Centre intégré universitaire de santé et de services sociaux de l’Ouest-de-l’Île-de-Montréal
Accueil Plan du site Courrier Portail Québec Passer directement au contenu

Ask the expert
Treatment and medication

What is an example of a new treatment that is being investigated for bipolar disorders?

BDNF is a protein encoded by a gene in the human body. Researchers at Yale University have put BDNF directly into the brains of depressed rats, and, within forty-eight hours reversed the depressive symptoms of these animals. So clearly BDNF plays an important role. The issue is that we need to find medication or develop medication that can, first of all, withstand the acid in the stomach, second of all, be absorbed properly, and, third, be crossing the blood-brain barrier, the barrier between the blood vessel and the brain, to get into the brain to do its job.

Unfortunately, BDNF is a small protein and each time chemists try to make these molecules into something that will be soluble in fat (because the brain is a very fatty), they have to twist the molecule and so on, and it becomes toxic to the liver. BDNF is an evolving story.

-Serge Beaulieu, PhD, Mini-Psych School 2009

Once a patient has been diagnosed with bipolar disorder and has been given appropriate medication, when should psychotherapy, family therapy, or even meditation be started?

What I often say to my patients when they are in a state of depression is that it’s very difficult to do psychotherapy because their concentration is not good. They are tired or they miss appointments. We prefer that the person is at least able to cooperate in the process of psychotherapy when we start it.

What do we do in that psychotherapeutic process? That’s specific to the individual and it depends on what the problem of the person is. Bipolar disorder in one person is not the same as bipolar disorder in another person. It depends on their life story and experiences and all sort of things. Sometimes we have to treat another disorder. A bipolar patient has 35 times more risk of having an anxiety disorder or an obsessive compulsive disorder, for at least one year in their life-time, compared to the general population. Sometimes we have people coming in with bipolar disorder and post-traumatic stress disorder. And also they are addicted to cocaine or alcohol or something else, and we have to treat all of this at the same time. We don’t tell them “Go treat your dependence of alcohol first, and come back to see me after.” Those days are over, we don’t do that anymore. We treat the whole thing at the same time. So it’s time-sensitive, but, yes, we prefer to have some kind of stability before starting psychotherapy.

We also do psychoeducation. We have had successful results with it in research trials and are now asking for funding to transfer these techniques to the CLSCs. We can then focus our efforts on more novel approaches such as MBCT. We’ll do more research on new approaches, and other people will do the psycho-education. That’s what we want to do.
-Serge Beaulieu, PhD, Mini-Psych School 2009

Is it true that mindfulness-meditation has been used as a therapy for bipolar disorder?

Zindel Segal has written books on mindfulness-meditation therapy, and is one of the three authors who developed this technique. Kabat-Zinn is a biologist and the therapy we use at the Douglas is based on his technique. It is called mindfulness-based cognitive therapy (MBCT).

I was inspired by a study done by Zindel and his colleagues that showed that, in patients who have had three major depressive episodes in their life and are now doing fine, MBCT works to improve their maintenance and prevent a relapse. However, MBCT does not work in patients who have had only one episode of major depression – that is, it won’t delay their relapse into another episode.

I was impressed because it was the first time I saw a therapy that was almost designed for sicker patients. That’s why we are focussing on studying this technique. In order to get the funding we need to continue our work, we need to obtain pilot data on MBCT. This is what we are currently doing. It’s not blinded because it’s a pilot and we want to see how it works, what kind of problems occur, whether people come to the therapies, and whether they stop applying the principles of MBCT. These are the kinds of questions we ask. How many patients persisted in the study? How many patients stopped coming, and how will this affect the power of your study and your result, etc? If we get the funding, we would have a four or five year study to really find the data we are looking for regarding the effectiveness of MBCT.

-Serge Beaulieu, PhD, Mini-Psych School 2009

What do you think about the potential of tryptophan for treating bipolar depression?

Tryptophan has been studied not so much as a stand-alone treatment for depression or bipolar depression, but certainly as an add-on to antidepressants and other agents to stabilize and improve the mood. Simon Young at McGill University has demonstrated that, by depriving people from tryptophan in their diet for 24 hours, you can trigger depressive symptoms. So, clearly, it has a role.

Now, tryptophan comes from our diet. So, if you eat well, unless you have a problem with the absorption of proteins and amino acids, you should have enough tryptophan in your system in order to synthesize enough serotonin in your brain. So, it would be surprising that tryptophan alone would be sufficient enough a treatment to resolve depression. But as an add-on agent, it could be tried.

-Serge Beaulieu, PhD, Mini-Psych School 2009

What is psychoeducation and how is it used to treat bipolar disorder?

Psychoeducation is basically giving the power to the patient. It’s teaching the patients what their disease is all about and how they can help themselves to be better treated. When you are diagnosed with diabetes, for example, you have to go meet a nurse who will teach you how to eat properly, check the sugar in your blood, inject insulin into yourself if you need to, etc. That’s psychoeducation, and that’s the motto of treatment with any chronic disorder.

Bipolar disorder is not something that will go away. Sure we can treat the first episode, the second episode, etc. Except that, if you don’t take the treatment, it will come back. And the treatments are not always perfect either. So the patient needs to be able to tell me “Dr. Beaulieu, you need to see me, because I’m not doing too well” They need to be able to identify that for themselves.

-Serge Beaulieu, PhD, Mini-Psych School 2009

Can a bipolar patient ever stop taking medication like Lithium?

No. If a person is bipolar and goes off Lithium, chances are that this person will relapse. It could happen that there will not be a relapse but evidence suggests that most people will relapse. 

- Joseph Rochford, PhD, Mini-Psych School 2009

Find out more :