1. Bipolar Disorder For BIO 443: Drugs and Disease Presented by: Abby Normal

2. Bipolar Disorder … Also known as Manic Depression Results in pathological mood swings from mania to depression These mood swings occur spontaneously

3. Manic Phase Characterized by –Hyperactivity –Over-involvement –Inflated self-esteem –Easily distracted –Little need for sleep Hypomania –Less severe –Does not cause significant distress

4. Depressive Phase Characterized by –Sluggishness –Loss of self-esteem –Withdrawal –Sadness –Excess need for sleep –Risk of suicide

5. Epidemiology Overall affects men and women equally Affects about 1% of adults in the US Usually appears between 15-25 years No difference among racial groups

6. Types of Bipolar Disorder Bipolar I –More time in depressed state –Long periods of normality Bipolar II –Long episodes of depression, occasional hypomania –Virtually no time of wellness

7. Types of Bipolar Disorder Cyclothymia –Many episodes of hypomania –Occasional mild depression Mixed states –Signs of depression and mania at same time Rapid cycling –Many cycles of mania and depression each year –Four or more episodes a year

8. Childhood Onset Bipolar Disorder Affects those younger than age 15 Often involves mixed episodes Extreme amounts of cycling – many times a day Bipolar is more severe when present in children and harder to treat

9. Genetics Environment can trigger it and affect the severity of the disorder No single genetic basis Most likely complex genetic disorder One possibility … inherited variation in serotonin transporter gene may play a role

10. Serotonin Low levels can set off impulsive and aggressive behaviors, depression Low levels can also lead to inability to handle powerful emotions

11. Pet Scan for serotonin Person in depressive episode Healthy individual

12. Treatments Older Mood Stabilizers –Lithium –Valproic Acid New Mood Stabilizers –Lamictal –Neurotonin –Topamax

13. Old Mood Stabilizers Have been shown to reduce mania and slow cycling Often require blood levels frequently for monitoring Many side effects –Nausea, vomiting –Weight gain or loss –Acne problems –Hair loss –Affects balance

14. Lithium and Valproic Acid Slow action suggest that they may regulate gene expression Thought to inhibit protein kinase C which regulates neurohormonal release Interferes with the reuptake of serotonin and norepinephrine

15. New Mood Stabilizers Have been shown to be effective in adults Effects are not known in children yet Mechanisms are unknown Effects are quicker Side effects appear less May have long term side effects that are not known of yet

16. Future? Researchers believe they are coming closer to finding a genetic link and mechanism of the disorder This could lead to better drugs that would act specifically for bipolar disorder

17. Questions?