Pittsburgh Reflections

It’s almost 5 PM. I should be flying out of Pittsburgh right now, but - wouldn’t you know it? - my plane is not in the gate.

I cut out of my Bipolar Conference early for this?

A few observations on the International Conference on Bipolar Disorder:

I attended my first conference in 2001. Then, the brain science was only mentioned peripherally and speculatively, and the brain science posters strictly concerned size and structure rather than function and connectivity. The meds researchers were the stars of the show, and for very good reason - a lot of what we take for granted now in prescribing meds was emerging knowledge back then.

For instance, Gary Sachs of Harvard spoke about the NIMH-underwritten STEP-BD real world clinical trials that would be getting underway. That study, which yielded a lot of valuable information, wrapped up two or three years ago. Clinical trials results tended to dominate the posters sessions.

On the other hand, some things stay the same. There was a lot of talk back then about the safety and efficacy of using antidepressants to treat bipolar. With a lot more knowledge now, opinion now leans on the side of “No,” but the debate is by no means closed.

(Boarding call. ... I’m back, cruising over western PA, en route to the east coast.)

Significantly, Robert Post, then of the NIMH, disclosed new findings from the Stanley Foundation Bipolar Network that revealed that although mania gets most of the attention in bipolar, our population is depressed three times more than it is manic. Knock me over with a feather. Everyone else in the room, too.

A completely new and controversial topic was child bipolar. One of the presenters acknowledged the issue wouldn’t have even come up two years ago. Barbara Geller of Washington University (St Louis) reported on a study she was about to publish showing that bipolar kids are sicker than bipolar adults. Two major differentiating features from ADHD, she reported, were grandiosity and risk-taking.

Fast forward to 2009. The brain scientists are the stars of the show. Thomas Insel, head of the NIMH, tells the conference in so many words that bipolar research is starting to catch up to other fields. Husseini Manji who now works for Johnson and Johnson and had spoken before at the conference, talks about how things work at the cellular level while Mary Phillips (another return speaker) connects the dots at the systems level and Nick Craddock of Cardiff University reports on a gene that affects calcium channel function in a small segment of the bipolar population.

(Bear with me. We’re approaching Baltimore-Washington. Time to stow my laptop. ... I’m eating diner food in the terminal, waiting for my connecting flight to Hartford. To continue ...)

The brain science posters are starting resemble an illustrated owner’s manual to how our mind actually works (or fails to work). Hardly any industry sponsored drug trials. I spend a good 20 minutes talking with a researcher about the significance of one of the lit up areas from the functional images on display. It’s too soon to draw conclusions, but it looks like we can show the circuitry that makes bipolars over-react to both reward and disappointment. In the same area of the brain? I’m asking. Two opposite effects? Holy crap!

Meanwhile, at other posters, the first results of a longitudinal study tracking 400 bipolar kids are starting to roll in. The study is going to tell us a lot about the course of early onset bipolar, and whether it turns into adult bipolar over the years. Unlike eight years ago, virtually no one here is questioning the diagnosis. Instead, the debate is over achieving a consensus on the diagnostic fine points.

Of course, the more we find out the more we realize how ignorant we are. Moreover, in the real world, patients would be hard-put to point out any personal benefits from new scientific discovery. Quite the contrary, services have significantly deteriorated over the years while the new-generation meds have failed to live up to their promise, which has set off a justifiable reaction.

You’ll have to trust me on this: The difference between my first conference and the one I just attended is night and day. Mind-boggling findings are coming in thick and fast. Perhaps our generation will only achieve a marginal benefit, but be assured - future generations will be spared a lot of our suffering. It was my privilege to be talking to the people who have dedicated their lives to making this happen.

Time to board my flight. This is John McManamy. Over and out ...