Iain Campbell, a researcher based at the University of Edinburgh, has a special perspective on bipolar depression. He lives with the condition and has lost family members who took their own lives due to their depression. It remains an intractable, devastating health problem, he says.
More than a million people in the UK have bipolar depression, a third of whom are likely to attempt suicide. Yet the condition’s roots remain unknown – despite considerable efforts to understand them.
However, a major new approach to the disease has recently been adopted by psychiatrists to discover its causes and highlight possible treatments. Rather than viewing bipolar depression as a mood disorder, it should be viewed as a metabolic disorder that can be addressed through diets and other interventions that can alter bodily processes.
“We need to think of bipolar depression not as a primary emotional problem, but as a dysfunction of energy regulation in the body,” says Campbell, who played a key role in drafting Edinburgh University’s Hub for Metabolic Psychiatry, which opened last week. “It’s a very different way of thinking about mental illness.”
Supported by the Baszucki Foundation, a Canadian charity, and UK Research and Innovation, the national funding agency, the hub will investigate bipolar depression’s links to metabolic disorders, such as diabetes and obesity, and will also investigate how these are affected by disruptions of circadian rhythms.
“Systems involving energy, metabolism and light are all connected in our bodies and one outcome of their disruption is bipolar depression, we believe,” says Professor Danny Smith, head of the new Hub for Metabolic Psychiatry.
Bipolar depression was originally known as manic depression, a label that caught its progression, Smith added. “Sometimes people have no energy. In others, they simply have too much. They are manic. They don’t need sleep. They are really active and do things that are out of character. Psychiatrists will say to them: how do you feel? In fact, they should be asking: what do you do?”
One approach is developing metabolic treatments that can limit their bouts of mania and lethargic depression, Campbell said. “Ketogenic diets, in which a person eats no carbohydrates but lots of fats, are quite common. They are used to reduce weight but also to treat epilepsy in some cases. However, it is now becoming clear that they can help alleviate bipolar depression.”
A recent study conducted at the University of Edinburgh involved 27 individuals with bipolar depression who were put on a keto diet for eight weeks.
“A third of them did very well. Their mood was more stable, they were less impulsive and their depression lifted,” Smith said. “[Finding] “Finding out why some responded and others didn’t will be one of the first undertakings for researchers at the new hub.”
Other research will focus on the fact that many bipolar individuals suffer from depressive episodes that peak in the fall and winter, while their mania peaks in the spring and fall. “We all feel a bit gloomy in the winter compared to the summer, but it’s a very intense experience for bipolar people and it’s a problem that results from disruption of the circadian rhythms that control their internal body clocks,” Smith said.
“One patient told me that she knew she was becoming manic because she experienced an increased sensitivity to color and light. In other words, bipolar individuals appear to be more sensitive to light at certain times of the year. But why?”
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One attempt to answer this question will involve the Edinburgh-led group growing retinal cells – derived from bipolar people – in the laboratory. Scientists will then use this to see if they react differently to light shining through them and impact how they perceive and respond to light and changing seasons.
Other technological approaches would involve the use of radar sleeper technology. These devices measure a person’s breathing, movement and heart rate and can tell when someone is awake or not and what stages of sleep they are going through.
“We’re going to use it for very long periods of time, for 18 months or so, in bipolar people’s bedrooms. Whenever they get sick, we can see how their sleep patterns have changed and find ways that we can use to predict that they will get sick in the future – based on changes in their sleep patterns.
“In fact, there are a host of different approaches we can take to measure how sleep, circadian and metabolic factors can affect a person’s mental health—and we’re aiming to identify the most important ones over the next few years.”
