These are the groundbreaking drugs in the pipeline for treating bipolar disorder (including ketamine)

A wide range of possible new treatments are currently in development.

06 May 2019

Bipolar disorder is a serious mental illness that’s thought to be caused
by an imbalance in the way brain cells communicate with each other.
This imbalance causes extreme mood swings that go way beyond the
normal ‘ups and downs’ of everyday life, wildly exaggerating the mood
changes that everyone has. Someone with bipolar can have long or short
periods of stability, but then tends to go ‘low’ (into deep depression)
or ‘high’ (experiencing mania or psychosis). They can go into a ‘mixed
state’ too, where symptoms of depression and mania occur at the
same time.

According to a World Mental Health survey by the World Health
Organization (WHO), bipolar disorder affects a total of 2.4% of the
world’s population. The survey found that the US has the highest rate of
bipolar spectrum disorders (4.4%), while India has the lowest rate (0.1%).
In the UK, the mental health charity Bipolar UK estimates that 1% to 2%
of the country’s population experience a lifetime prevalence of bipolar
disorder.

Here, in an extract from their new book Bipolar Disorder: The Ultimate Guide, first cousin and co-authors Sarah Owen and Amanda Saunders - who have four close family members diagnosed with the condition - explore the developments in drugs which are paving the way forward for sufferers of bipolar.

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‘Current medications for bipolar disorder reduce symptoms but often don’t
do a good enough job,’ says Professor Allan Young, Director of the Centre
for Aff ective Disorders at King’s College London. ‘The good news is that
researchers are currently exploring a wide range of possible new treatments and I’m hopeful that by 2020 exciting new drugs will be available.’ Ones to watch include:

Ketamine

Originally developed as an animal anaesthetic used by vets, several small
clinical trials have shown that a single infusion of ketamine can work as a fast-acting antidepressant. Patients report an improvement in symptoms
after two to four hours and the eff ect can last for between seven and 14
days.

Ketamine is typically delivered intravenously, though it can also be given
via an inhaler or injected. Worryingly, Ketamine is sometimes abused as a
‘club’ drug known as ‘K’, ‘Ket’ or ‘Special K’ and has been linked to confusion, agitation, panic attacks and short- and long-term memory loss. Frequent use sometimes causes very serious bladder problems.

In a clinical setting, ketamine’s promise as a rapidly acting antidepressant means many ketamine treatment clinics have opened (especially in the US) over the past several years. However, its clinical use is still highly cautioned; there are no current long-term safety data to support ketamine’s repeated use in depression beyond a few weeks. It is hoped that larger, more rigorous clinical trials will be completed in the next few years.

Oxytocin

A natural hormone known for its role in childbirth and breastfeeding, oxy-
tocin is now thought to be linked to social bonding and sexual fulfilment. Researchers at the University of Oslo in Norway have tested a new device
for delivering the hormone oxytocin via the nose. Although there’s still a
poor understanding of how oxytocin reaches and aff ects the brain, early
studies show it can help regulate social behaviour and improve mental health symptoms. Trials are ongoing.

Light therapy

According to a paper published in the American Journal of Psychiatry it
seems that bright light therapy may lead to a signifi cant improvement in the symptoms of bipolar depression. The timing of the light therapy appears to be key – researchers found that light therapy given between midday and 2.30pm was most effective.

Individuals increased their exposure to bright white light (7000 lux)
from 15 minutes to 60 minutes a day. After six weeks, about 68% of
those with a moderate severity of depressive symptoms were in remission
compared to 22% of those who received placebo (red light) treatments.
Interestingly, most of the improvement occurred during weeks four to
six. As the study ended at six weeks, researchers speculate that an even
higher number of participants would have improved if they’d continued
with the treatment.