From pole to pole: exploring bipolar

Up Close: Where are we right now in understanding the causative mechanisms of bipolar disorder? Are there genetic and environmental factors that determine if an individual is susceptible?

Allan Young: We have seen a big advance in the genetics of psychiatric disorder over the past 15 years. We now know that the common severe psychiatric disorders like bipolar disorder and schizophrenia are not caused by one single gene but rather they are due to a number of genes of small effect. 

The genetic element appears to be pretty strong in bipolar disorder but it is not inevitable that if you have got bipolar disorder your kids will [too]. In actual fact your kids are more likely to have depression than to have straightforward bipolar disorder. 

In terms of the other factors that cause [bipolar disorder], one of the big things is stress and we know that there is an excess of stressful life events before the first episode. 

Up Close: Is it just the brain that is affected in bipolar disorder? Are there any other areas of the body that are affected?

Allan Young: We know that people with severe mental illness (and that is schizophrenia, bipolar disorder and severe depression) die younger than the average age in the population. 

There is, of course, an early mortality due to suicide but the bulk of the deaths are from the common killers, things like cancer and cardiovascular disease and so on. This is undoubtedly partly due to lifestyle factors and a big one is smoking which is excessively represented in these groups, but there also may be some link at a more fundamental level. 

Certainly one of the things we have been very poor at is looking after the physical health of people with mental health issues. That really is a crying shame and most healthcare systems have been quite neglectful of these people because physical ill health issues and mental ill health issues tend to go together. 

Up Close: If individuals with bipolar disorder stop taking the medication are they just as susceptible to having a manic or depressive episode?

Allan Young: if you stop taking your medicine you have a rebound effect where you are actually more likely to get an episode of illness. One of the key determinants of a good outcome in bipolar disorder is adherence to medication and that is something [that] can be difficult to accept. 

Up Close: Tell us a bit more about the course of the cognitive deficits [seen in bipolar patients]? 

Allan Young: At the first episode people with bipolar disorder do not appear to perform much worse than the general population. Indeed in some things they are brighter than average. However, what seems to happen in bipolar disorder is that each episode appears to produce decrements in your cognitive functioning. If you can reduce the number of episodes of illness you can actually reduce the occurrence of the cognitive deficits. 

People with bipolar disorder are often very talented bright people who are very accomplished. The cognitive deficits are very subtle but they feel them quite deeply because they have lost an ability that they took for granted. [However], we have certainly seen people who have stayed well for two or three years who have actually recovered a great deal of cognitive function objectively verified by our tests. 

Up Close: How close do you think we are in terms of finding a treatment that will lead to typical or normal functioning individuals with bipolar disorder?

Allan Young: I actually think we have treatments that can do that at the moment. What we are not very good at is applying these treatments. 

I think there is a great argument for first of all improving diagnosis. People with bipolar disorder have a desire for accurate diagnosis because typically they can go for 10 years and they have been told that they have got depression or substance abuse or an anxiety disorder or whatever and in actual fact it is bipolar disorder. 

If there is early diagnosis and then there is early appropriate treatment with combined medication and psychological treatments, I think you can make outcomes an awful lot better. 

Professor Young is Chair of Mood Disorders and Director of the Centre for Affective Disorders in the Department of Psychological Medicine in the Institute of Psychiatry, King’s College London. To listen to the podcast in full, visit 

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