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Treatments For Bipolar Disorder Expanding

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By MALCOLM RITTER, The Associated Press

Published: September 3, 2007

NEW YORK - Scientists are testing seasickness patches and other surprising options in a challenging search for ways to treat the crushing depression and uncontrolled mania of bipolar disorder.

Also called manic-depression, it's an illness that can rip careers and marriages apart and drive people to suicide. And it's so complex and mysterious that researchers haven't developed a medication specifically for it since lithium, more than half a century ago.

Yet bipolar appears in various forms and severity in about 1 in every 25 American adults at some point in their lives, according to a major study published in May.

Current medicines help, but often fall short.

They 'certainly reduce symptoms but don't do a good enough job,' said Husseini Manji of the National Institute of Mental Health. 'Many patients are helped, but they're not well.'

Nobody knows yet whether the latest crop of possible treatments will pan out. Besides the motion sickness patch, choices include a drug that treats Lou Gehrig's disease and a device that produces an electric field around the brain.

The disorder's classic feature is episodes of mania, which are periods of boosted energy and restlessness that can run for a week or more.
Bipolar disorder is hard to treat chiefly because the depressive episodes are more severe and more resistant to therapy than ordinary 'unipolar' depression, says Andrea Fagiolini, an associate professor of psychiatry at the University of Pittsburgh.

What's more, many patients can't tolerate bipolar medications because of side effects such as weight gain, sleepiness, tremor, and the sense of feeling 'drugged,' Fagiolini said.

'That means there's a lot of room for improvement,' said Andrew Nierenberg, professor of psychiatry at Harvard Medical School. 'That's why we need new treatments.'

But there's a basic problem. Just as heart attacks come from chronic heart disease, the manic and depressive episodes come from an underlying chronic brain disease. And 'we just don't really understand what's behind the illness,' said Gary Sachs, who directs bipolar research at Harvard's Massachusetts General Hospital.

Take the experience of NIMH researchers Maura Furey and Wayne Drevets with the drug scopolamine, which is normally used to keep people from getting seasick or carsick. Several years ago, they were studying whether scopolamine could improve memory and attention in depressed people. They gave the drug intravenously to depressed patients, trying to find the right dose for a brain-imaging study.

Then they noticed an odd thing. The patients started feeling less depressed the night after the injections, a remarkable thing because most antidepressants take weeks to kick in.

Drevets and Furey quickly changed their research focus to test the drug's effect on depression itself. And in October, they published an encouraging, though preliminary, result with a small group of depressed patients, some of whom had bipolar disorder.

Now Furey is leading a study using scopolamine skin patches - like those travelers wear to prevent motion sickness - to treat depression in bipolar disorder as well as ordinary depression.

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