Iain Campbell, a researcher at the University of Edinburgh, has a special perspective on bipolar depression. He lives with the condition and has lost family members who have committed suicide because of their depression. It remains a persistent, devastating health problem, he says.
More than a million people in the UK have bipolar depression, with a third likely to attempt suicide. Yet the roots of the condition remain unknown – despite significant efforts to understand them.
However, a major new approach to the illness has recently been adopted by psychiatrists to reveal its causes and highlight potential treatments. Rather than viewing bipolar depression as a mood disorder, it should be viewed as a metabolic disorder that can be addressed through diet and other interventions that can alter bodily processes.
“We should not think of bipolar depression as a primarily emotional problem, but as a breakdown in the energy regulation in the body,” said Campbell, who has played a key role in setting up the University of Edinburgh’s Hub for Metabolic Psychiatry, which opened last week. “It’s a very different way of thinking about mental illness.”
The centre is supported by the Baszucki Foundation, a Canadian charity, and UK Research and Innovation, the national funding agency. It will investigate how bipolar depression is linked to metabolic disorders, such as diabetes and obesity. It will also investigate how bipolar depression is affected by disruptions to circadian rhythms.
“Systems related to energy, metabolism and light are all interconnected in our bodies and one of the consequences of their disruption, we believe, is bipolar depression,” said Professor Danny Smith, head of the new Hub for Metabolic Psychiatry.
Bipolar depression was originally known as manic depression, a label that captures its progression, Smith added. “Sometimes people have no energy. Sometimes they just have too much. They’re manic. They don’t need sleep. They’re very active and do things that are out of character. Psychiatrists will say to them, How are you feeling? They should really ask, What are you doing?”
One approach is to develop metabolic treatments that can curb their bouts of mania and lethargic depression, Campbell said. “Ketogenic diets, where a person eats no carbohydrates but lots of fat, are quite common. They’re used for weight loss, but in some cases also to treat epilepsy. But it’s now becoming clear that they can help alleviate bipolar depression.”
A recent study conducted at the University of Edinburgh involved 27 individuals with bipolar disorder who followed a ketogenic diet for eight weeks.
“A third of them did very well. Their mood was more stable, they were less impulsive and their depression went away,” Smith said. “(Finding out) why some responded and others didn’t will be one of the first undertakings for researchers in the new hub.”
Other research will focus on the fact that many bipolar individuals experience depressive episodes that peak in the fall and winter, while their mania increases in the spring and fall. “We all feel a little bit sad in the winter compared to the summer, but it’s a very intense experience for bipolar individuals and it’s a problem that stems from disruptions to the circadian rhythms that control their internal biological clocks,” Smith said.
“A patient told me that she knew she was going manic because she experienced an increased sensitivity to color and light. In other words, bipolar individuals seem to be more sensitive to light at certain times of the year. But why?”
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An attempt to answer this question will involve the Edinburgh-led group growing retinal cells – taken from people with bipolar disorder – in the lab. Scientists will then use them to see if they respond differently to light shining through them, and whether this affects how they perceive and respond to light and changing seasons.
Other technological approaches will involve the use of radar sleep technology. These devices measure a person’s breathing, movement and heart rate and can tell when a person is awake or not and what stages of sleep they are going through.
“We’re going to use these for very long periods of time, about 18 months, in the bedrooms of bipolar people. When they get sick, we can look at how their sleep patterns change and find ways to predict whether they’re going to get sick in the future – based on changes in their sleep patterns.
“There are actually a lot of different approaches we can use to measure how sleep, circadian and metabolic factors can influence a person’s mental health – and we aim to identify the most important ones in the coming years.”