Chris - Your research looks at Bipolar disorder, which is a reasonably common neuropsychiatric disorder, also known as manic depression. Tell us a bit about it.
Nick - Bipolar disorder, as you say, used to be called manic depression. It's a severe disturbance of mood in which sometimes people sometimes have episodes of depression and sometimes episodes of elevated mood, or mania, where they're in an energised state, rush around, think very quickly, often make judgements that they later regret, perhaps spend a lot of money. It's quite often associated with delusions and hallucinations, perhaps somebody believes that they are a very important person or they're on a special mission.
Chris - It's quite common, isn't it? One percent of the population?
Nick - Yeah, the most severe form affects about one percent of the population but we know that several more percent have a milder form that's usually just diagnosed as depression, but actually is a form of bipolar disorder.
Chris - Why is it that people should have this alternation between being very depressed and then getting so high that they're out of control? What's actually going on?
Nick - We don't know. Clearly there are changes in the systems which regulate mood, which are operating in a different way in people with bipolar illness from normal, so that the stresses and strains of normal life are essentially sending the mood stabilisation system out of control at certain times. Unfortunately, we haven't really pinned down exactly which those systems are, hence a lot of research is going on at the moment to understand that better so we can have much more effective treatments.
Chris - Some pretty famous people have had it, or have got it. They say that when people are high they are so creative that this is what makes them stand out from the crowd and be great writers, poets, people like Stephen Fry, even, great sense of humour.
Nick - Unfortunately that's only true up to a point. If somebody is mildly high, then they can be very creative and productive. The problem is that when somebody becomes severely ill, they certainly won't be creative and productive because they'll be distractible, unable to focus on things, very likely to do completely reckless things; blowing all their savings within a day, getting into fights, driving dangerously. So, in a milder form, yes it can be associated with creativity, but not in the more severe forms.
Chris - Does one tend to turn into the other? Do people start off mild and then slowly lose control? I have some close colleagues who've been absolutely academically brilliant, and have subsequently been diagnosed with this, and have lost control. But in the early days I'd never met someone so clever; they were the only person I've met who could have a conversation with you while typing a grant application with the other hand on a computer he wasn't even watching, and it would make perfect sense what was coming up on that screen. That's how that person was in the early days.
Nick - Yeah, absolutely. If it's in the milder stages of the illness, then it's possible that can be quite a productive state, the real problem is that there is a tendency then for the mood to just go out of control. Then, it's very problematic for the person and their family; it often leads to them losing jobs.
Chris - Is it not the mental illness that has the highest suicide rate attached to it, because it makes life hell on Earth for the people who have it?
Nick - That's right, about 1 in 6 people with bipolar illness will eventually end their life by suicide.
Chris - Is it a one way street when you get to that very severe spectrum of the problem, can you wind it back and get back to being relatively normal, and functioning when you can focus again. Or once you've got very bad is it pretty much a life sentence?
Nick - An episode of mania can be treated effectively with medication, and the person can get back to essentially having normal mood. It's likely that they will then need medication to keep the mood within normal levels. The problem at the moment is that our treatments are only effective in a proportion of people and they can have intolerable side effects. So what we're doing is trying to do research to understand better the causes of illness and develop much more effective treatments.
Chris - It has a genetic association, doesn't it? Does it run in families?
Nick - Yes, a very strong genetic association. Family and twin studies have shown very clearly that genes play a major role in influencing risk.
Chris - Do we know which ones?
Nick - No, not yet. The research is going on, and there are a number of genes that we are working on at the moment that we're confident do play a role, but exactly characterising that and pinning down the systems is going to take a little more work yet. I think we can be very optimistic that over the next few years we're going to have a much better understanding and we'll be able to develop much better methods of diagnosis and treatment.