Most clinicians say they believe that there will eventually be clear \u201cbiological markers\u201d\u009d of bipolar disorder: ways to see and measure the disease as we can seizures, cancer or hypertension. Scientists are working to identify the genes (there appear to be many) involved in creating a predisposition for bipolar disorder. Brain imaging, still in its infancy, can already detect broad differences of size, shape and function among different brains. The hope is to know early on who is at risk so their condition can be diagnosed and treated as early as possible. Mental illness wreaks brutal damage on a life, crippling decision-making, competence and self-esteem to the point where digging out from under years of it can be next to impossible. And there is also a biological theory for why going untreated might worsen a bipolar person\u2019s long-term prognosis. Epilepsy researchers have found that by electrically triggering seizures in the brains of animals, they can prompt spontaneous seizures, a phenomenon known as \u201ckindling.\u201d\u009d Simply having seizures \u201d\u201d even artificially generated ones \u201d\u201d seems to alter the brain in such a way that it develops an organic seizure disorder. Some scientists say that a kindling process may happen with mania, too \u201d\u201d that simply experiencing a manic episode could make it more likely that a particular brain will continue to do so. They say this explains why, once a person has had a manic episode, there is a 90 percent chance that he will have another.<\/p>\n
Kiki Chang, director of the pediatric bipolar-disorders program at Stanford, has embraced the kindling theory. \u201cWe are interested in looking at medication not just to treat and prevent future episodes, but also to get in early and \u201d\u201d this is the controversial part \u201d\u201d to prevent the manic episode,\u201d\u009d he told me. \u201cOnce you\u2019ve had a manic episode, you\u2019ve already crossed the threshold, you\u2019ve jumped off the bridge: it\u2019s done. The chances that you\u2019re going to have another episode are extremely high.\u201d\u009d<\/p>\n
Along with medication, Chang is exploring family therapy and other forms of stress reduction that might help fortify a child against a genetic proclivity for bipolar disorder. \u201cIf we wait too long, they will probably need chronic medication treatment,\u201d\u009d he told me. \u201cBut if we can get in early enough, they may not need to stay on medication. So we\u2019re hoping to get in and get out, and not subject them to the long-term side effects.\u201d\u009d<\/p>\n