They often remain happy, and then suddenly get depressed. People, suffering from mental illness, sometimes find it difficult to get out of bed for weeks because of their mood swings. This complex mental illness is called Bipolar Disorder. Treating these patients is a long-term affair. Lithium is the main drug that is commonly used to control the mood swing of patients with bipolar disorder. Although the silvery-white alkali metal cures the disease in most of the cases, medical experts have no idea about exactly how lithium acts on brain cells to change neural activity. Hence, it is a bit difficult for doctors to judge the efficiency of this chemical element in treating patients.

A team of researchers from National Centre for Biological Sciences (NCBS), based in the southern Indian city of Bengaluru, has made an attempt to address this issue by conducting a new study. The study, published recently in Life Science Alliance journal, has tried to reveal how lithium acts on brain cells. In this study paper, the Rohini Nilekani Centre for Brain and Mind of the NCBS has mentioned that mood stabiliser is quite important as far as the treatment of bipolar disorder is concerned. Dr Raghu Padinjat, the Professor and Psychiatrist at Rohini Nilekani Centre, has explained that only mood stabiliser can control the hyperactivity of the brain or the mental instability of a patient, and lithium acts as a mood stabiliser.

According to Dr Padinjat, young adults often suffer from bipolar disorder. Mainly two types of mood swings can be observed among these patients… Mania or Manic or over-energetic and extreme Depression or Depressive. In case of mania or manic, patients usually remain hyperactive in all activities, and they may be in danger because of this. Dr Padinjat has claimed that the phase of depression begins after a week-long or a month-long hyperactive stage. Then the patients are down with extreme fatigue and bad mood. During this period, patients cannot concentrate on anything, and also do not feel hungry. They do not even want to meet anyone and to talk. A depressed person may spend a week lying down.

In this situation, doctors usually prescribe mood stabilisers to control the mental state of patients after diagnosing the disease. The most common way to treat people suffering from bipolar disorder is the use of lithium, and this procedure is called the Gold Standard treatment. It may be noted that the low-cost drug, having no side effects, is easily available. Hence, this medicine is quite suitable for long-term treatment.

However, it is still not clear how this drug works on brain cells. Another problem is that the drug does not suit everyone. It is found to be effective in only one-third of patients. The NCBS has stated: “Bipolar disorder stands as the sixth leading cause of disability globally, demanding effective therapeutic intervention. While mood stabilisers, like lithium, are the go-to treatment to soothe a bipolar brain, only about one-third of patients benefit from lithium treatment. The remaining patients with bipolar disorder show limited or no response to lithium treatment.” Doctors have no other option, but to wait to see if the medicine works. In some cases, it takes a month-and-a-half or more for medical practitioners to realise the effectiveness of lithium. If the drug is not effective (or in case of lithium non-responder), then the condition of patients does not improve even after using it. The suicidal tendencies, too, may increase in that case. Researchers are quite concerned about this.

Sankhanil Saha, the Lead Author of the study and a Postdoctoral researcher at NCBS, has stressed that the lack of effectiveness of lithium in patients with bipolar disorder is of great concern. “To understand why some patients do not respond to lithium treatment, we need to know how lithium exerts its effects.” he said. According to the lead author, researchers have used a special (IPSC) technique to specifically generate neurons found in the patient’s cortex (the outer part of the brain). Those neurons have been tested in the laboratory to find how lithium works. Researchers have claimed in the study paper that by regulating the amount of a specific lipid, called PIP2, through phosphatidylinositol signalling, it is possible to reduce hyperactivity and to keep the brain calm. “In individuals with Bipolar Affective Disorder (BPAD), the PIP2 pathway is in hyperactive mode which leads to elevated calcium levels in the cell,” added Saha.

For his part, Dr Padinjat said: “The insights from our study into how lithium acts on human brain cells will pave the way for laboratory tests to help doctors predict which bipolar patients will respond to lithium. It will be valuable for doctors to clearly predict which patient will respond to a given medicine to devise a treatment uniquely suited for that individual; this is a very exciting area called precision medicine that is expanding worldwide.”

Psychiatrist Dr Jai Ranjan Ram, too, has admitted that doctors can start treating patients quickly if it is possible to know how lithium works on brain cells. At the same time, he believes that as different patients face different problems, the procedure to treat the same disease will also be different.

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Published by Koushik Das

Koushik Das (born on May 16, 1976 in Kolkata) is a career journalist. Based in the Indian capital of New Delhi, Koushik writes mainly about foreign policies and current geopolitical issues, and rarely about other topics. His own political ideas are highly influenced by Antonio Gramsci, Louis Althusser, Michel Foucault, Michael Oakeshott and others. English philosopher and political theorist Oakeshott (Dec 11, 1901-Dec 19, 1990) says that “in political activity, men sail a boundless and bottomless sea. There is neither harbour for shelter nor floor for anchorage, neither starting-place, nor appointed destination. But we have to keep afloat”. (Rationalism in Politics, 1962) As a student of Political Science, Koushik loves to share his views on issues, which have great impacts on his thought process (and also on India, South Asia and of course on the global community), with his readers through his website – Boundless Ocean of Politics. By doing so, he tries to keep himself afloat. You will find some of his articles in https://inserbia.info/today/ (https://inserbia.info/today/author/kou_das13_i/), as he has been trying to assess the global geopolitics since 2003. You can also mail him at kousdas@gmail.com View all posts by Koushik Das