Toward stratified treatments for bipolar disorders

Area of Science:

• Psychiatry and Neuroscience
• Pharmacogenomics
• Clinical Psychology

Background:

• Bipolar disorders exhibit unclear diagnostic boundaries with unipolar depression and schizophrenia, leading to inconsistent treatment guidelines.
• Current treatment optimization involves lengthy trial-and-error phases, often with complex combination therapies lacking empirical evidence.
• The heterogeneity of bipolar disorders suggests current clinical symptom-based definitions are insufficient for effective treatment stratification.

Purpose of the Study:

• To provide a theoretical framework for identifying biomarkers in bipolar disorders.
• To summarize promising markers for stratifying treatments based on beneficial and adverse effects.
• To assess the predictive ability of various markers for treatment response in bipolar disorder populations.

Main Methods:

• Review of existing literature on biomarkers for bipolar disorder treatment stratification.
• Discussion of state and stage specifiers, neuropsychological tests, neuroimaging, and genetic/epigenetic markers.
• Evaluation of marker utility in predicting response to pharmacological and psychosocial therapies.

Main Results:

• Clinical psychopathology and history-taking currently provide the most reliable markers for treatment response in bipolar disorders.
• No single biomarker has yet been identified that reliably predicts individual treatment responses.
• Existing markers show potential but require further validation for precise treatment targeting.

Conclusions:

• Improved clinical diagnostic skills are essential for managing bipolar disorders.
• Biological research is critical for identifying robust biomarkers to personalize bipolar disorder treatments.
• Biomarker discovery will enable targeted therapies for specific patient sub-populations, enhancing efficacy and minimizing adverse reactions.