4

You can order your own MindX One™ blood test. But the cost ranges from $1,999 to $2,999, and it is not covered by insurance.3,4

Genetic testing

A study led by researchers from Harvard and MIT found that having changes (mutations) on the gene AKAP-11 puts a person at risk for both BPD and schizophrenia. Lithium also interacts with the AKAP-11 protein.2

This finding may help doctors understand why BPD develops and why lithium works for only some people. It may help doctors develop new, more accurate treatments for the condition.2

The evidence for genetic testing is limited. More research is needed. At this time it is not considered to be a method of guiding treatment.

Botox

Doctors do not fully understand why, but some people’s depression improves after they receive a botox injection in their face. It may be that botox slows or blocks nerve and muscle signals in the brain. Experts do not yet know what doses are most effective and how often they should be given.5

Botox may be a good option for people with BPD for whom antidepressant drugs trigger mania.5

Ketamine

Several studies are looking at how the drug ketamine may improve BPD and reduce suicide risk. Early evidence suggests that ketamine works quickly to improve symptoms of BPD that do not respond to other treatment.1

Ketamine has been used for decades as an anesthesia in humans and animals. It has also become a popular illegal drug that often is called Special K.6

In 2019, the US Food and Drug Administration (FDA) approved a nasal spray version of ketamine for treatment-resistant depression. The spray must be administered in a doctor’s office so the person can be monitored closely. Symptoms of depression begin to lift within 40 minutes but can return if treatment is not stabilized. Doctors can then find other mood stabilizers or antidepressants that may work long term.6

Ketamine is not recommended for people who have had psychotic episodes or substance use problems in the past. Teens, the elderly, and people who are pregnant or breastfeeding also should not use ketamine.6

Bright light therapy (phototherapy)

Bright light therapy may also be called phototherapy or light therapy. It involves sitting in front of a light box for a certain amount of time per day. The box delivers a particular type of light. It is used to treat depression, especially depression linked to seasons with less light. It also has proven helpful for people with bipolar depression.7

Light therapy is easy to use and carries few side effects. Headache was the most common side effect in 1 study. It may be a good add-on treatment for pregnant people, older adults, and others who wish to try a nondrug option.7

Many studies about what causes bipolar disorder and how to treat it are underway.

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