Dr. Marchand is an investigator at the George E. Wahlen Veterans Administration Medical Center in Salt Lake City, Utah and Assistant Professor of Psychiatry at the University of Utah.
Bipolar disorder is a severe psychiatric illness characterized by episodes of depression as well as periods of elevated mood, known as mania. This condition, previously known as manic-depressive illness, causes considerable suffering and disability. Furthermore, bipolar depression is often difficult to treat and associated with anxiety symptoms and an increased risk of suicide. Thus, additional treatment approaches are needed. Interventions that target anxiety and suicide risk, in addition to depression, could be particularly useful.
Mindfulness-based interventions have demonstrated effectiveness for symptoms of unipolar depression (major depression not associated with manic episodes) and anxiety. There is also evidence accumulating that these approaches may help reduce suicide risk. Therefore, I recently reviewed the literature to determine whether clinical trials of mindfulness-based approaches for bipolar depression are warranted. The results of that review were recently published in Depression Research and Treatment.
Several lines of evidence support studies of mindful-based interventions for bipolar depression. From a psychological perspective, bipolar depression appears to be associated with abnormal self-referential thinking, as has been established for unipolar illness. Further, ruminative analytical thinking about the self may contribute to symptom expression in both disorders. Thus, the practice of mindfulness would be expected to be beneficial for bipolar depression as a result of decreasing maladaptive self-focused thinking patterns. Similar mechanisms might also contribute to decreased suicide risk among those suffering from this condition.
Brain imaging studies also support clinical trials of mindfulness-based interventions for bipolar depression. Evidence links the function of the cortical midline structures with both emotional dysregulation and self-referential thinking in unipolar illness. Therefore, this brain region may mediate the relationship between aberrant self-referential thinking and negative emotion in major depression. Some evidence suggests that similar mechanisms may play a role in bipolar depression. Thus, while unipolar and bipolar depression are different psychiatric disorders, similar psychological and neurobiological mechanisms may underlie symptom expression in both conditions. This suggests that the response to mindfulness-based interventions may be similar across the disorders and provides a theoretical basis for the study of these approaches for bipolar depression.
A few studies (see references) have provided early evidence that mindfulness-based treatments may be useful for bipolar disorder. Moreover, diverse lines of investigation provide a conceptual background supporting continued clinical trials of mindfulness-based approaches for bipolar depression.
Please see Mindfulness Interventions for Bipolar Depression by William R. Marchand, MD for a free download of the complete review.
P. Chadwick, H. Kaur, M. Swelam, S. Ross, and L. Ellett, “Experience of mindfulness in people with bipolar disorder: a qualitative study,” Psychotherapy Research, vol. 21, no. 3, pp. 277–285, 2011.
W. R. Marchand, J. N. Lee, C. Garn et al., “Aberrant emotional processing in posterior cortical midline structures in bipolar II depression,” Progress in Neuro-Psychopharmacology and Biological Psychiatry, vol. 35, no. 7, pp. 1729–1737, 1729.
W.R. Marchand, “Self-Referential Thinking, Suicide, and Function of the Cortical Midline Structures and Striatum in Mood Disorders: Possible Implications for Treatment Studies of Mindfulness-Based Interventions for Bipolar Depression,” Depression Research and Treatment, doi: 10.1155/2012/246725
B. Weber, F. Jermann, M. Gex-Fabry, A. Nallet, G. Bondolfi, and J. M. Aubry, “Mindfulness-based cognitive therapy for bipolar disorder: a feasibility trial,” European Psychiatry, vol. 25, no. 6, pp. 334–337, 2010.
J. M. G. Williams, Y. Alatiq, C. Crane et al., “Mindfulness- based cognitive therapy (MBCT) in bipolar disorder: preliminary evaluation of immediate effects on between-episode functioning,” Journal of Affective Disorders, vol. 107, no. 1–3, pp. 275–279, 2008.