Seeking the Key to the Best Medication for Every Bipolar Child

Bipolar disorder, also know as manic depression, is a serious psychiatric illness in which individuals find themselves trapped in an uncontrollable cycle of euphoric or extremely anxious mania and dark, despairing lows.

When this disorder occurs among adults who might be able to recognize their unhealthy state, it is difficult enough to struggle through and find help. But it's even more disturbing when bipolar disorder occurs among children, who have a much harder time understanding the mysterious shuttling between the whirlwind of mania and all-encompassing depression.

Moreover, doctors have great difficulty finding the proper medication for their patients, each of whom possesses a vastly different genetic makeup and body chemistry. Some medications can create disturbing side effects or fail to provide relief, which can result in patients discontinuing them.

But a study being led by Russell Scheffer, MD, Medical College of Wisconsin Associate Professor of Psychiatry and Behavioral Medicine (Pediatrics), is searching for new insights into "how the genetic makeup of the child interacts with particular drugs." Dr. Scheffer is hoping that over the next decade, the medical profession will be able to much more effectively treat bipolar disorder based on a better understanding of each person's genetic, psychological, and physical makeup. Dr. Scheffer practices at the Children's Hospital of Wisconsin Child Psychiatry Center.

The two-year study is being conducted by a team that includes Dr. Scheffer, Jennifer Niskala Apps, PhD, Assistant Professor of Psychiatry Child & Adolescent Medicine at Children's Hospital; and Robert Prost, PhD, Medical College of Wisconsin Assistant Professor of Radiology.

"We're very hopeful that there will be a big benefit for patients in the not-too-distant future," says Dr. Scheffer. "We have a goal of truly 'individualized medicine' that allow would allow us to find the predictors of the right medications for each person."

The study involves a uniquely multidimensional approach. It includes a procedure called "spectroscopy" to look at the chemical composition of the brain, careful evaluation of the child's genetic makeup, and detailed observation of the child's behavior. "We use an MRI (Magnetic Resonance Imaging) device with a special head coil to look at the chemical composition of the brain. It doesn't capture everything, but it does give us a good idea of the level of various key chemicals in the patient's brain," the doctor notes.

"We hope to find that there are different subsets among the patients, so that we can find common spectrograms that will ultimately be predictive of the reaction to the drugs."

Rapid Testing is Essential
With the latest equipment, the research team is able to perform a brain scan very rapidly, which is vital for bipolar patients. "Someone with severe mania can't pay attention to other kinds of tests, and with the spectroscopy, we just need them to stay still for a short period of time," Dr. Scheffer says. I think we will be the first site to look at the brain of an acutely manic child in a meaningful way.

"We're also working on pharmacogenomics, the study of how genetic makeup interacts with particular drugs," he explains. "I think we're near the forefront of work on this at our center.

"We think that our work will be helpful in the near future in avoiding drugs that cause harm or have negative side effects. Within three years, we will have a lot more information to guide us. It will probably be a little further down the road when we can use the predictors to find the most effective drug for each patient," he says.

Avoiding negative side effects - the "does no harm" part of the Hippocratic Oath (the oath typically taken upon becoming an MD) - is extremely important for the health of patients and the peace of mind of those around them. "If a patient gains 50 pounds, has really painful muscle cramps or is having such severe restlessness that they feel suicidal, they're going to stop taking the medication," Dr. Scheffer points out. If this occurs, the patient's condition may spin further out of control, with severe repercussions for them and other people in their lives.

"If they stop taking medications because of adverse side effects, it can really have an adverse effect on their overall treatment," he says.

While the genetic differences between individuals are rather small, "The adverse effects vary dramatically," Dr. Scheffer stresses. "There are many possible neural pathways through which people can become manic."

With the ultimate goal of tailoring medication for each bipolar patient, Dr. Scheffer and his team decided to bring together detailed behavioral observation and neuropsychiatric work, the spectroscopic brain scan to look at chemical levels, and genetic research on each patient.

Reducing Pain and Suffering Is Key Goal
"We will be able to have a baseline brain scan of the child, and then do another scan in a matter of at about two weeks out to see how a medication is working," Dr. Scheffer explains.

Currently, it takes up to six weeks to judge how well a medication is interacting with a bipolar child. It's hoped that the tests now under development will eventually permit doctors to prescribe the most appropriate drug right from the start. "It will really increase the patient's compliance in taking the medication if they don't have a bad experience with side effects up front," the doctor emphasizes.

"Getting them on the right medicine is really crucial," says Dr. Scheffer. "Decreasing pain and suffering from the wrong medication is a huge goal of ours."

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.